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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 6/2016

01-06-2016 | Original Article

HFSRT of the resection cavity in patients with brain metastases

Authors: Hanno M. Specht, Kerstin A. Kessel, Markus Oechsner, Bernhard Meyer, Claus Zimmer, Prof. Dr. Stephanie E. Combs

Published in: Strahlentherapie und Onkologie | Issue 6/2016

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Abstract

Purpose

Aim of this single center, retrospective study was to assess the efficacy and safety of linear accelerator-based hypofractionated stereotactic radiotherapy (HFSRT) to the resection cavity of brain metastases after surgical resection. Local control (LC), locoregional control (LRC = new brain metastases outside of the treatment volume), overall survival (OS) as well as acute and late toxicity were evaluated.

Patients and methods

46 patients with large (> 3 cm) or symptomatic brain metastases were treated with HFSRT. Median resection cavity volume was 14.16 cm3 (range 1.44–38.68 cm3) and median planning target volume (PTV) was 26.19 cm3 (range 3.45–63.97 cm3). Patients were treated with 35 Gy in 7 fractions prescribed to the 95–100 % isodose line in a stereotactic treatment setup. LC and LRC were assessed by follow-up magnetic resonance imaging.

Results

The 1-year LC rate was 88 % and LRC was 48 %; 57% of all patients showed cranial progression after HFSRT (4% local, 44% locoregional, 9% local and locoregional). The median follow-up was 19 months; median OS for the whole cohort was 25 months. Tumor histology and recursive partitioning analysis score were significant predictors for OS. HFSRT was tolerated well without any severe acute side effects > grade 2 according to CTCAE criteria.

Conclusion

HFSRT after surgical resection of brain metastases was tolerated well without any severe acute side effects and led to excellent LC and a favorable OS. Since more than half of the patients showed cranial progression after local irradiation of the resection cavity, close patient follow-up is warranted. A prospective evaluation in clinical trials is currently being performed.
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Metadata
Title
HFSRT of the resection cavity in patients with brain metastases
Authors
Hanno M. Specht
Kerstin A. Kessel
Markus Oechsner
Bernhard Meyer
Claus Zimmer
Prof. Dr. Stephanie E. Combs
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 6/2016
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-016-0955-2

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