Cargando…

Local control and possibility of tailored salvage after hypofractionated stereotactic radiotherapy of the cavity after brain metastases resection

In patients undergoing surgical resection of brain metastases, the risk of local recurrence remains high. Adjuvant whole brain radiation therapy (WBRT) can reduce the risk of local relapse but fails to improve overall survival. At two tertiary care centers in Germany, a retrospective study was perfo...

Descripción completa

Detalles Bibliográficos
Autores principales: Bilger, Angelika, Bretzinger, Eva, Fennell, Jamina, Nieder, Carsten, Lorenz, Hannah, Oehlke, Oliver, Grosu, Anca‐Ligia, Specht, Hanno M., Combs, Stephanie E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010898/
https://www.ncbi.nlm.nih.gov/pubmed/29745035
http://dx.doi.org/10.1002/cam4.1486
_version_ 1783333687038836736
author Bilger, Angelika
Bretzinger, Eva
Fennell, Jamina
Nieder, Carsten
Lorenz, Hannah
Oehlke, Oliver
Grosu, Anca‐Ligia
Specht, Hanno M.
Combs, Stephanie E.
author_facet Bilger, Angelika
Bretzinger, Eva
Fennell, Jamina
Nieder, Carsten
Lorenz, Hannah
Oehlke, Oliver
Grosu, Anca‐Ligia
Specht, Hanno M.
Combs, Stephanie E.
author_sort Bilger, Angelika
collection PubMed
description In patients undergoing surgical resection of brain metastases, the risk of local recurrence remains high. Adjuvant whole brain radiation therapy (WBRT) can reduce the risk of local relapse but fails to improve overall survival. At two tertiary care centers in Germany, a retrospective study was performed to evaluate the role of hypofractionated stereotactic radiotherapy (HFSRT) in patients with brain metastases after surgical resection. In particular, need for salvage treatment, for example, WBRT, surgery, or stereotactic radiosurgery (SRS), was evaluated. Both intracranial local (LF) and locoregional (LRF) failures were analyzed. A total of 181 patients were treated with HFSRT of the surgical cavity. In addition to the assessment of local control and distant intracranial control, we analyzed treatment modalities for tumor recurrence including surgical strategies and reirradiation. Imaging follow‐up for the evaluation of LF and LRF was available in 159 of 181 (88%) patients. A total of 100 of 159 (63%) patients showed intracranial progression after HFSRT. A total of 81 of 100 (81%) patients received salvage therapy. Fourteen of 81 patients underwent repeat surgery, and 78 of 81 patients received radiotherapy as a salvage treatment (53% WBRT). Patients with single or few metastases distant from the initial site or with WBRT in the past were retreated by HFSRT (14%) or SRS, 33%. Some patients developed up to four metachronous recurrences, which could be salvaged successfully. Eight (4%) patients experienced radionecrosis. No other severe side effects (CTCAE≥3) were observed. Postoperative HFSRT to the resection cavity resulted in a crude rate for local control of 80.5%. Salvage therapy for intracranial progression was commonly needed, typically at distant sites. Salvage therapy was performed with WBRT, SRS, and surgery or repeated HFSRT of the resection cavity depending on the tumor spread and underlying histology. Prospective studies are warranted to clarify whether or not the sequence of these therapies is important in terms of quality of life, risk of radiation necrosis, and likelihood of neurological cause of death.
format Online
Article
Text
id pubmed-6010898
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-60108982018-06-27 Local control and possibility of tailored salvage after hypofractionated stereotactic radiotherapy of the cavity after brain metastases resection Bilger, Angelika Bretzinger, Eva Fennell, Jamina Nieder, Carsten Lorenz, Hannah Oehlke, Oliver Grosu, Anca‐Ligia Specht, Hanno M. Combs, Stephanie E. Cancer Med Clinical Cancer Research In patients undergoing surgical resection of brain metastases, the risk of local recurrence remains high. Adjuvant whole brain radiation therapy (WBRT) can reduce the risk of local relapse but fails to improve overall survival. At two tertiary care centers in Germany, a retrospective study was performed to evaluate the role of hypofractionated stereotactic radiotherapy (HFSRT) in patients with brain metastases after surgical resection. In particular, need for salvage treatment, for example, WBRT, surgery, or stereotactic radiosurgery (SRS), was evaluated. Both intracranial local (LF) and locoregional (LRF) failures were analyzed. A total of 181 patients were treated with HFSRT of the surgical cavity. In addition to the assessment of local control and distant intracranial control, we analyzed treatment modalities for tumor recurrence including surgical strategies and reirradiation. Imaging follow‐up for the evaluation of LF and LRF was available in 159 of 181 (88%) patients. A total of 100 of 159 (63%) patients showed intracranial progression after HFSRT. A total of 81 of 100 (81%) patients received salvage therapy. Fourteen of 81 patients underwent repeat surgery, and 78 of 81 patients received radiotherapy as a salvage treatment (53% WBRT). Patients with single or few metastases distant from the initial site or with WBRT in the past were retreated by HFSRT (14%) or SRS, 33%. Some patients developed up to four metachronous recurrences, which could be salvaged successfully. Eight (4%) patients experienced radionecrosis. No other severe side effects (CTCAE≥3) were observed. Postoperative HFSRT to the resection cavity resulted in a crude rate for local control of 80.5%. Salvage therapy for intracranial progression was commonly needed, typically at distant sites. Salvage therapy was performed with WBRT, SRS, and surgery or repeated HFSRT of the resection cavity depending on the tumor spread and underlying histology. Prospective studies are warranted to clarify whether or not the sequence of these therapies is important in terms of quality of life, risk of radiation necrosis, and likelihood of neurological cause of death. John Wiley and Sons Inc. 2018-05-09 /pmc/articles/PMC6010898/ /pubmed/29745035 http://dx.doi.org/10.1002/cam4.1486 Text en © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Cancer Research
Bilger, Angelika
Bretzinger, Eva
Fennell, Jamina
Nieder, Carsten
Lorenz, Hannah
Oehlke, Oliver
Grosu, Anca‐Ligia
Specht, Hanno M.
Combs, Stephanie E.
Local control and possibility of tailored salvage after hypofractionated stereotactic radiotherapy of the cavity after brain metastases resection
title Local control and possibility of tailored salvage after hypofractionated stereotactic radiotherapy of the cavity after brain metastases resection
title_full Local control and possibility of tailored salvage after hypofractionated stereotactic radiotherapy of the cavity after brain metastases resection
title_fullStr Local control and possibility of tailored salvage after hypofractionated stereotactic radiotherapy of the cavity after brain metastases resection
title_full_unstemmed Local control and possibility of tailored salvage after hypofractionated stereotactic radiotherapy of the cavity after brain metastases resection
title_short Local control and possibility of tailored salvage after hypofractionated stereotactic radiotherapy of the cavity after brain metastases resection
title_sort local control and possibility of tailored salvage after hypofractionated stereotactic radiotherapy of the cavity after brain metastases resection
topic Clinical Cancer Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010898/
https://www.ncbi.nlm.nih.gov/pubmed/29745035
http://dx.doi.org/10.1002/cam4.1486
work_keys_str_mv AT bilgerangelika localcontrolandpossibilityoftailoredsalvageafterhypofractionatedstereotacticradiotherapyofthecavityafterbrainmetastasesresection
AT bretzingereva localcontrolandpossibilityoftailoredsalvageafterhypofractionatedstereotacticradiotherapyofthecavityafterbrainmetastasesresection
AT fennelljamina localcontrolandpossibilityoftailoredsalvageafterhypofractionatedstereotacticradiotherapyofthecavityafterbrainmetastasesresection
AT niedercarsten localcontrolandpossibilityoftailoredsalvageafterhypofractionatedstereotacticradiotherapyofthecavityafterbrainmetastasesresection
AT lorenzhannah localcontrolandpossibilityoftailoredsalvageafterhypofractionatedstereotacticradiotherapyofthecavityafterbrainmetastasesresection
AT oehlkeoliver localcontrolandpossibilityoftailoredsalvageafterhypofractionatedstereotacticradiotherapyofthecavityafterbrainmetastasesresection
AT grosuancaligia localcontrolandpossibilityoftailoredsalvageafterhypofractionatedstereotacticradiotherapyofthecavityafterbrainmetastasesresection
AT spechthannom localcontrolandpossibilityoftailoredsalvageafterhypofractionatedstereotacticradiotherapyofthecavityafterbrainmetastasesresection
AT combsstephaniee localcontrolandpossibilityoftailoredsalvageafterhypofractionatedstereotacticradiotherapyofthecavityafterbrainmetastasesresection