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Open Access 23-09-2022 | Metastasis | Original Article

Focal cavity radiotherapy after neurosurgical resection of brain metastases: sparing neurotoxicity without compromising locoregional control

Authors: Klaus-Henning Kahl, MD, Ehab Shiban, Susanne Gutser, Christoph J. Maurer, Björn Sommer, Heiko Müller, Ina Konietzko, Ute Grossert, Ansgar Berlis, Tilman Janzen, Georg Stüben

Published in: Strahlentherapie und Onkologie | Issue 12/2022

Abstract

Purpose

Does focal cavity radiotherapy after resection of brain metastasis “spare” whole-brain radiotherapy, which is associated with toxicity for patients, through the complete course of their disease without compromising long-term local control of the brain?

Methods

We retrospectively analyzed outcomes of patients who underwent adjuvant focal cavity radiotherapy between 2014 and 2021 at our center.

Results

A total of 83 patients with 86 resected brain metastases were analyzed. 64% had singular, 36% two to four brain metastases. In cases with multiple metastases, omitted lesions were treated with radiosurgery. Median follow-up was 7.3 months (range 0–71.2 months), 1‑year overall survival rate was 57.8% (95% CI 44.9–68.8%). Radiotherapy was administered with a median biologically effective dose (α/β 10) surrounding the planning target volume of 48 Gy (range 23.4–60 Gy). Estimated 1‑year local control rate was 82.7% (95% CI 67.7–91.2%), estimated 1‑year distant brain control rate was 55.7% (95% CI 40.5–68.4%), estimated 1‑year leptomeningeal disease rate was 16.0% (95% CI 7.3–32.9%). Eleven distant brain recurrences could be salvaged with radiosurgery. In the further course of disease, 14 patients (17%) developed disseminated metastatic disease in the brain. Estimated 1‑year free of whole-brain radiotherapy rate was 72.3% (95% CI 57.1–82.9%). All applied treatments led to an estimated 1‑year neuro-control rate of 79.1% (95% CI 65.0–88.0%), estimated 1‑year radionecrosis rate was 23% (95% CI 12.4–40.5%).

Conclusion

In our single-center study, focal cavity radiotherapy was associated with high local control. In three out of four patients, whole-brain radiotherapy could be avoided in the complete course of disease, using radiosurgery as salvage approach without compromising neuro-control.

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Title: Focal cavity radiotherapy after neurosurgical resection of brain metastases: sparing neurotoxicity without compromising locoregional control
Authors: Klaus-Henning Kahl, MD
Ehab Shiban
Susanne Gutser
Christoph J. Maurer
Björn Sommer
Heiko Müller
Ina Konietzko
Ute Grossert
Ansgar Berlis
Tilman Janzen
Georg Stüben
Publication date: 23-09-2022
Publisher: Springer Berlin Heidelberg
Keywords: Metastasis
Radiotherapy
Published in: Strahlentherapie und Onkologie / Issue 12/2022
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-022-02003-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Focal cavity radiotherapy after neurosurgical resection of brain metastases: sparing neurotoxicity without compromising locoregional control

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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