Cargando…

50. RISK OF TRACT RECURRENCE WITH STEREOTACTIC BIOPSY OF BRAIN METASTASES: AN 18-YEAR CANCER CENTER EXPERIENCE

BACKGROUND: Stereotactic biopsy is increasingly performed on brain metastases (BrM) as improving cancer outcomes drive aggressive multimodality treatment, however the risk of tract recurrence for such biopsies, in both the upfront and recurrent settings, are poorly defined in an era defined by focus...

Descripción completa

Detalles Bibliográficos
Autores principales: Carnevale, Joseph, Winston, Graham, Goldberg, Jacob, Brennan, Cameron, Tabar, Viviane, Moss, Nelson
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7401380/
http://dx.doi.org/10.1093/noajnl/vdaa073.038
_version_ 1783566551410016256
author Carnevale, Joseph
Winston, Graham
Goldberg, Jacob
Brennan, Cameron
Tabar, Viviane
Moss, Nelson
author_facet Carnevale, Joseph
Winston, Graham
Goldberg, Jacob
Brennan, Cameron
Tabar, Viviane
Moss, Nelson
author_sort Carnevale, Joseph
collection PubMed
description BACKGROUND: Stereotactic biopsy is increasingly performed on brain metastases (BrM) as improving cancer outcomes drive aggressive multimodality treatment, however the risk of tract recurrence for such biopsies, in both the upfront and recurrent settings, are poorly defined in an era defined by focused-irradiation paradigms. As such, the rate of tract recurrence was evaluated. METHODS: A retrospective review was performed to identify stereotactic biopsies performed for BrM at Memorial Sloan Kettering Cancer Center from 2002–2020. Data including surgical indications, tumor type, radiographic characteristics, stereotactic planning, pre- and post-operative CNS-directed and systemic treatments, and clinical courses were collected. Recurrence was evaluated using RANO-BM criteria. RESULTS: Four-hundred-and-seventy-nine patients underwent stereotactic intracranial biopsy for any diagnosis (>80% were gliomas or CNS lymphoma). Twenty-two (4.5%) were for pathologically-confirmed viable BrM and 91% (20/22) of these underwent postoperative irradiation with either stereotactic radiotherapy (14/20, 70%; SBRT) in plans that did not specifically target the biopsy tract, or whole-brain irradiation (6/20, 30%; WBRT). Eleven patients (50%) had >/=3 months radiographic follow-up (median 11.9; 4.5–30.6), of which 6 (55%) developed discontinuous enhancement along the tract at a median 6.4 months (2.3–17.1) post-biopsy. Of these, 2 had previously been treated with SBRT and were sampled in the setting of diagnostic ambiguity (one additionally with WBRT for small cell carcinoma) and underwent intraoperative laser interstitial thermal therapy (LITT) immediately following biopsy. The remainder were treated with SBRT +/- LITT (n=3 and 4, respectively) following biopsy. Tract recurrences were treated with resection (n=2, both with pathologic confirmation), re-irradiation (n=1) or observation/systemic therapy. CONCLUSIONS: In this largest reported series of biopsied BrM, we identify a nontrivial rate, higher than previously described, of recurrence along stereotactic biopsy tracts. As BrM are most commonly treated with focused radiotherapy centered on enhancing tumor margins, consideration should be made to include biopsy tracts where feasible.
format Online
Article
Text
id pubmed-7401380
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-74013802020-08-06 50. RISK OF TRACT RECURRENCE WITH STEREOTACTIC BIOPSY OF BRAIN METASTASES: AN 18-YEAR CANCER CENTER EXPERIENCE Carnevale, Joseph Winston, Graham Goldberg, Jacob Brennan, Cameron Tabar, Viviane Moss, Nelson Neurooncol Adv Supplement Abstracts BACKGROUND: Stereotactic biopsy is increasingly performed on brain metastases (BrM) as improving cancer outcomes drive aggressive multimodality treatment, however the risk of tract recurrence for such biopsies, in both the upfront and recurrent settings, are poorly defined in an era defined by focused-irradiation paradigms. As such, the rate of tract recurrence was evaluated. METHODS: A retrospective review was performed to identify stereotactic biopsies performed for BrM at Memorial Sloan Kettering Cancer Center from 2002–2020. Data including surgical indications, tumor type, radiographic characteristics, stereotactic planning, pre- and post-operative CNS-directed and systemic treatments, and clinical courses were collected. Recurrence was evaluated using RANO-BM criteria. RESULTS: Four-hundred-and-seventy-nine patients underwent stereotactic intracranial biopsy for any diagnosis (>80% were gliomas or CNS lymphoma). Twenty-two (4.5%) were for pathologically-confirmed viable BrM and 91% (20/22) of these underwent postoperative irradiation with either stereotactic radiotherapy (14/20, 70%; SBRT) in plans that did not specifically target the biopsy tract, or whole-brain irradiation (6/20, 30%; WBRT). Eleven patients (50%) had >/=3 months radiographic follow-up (median 11.9; 4.5–30.6), of which 6 (55%) developed discontinuous enhancement along the tract at a median 6.4 months (2.3–17.1) post-biopsy. Of these, 2 had previously been treated with SBRT and were sampled in the setting of diagnostic ambiguity (one additionally with WBRT for small cell carcinoma) and underwent intraoperative laser interstitial thermal therapy (LITT) immediately following biopsy. The remainder were treated with SBRT +/- LITT (n=3 and 4, respectively) following biopsy. Tract recurrences were treated with resection (n=2, both with pathologic confirmation), re-irradiation (n=1) or observation/systemic therapy. CONCLUSIONS: In this largest reported series of biopsied BrM, we identify a nontrivial rate, higher than previously described, of recurrence along stereotactic biopsy tracts. As BrM are most commonly treated with focused radiotherapy centered on enhancing tumor margins, consideration should be made to include biopsy tracts where feasible. Oxford University Press 2020-08-04 /pmc/articles/PMC7401380/ http://dx.doi.org/10.1093/noajnl/vdaa073.038 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Supplement Abstracts
Carnevale, Joseph
Winston, Graham
Goldberg, Jacob
Brennan, Cameron
Tabar, Viviane
Moss, Nelson
50. RISK OF TRACT RECURRENCE WITH STEREOTACTIC BIOPSY OF BRAIN METASTASES: AN 18-YEAR CANCER CENTER EXPERIENCE
title 50. RISK OF TRACT RECURRENCE WITH STEREOTACTIC BIOPSY OF BRAIN METASTASES: AN 18-YEAR CANCER CENTER EXPERIENCE
title_full 50. RISK OF TRACT RECURRENCE WITH STEREOTACTIC BIOPSY OF BRAIN METASTASES: AN 18-YEAR CANCER CENTER EXPERIENCE
title_fullStr 50. RISK OF TRACT RECURRENCE WITH STEREOTACTIC BIOPSY OF BRAIN METASTASES: AN 18-YEAR CANCER CENTER EXPERIENCE
title_full_unstemmed 50. RISK OF TRACT RECURRENCE WITH STEREOTACTIC BIOPSY OF BRAIN METASTASES: AN 18-YEAR CANCER CENTER EXPERIENCE
title_short 50. RISK OF TRACT RECURRENCE WITH STEREOTACTIC BIOPSY OF BRAIN METASTASES: AN 18-YEAR CANCER CENTER EXPERIENCE
title_sort 50. risk of tract recurrence with stereotactic biopsy of brain metastases: an 18-year cancer center experience
topic Supplement Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7401380/
http://dx.doi.org/10.1093/noajnl/vdaa073.038
work_keys_str_mv AT carnevalejoseph 50riskoftractrecurrencewithstereotacticbiopsyofbrainmetastasesan18yearcancercenterexperience
AT winstongraham 50riskoftractrecurrencewithstereotacticbiopsyofbrainmetastasesan18yearcancercenterexperience
AT goldbergjacob 50riskoftractrecurrencewithstereotacticbiopsyofbrainmetastasesan18yearcancercenterexperience
AT brennancameron 50riskoftractrecurrencewithstereotacticbiopsyofbrainmetastasesan18yearcancercenterexperience
AT tabarviviane 50riskoftractrecurrencewithstereotacticbiopsyofbrainmetastasesan18yearcancercenterexperience
AT mossnelson 50riskoftractrecurrencewithstereotacticbiopsyofbrainmetastasesan18yearcancercenterexperience