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The Relationship Between Tumor Volume and Timing of Post-resection Stereotactic Radiosurgery to Maximize Local Control: A Critical Review

After maximally safe neurosurgical resection of brain metastases, stereotactic radiosurgery (SRS) is now recommended as an alternative to whole-brain radiation therapy (WBRT), which has been associated with cognitive decline. One complicating factor associated with SRS is that postoperative cavity d...

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Autores principales: Yuan, Melissa, Behrami, Eltion, Pannullo, Susan, Schwartz, Theodore H, Wernicke, A. Gabriella
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825444/
https://www.ncbi.nlm.nih.gov/pubmed/31723521
http://dx.doi.org/10.7759/cureus.5762
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author Yuan, Melissa
Behrami, Eltion
Pannullo, Susan
Schwartz, Theodore H
Wernicke, A. Gabriella
author_facet Yuan, Melissa
Behrami, Eltion
Pannullo, Susan
Schwartz, Theodore H
Wernicke, A. Gabriella
author_sort Yuan, Melissa
collection PubMed
description After maximally safe neurosurgical resection of brain metastases, stereotactic radiosurgery (SRS) is now recommended as an alternative to whole-brain radiation therapy (WBRT), which has been associated with cognitive decline. One complicating factor associated with SRS is that postoperative cavity dynamics can change dramatically, creating significant variability in the recommended timing of SRS. While SRS has been shown to improve local control (LC) in smaller tumor cavities, achieving excellent LC rates still remains a challenge in larger ones. Furthermore, factors predicting the optimal timing of SRS in relation to the cavity size need to be defined and implemented. Variables such as the delay between postoperative MRI and treatment are critical but poorly understood. One potential treatment option that may improve outcomes is brachytherapy, but the widespread implementation of this technique has been slow. This critical review analyzes the relationship between preoperative tumor volume, resection cavity size, and timing of SRS and explores how these variables must be understood in order to achieve the highest LC possible.
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spelling pubmed-68254442019-11-13 The Relationship Between Tumor Volume and Timing of Post-resection Stereotactic Radiosurgery to Maximize Local Control: A Critical Review Yuan, Melissa Behrami, Eltion Pannullo, Susan Schwartz, Theodore H Wernicke, A. Gabriella Cureus Radiation Oncology After maximally safe neurosurgical resection of brain metastases, stereotactic radiosurgery (SRS) is now recommended as an alternative to whole-brain radiation therapy (WBRT), which has been associated with cognitive decline. One complicating factor associated with SRS is that postoperative cavity dynamics can change dramatically, creating significant variability in the recommended timing of SRS. While SRS has been shown to improve local control (LC) in smaller tumor cavities, achieving excellent LC rates still remains a challenge in larger ones. Furthermore, factors predicting the optimal timing of SRS in relation to the cavity size need to be defined and implemented. Variables such as the delay between postoperative MRI and treatment are critical but poorly understood. One potential treatment option that may improve outcomes is brachytherapy, but the widespread implementation of this technique has been slow. This critical review analyzes the relationship between preoperative tumor volume, resection cavity size, and timing of SRS and explores how these variables must be understood in order to achieve the highest LC possible. Cureus 2019-09-25 /pmc/articles/PMC6825444/ /pubmed/31723521 http://dx.doi.org/10.7759/cureus.5762 Text en Copyright © 2019, Yuan et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Radiation Oncology
Yuan, Melissa
Behrami, Eltion
Pannullo, Susan
Schwartz, Theodore H
Wernicke, A. Gabriella
The Relationship Between Tumor Volume and Timing of Post-resection Stereotactic Radiosurgery to Maximize Local Control: A Critical Review
title The Relationship Between Tumor Volume and Timing of Post-resection Stereotactic Radiosurgery to Maximize Local Control: A Critical Review
title_full The Relationship Between Tumor Volume and Timing of Post-resection Stereotactic Radiosurgery to Maximize Local Control: A Critical Review
title_fullStr The Relationship Between Tumor Volume and Timing of Post-resection Stereotactic Radiosurgery to Maximize Local Control: A Critical Review
title_full_unstemmed The Relationship Between Tumor Volume and Timing of Post-resection Stereotactic Radiosurgery to Maximize Local Control: A Critical Review
title_short The Relationship Between Tumor Volume and Timing of Post-resection Stereotactic Radiosurgery to Maximize Local Control: A Critical Review
title_sort relationship between tumor volume and timing of post-resection stereotactic radiosurgery to maximize local control: a critical review
topic Radiation Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825444/
https://www.ncbi.nlm.nih.gov/pubmed/31723521
http://dx.doi.org/10.7759/cureus.5762
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