Ahead of Print: Surgery Plus Radiosurgery to Cavity

Background: The standard treatment of resected brain metastasis is whole brain radiotherapy (WBRT). To avoid the potential toxicity of WBRT and improve local control, we have used radiosurgery alone to the surgical cavity.

Objective: To demonstrate the rates of local control, new intracranial metastasis, and overall survival using this treatment scheme without WBRT.

Methods: Eighty-five consecutive patients with brain metastasis were treated with surgical resection of at least one lesion followed by radiosurgery alone to the surgical cavity and any unresected lesions from August 2000 to March 2011. Sixty-eight percent had gross total resections. After surgery, radiosurgery was delivered to the surgical cavity with 2-3 mm margin. The median marginal radiosurgery dose was 16 Gy, and median target volume was 13.96 cm3. Follow-up imaging and clinical exam were obtained every 2-3 months.

Results: Median follow-up time was 11.2 months. Overall local control was 81.2%. The 6- month, 1-year, and 2-year rates of local control were 88.7%, 81.4%, and 75.7%, respectively. Forty-seven patients (55%) developed new intracranial metastases at a median time of 5.6 months. For the entire population, the rate of new metastases was 32.1%, 58.1%, and 62.9% at 6-months, 1-year, and 2-years, respectively. Median overall survival time was 12.1 months. From initial treatment until death or last follow-up, only 30 patients (35%) received WBRT as salvage treatment.

Conclusion: Radiosurgery to the surgical cavity without WBRT achieved excellent local control of resected brain metastasis. Close imaging follow-up allows for early intervention for any new metastasis.

From: Radiosurgery to the Surgical Cavity as Adjuvant Therapy for Resected Brain Metastasis by Robbins et al.

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