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RADI-22. Toxicity and local control outcomes for brain metastases managed with resection and aggressive reirradiation after initial radiosurgery failure

OBJECTIVES: To describe toxicity and tumor outcome after resection and aggressive re-irradiation (stereotactic radiosurgery(SRS) or brachytherapy) of brain metastasis that have pathologically confirmed recurrence after prior radiosurgery. METHODS: A retrospective chart review identified 40 lesions i...

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Autores principales: Bhatia, Rohini, Siu, Catherine, Baker, Brock, Redmond, Kristin, Jackson, Christopher, Bettegowda, Chetan, Lim, Michael, Kleinberg, Lawrence
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351188/
http://dx.doi.org/10.1093/noajnl/vdab071.092
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author Bhatia, Rohini
Siu, Catherine
Baker, Brock
Redmond, Kristin
Jackson, Christopher
Bettegowda, Chetan
Lim, Michael
Kleinberg, Lawrence
author_facet Bhatia, Rohini
Siu, Catherine
Baker, Brock
Redmond, Kristin
Jackson, Christopher
Bettegowda, Chetan
Lim, Michael
Kleinberg, Lawrence
author_sort Bhatia, Rohini
collection PubMed
description OBJECTIVES: To describe toxicity and tumor outcome after resection and aggressive re-irradiation (stereotactic radiosurgery(SRS) or brachytherapy) of brain metastasis that have pathologically confirmed recurrence after prior radiosurgery. METHODS: A retrospective chart review identified 40 lesions in 35 patients that were initially treated with SRS, then demonstrated evidence of recurrence with pathologic confirmation and underwent re-irradiation either with radiosurgery (n=28, 70%) or intracavitary brachytherapy with Cesium-131 seeds (n=12, 30%). Toxicity was measured by: steroids initiated or increased within 3 months, imaging evidence of treatment effect vs disease progression at any time point, further intervention for local recurrence or necrosis, and any grade 3/4 neurologic events. Local control (with failure defined by sustained progression on imaging or pathologic confirmation of tumor) was measured from time of retreatment. RESULTS: Median follow-up from time of re-irradiation was 11.8 months (range 1 – 89.7 months). Dose for repeat radiosurgery was 18–25 Gy in 1–5 fractions, and brachytherapy dose was 55–65 Gy at 5 mm depth. Twelve lesions subsequently had imaging evidence of radionecrosis vs. progression. Of these, eight underwent repeat resection with pathology demonstrating radiation necrosis in five patients (n=4 with SRS, n=1 with brachy) and tumor recurrence in 3 (n=2 with brachy, and n=1 with SRS). Toxicities included: Steroids, 14(35%); imaging progression/necrosis 12(30%); grade 3/4 event, 3(20%); and surgically confirmed radionecrosis 5(12.5%). Local control of retreated lesions at 6 months is 85.5%, and at 12 months is 79.3%, OS at 1 year is 52.5% and at 2 years 46.6%. Local control at one year for repeat stereotactic treatment was 82.9% and for Cs131 brachytherapy was 80.8% CONCLUSIONS: Aggressive re-irradiation after resection for pathologic confirmation appears to be appropriately safe and effective for the majority of patients after local failure of initial radiosurgery.
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spelling pubmed-83511882021-08-09 RADI-22. Toxicity and local control outcomes for brain metastases managed with resection and aggressive reirradiation after initial radiosurgery failure Bhatia, Rohini Siu, Catherine Baker, Brock Redmond, Kristin Jackson, Christopher Bettegowda, Chetan Lim, Michael Kleinberg, Lawrence Neurooncol Adv Supplement Abstracts OBJECTIVES: To describe toxicity and tumor outcome after resection and aggressive re-irradiation (stereotactic radiosurgery(SRS) or brachytherapy) of brain metastasis that have pathologically confirmed recurrence after prior radiosurgery. METHODS: A retrospective chart review identified 40 lesions in 35 patients that were initially treated with SRS, then demonstrated evidence of recurrence with pathologic confirmation and underwent re-irradiation either with radiosurgery (n=28, 70%) or intracavitary brachytherapy with Cesium-131 seeds (n=12, 30%). Toxicity was measured by: steroids initiated or increased within 3 months, imaging evidence of treatment effect vs disease progression at any time point, further intervention for local recurrence or necrosis, and any grade 3/4 neurologic events. Local control (with failure defined by sustained progression on imaging or pathologic confirmation of tumor) was measured from time of retreatment. RESULTS: Median follow-up from time of re-irradiation was 11.8 months (range 1 – 89.7 months). Dose for repeat radiosurgery was 18–25 Gy in 1–5 fractions, and brachytherapy dose was 55–65 Gy at 5 mm depth. Twelve lesions subsequently had imaging evidence of radionecrosis vs. progression. Of these, eight underwent repeat resection with pathology demonstrating radiation necrosis in five patients (n=4 with SRS, n=1 with brachy) and tumor recurrence in 3 (n=2 with brachy, and n=1 with SRS). Toxicities included: Steroids, 14(35%); imaging progression/necrosis 12(30%); grade 3/4 event, 3(20%); and surgically confirmed radionecrosis 5(12.5%). Local control of retreated lesions at 6 months is 85.5%, and at 12 months is 79.3%, OS at 1 year is 52.5% and at 2 years 46.6%. Local control at one year for repeat stereotactic treatment was 82.9% and for Cs131 brachytherapy was 80.8% CONCLUSIONS: Aggressive re-irradiation after resection for pathologic confirmation appears to be appropriately safe and effective for the majority of patients after local failure of initial radiosurgery. Oxford University Press 2021-08-09 /pmc/articles/PMC8351188/ http://dx.doi.org/10.1093/noajnl/vdab071.092 Text en © The Author(s) 2021. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://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
Bhatia, Rohini
Siu, Catherine
Baker, Brock
Redmond, Kristin
Jackson, Christopher
Bettegowda, Chetan
Lim, Michael
Kleinberg, Lawrence
RADI-22. Toxicity and local control outcomes for brain metastases managed with resection and aggressive reirradiation after initial radiosurgery failure
title RADI-22. Toxicity and local control outcomes for brain metastases managed with resection and aggressive reirradiation after initial radiosurgery failure
title_full RADI-22. Toxicity and local control outcomes for brain metastases managed with resection and aggressive reirradiation after initial radiosurgery failure
title_fullStr RADI-22. Toxicity and local control outcomes for brain metastases managed with resection and aggressive reirradiation after initial radiosurgery failure
title_full_unstemmed RADI-22. Toxicity and local control outcomes for brain metastases managed with resection and aggressive reirradiation after initial radiosurgery failure
title_short RADI-22. Toxicity and local control outcomes for brain metastases managed with resection and aggressive reirradiation after initial radiosurgery failure
title_sort radi-22. toxicity and local control outcomes for brain metastases managed with resection and aggressive reirradiation after initial radiosurgery failure
topic Supplement Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351188/
http://dx.doi.org/10.1093/noajnl/vdab071.092
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