Top

Published in:

01-01-2018 | Clinical Study

Local control and overall survival for adjuvant stereotactic radiosurgery in patients with residual or recurrent disease

Authors: Tavish Nanda, Andrew Yaeh, Cheng-Chia Wu, Ashish Jani, Shumaila Saad, Yasir H. Qureshi, Keith A. Cauley, Jeraldine Lesser, Simon K. Cheng, Steven R. Isaacson, Michael B. Sisti, Jeffrey N. Bruce, Guy M. McKhann, Sameer A. Sheth, Andrew B. Lassman, Tony J. C. Wang

Published in: Journal of Neuro-Oncology | Issue 2/2018

Abstract

Prior studies of post-operative stereotactic radiosurgery (SRS) have not distinguished between Adjuvant SRS (ARS) versus Adjuvant SRS to residual/recurrent disease (ARD). In this study, we defined ARS and ARD and investigated local control (LC), overall survival (OS), distant development of brain metastases (DBF), and leptomeningeal disease (LMD). We retrospectively identified BM patients who received surgical resection and SRS for BM from an IRB approved database between Jan 2009–Aug 2015. Patients were stratified into two groups: ARS and ARD. LC was determined by follow-up MRI studies and OS was measured from the date of surgery. LC and OS were assessed using the Kaplan–Meier method. 70 cavities underwent surgical resection of BM and received SRS to the post-operative bed. 41 cavities were classified as ARS and 29 as ARD. There was no significant difference in 12-month LC between the ARS and ARD group (71.4 vs. 80.8%, respectively; p = 0.135) from the time point of SRS. The overall 1-year survival for ARS and ARD was 79.9 and 86.1%, respectively (p = 0.339). Mean time to progression was 6.45 and 8.0 months and median follow-up was 10 and 15 months for ARS and ARD, respectively. 11.8% of ARS patients and 15.4% of ARD patients developed LMD, p = 0.72. 29.4% of ARS and 48.0% of ARD patients developed DBF, p = 0.145. Our findings suggest that observation after surgical resection, with subsequent treatment with SRS after the development of local failure, may not compromise treatment efficacy. If validated, this would spare patients who do not recur post-surgically from additional treatment.

Choi CYH, Chang SD, Gibbs IC et al (2012) Stereotactic radiosurgery of the postoperative resection cavity for brain metastases: prospective evaluation of target margin on tumor control. Int J Radiat Oncol Biol Phys 84(2):336–342CrossRefPubMed

Do L, Pezner R, Radany E, Liu A, Staud C, Badie B (2009) Resection followed by stereotactic radiosurgery to resection cavity for intracranial metastases. Int J Radiat Oncol Biol Phys 73(2):486–491CrossRefPubMed

Hartford AC, Paravati AJ, Spire WJ, Li Z, Jarvis LA, Fadul CE et al (2013) Postoperative stereotactic radiosurgery without whole-brain radiation therapy for brain metastases: potential role of preoperative tumor size. Int J Radiat Oncol Biol Phys 85(3):650–655CrossRefPubMed

Hwang SW, Abozed MM, Hale A, Eisenberg RL, Dvorak T, Yao K et al (2010) Adjuvant gamma knife radiosurgery following surgical resection of brain metastases: a 9-year retrospective cohort study. J Neurooncol 98(1):77–82CrossRefPubMed

Iwai Y, Yamanaka K, Yasui T (2008) Boost radiosurgery for treatment of brain metastases after surgical resections. Surg Neurol 69(2):181–186CrossRefPubMed

Jagannathan J, Yen CP, Ray DK, Schlesinger D, Oskouian RJ, Pouratian N et al (2009) Gamma knife radiosurgery to the surgical cavity following resection of brain metastases: clinical article. J Neurosurg 111(3):431–438CrossRefPubMed

Jensen CA, Chan MD, McCoy TP, Bourland JD (2011) Cavity-directed radiosurgery as adjuvant therapy after resection of a brain metastasis. J Neurosurg 114(6):1585CrossRefPubMed

Kalani MY, Filippidis AS, Kalani MA, Sanai N, Brachman D, McBridal HL et al (2010) Gamma knife surgery combined with resection for treatment of a single brain metastasis: preliminary results: clinical article. J Neurosurg 113(Special Supplement):90–96PubMed

Kelly PJ, Lin YB, Alvin YY, Alexander BM, Hacker F, Marcus KJ et al (2012) Stereotactic irradiation of the postoperative resection cavity for brain metastasis: a frameless linear accelerator-based case series and review of the technique. Int J Radiat Oncol Biol Phys 82(1):95–101CrossRefPubMed

10.

Kresl J, Pueschel J, Porter R, Yan E, McDermott M, Sneed P (2013) Surgical resection and postoperative radiosurgery for single brain metastases. In: Society for Neuro-Oncology Eighth Annual Meeting A [Abstract], vol 338, 13 Nov 2013

11.

Limbrick DD, Lusis EA, Chicoine MR, Rich KM, Dacey RG, Dowling JL et al (2009) Combined surgical resection and stereotactic radiosurgery for treatment of cerebral metastases. Surg Neurol 71(3):280–288CrossRefPubMed

12.

Mathieu D, Kondziolka D, Flickinger JC, Fortin D, Kenny B, Michaud K et al (2008) Tumor bed radiosurgery after resection of cerebral metastases. Neurosurgery 62(4):817–824CrossRefPubMed

13.

Minniti G, Esposito V, Clarke E, Scaringi C, Lanzetta G, Salvati M et al (2013 Jul) Multidose stereotactic radiosurgery (9 Gy × 3) of the postoperative resection cavity for treatment of large brain metastases. Int J Radiat Oncol Biol Phys 15(4):623–629 86(CrossRef

14.

Narayana A, Chan K, Brennan C, Chang J, Higgins V, Lymberis S et al (2006) A phase II trial of stereotactic radiosurgery boost following surgical resection for solitary brain metastases. In: ASCO annual meeting proceedings [Abstract] vol 24, no 18_suppl, p 1552, 20 Jun 2006

15.

Quigley MR, Fuhrer R, Karlovits S, Karlovits B, Johnson M (2008) Single session stereotactic radiosurgery boost to the post-operative site in lieu of whole brain radiation in metastatic brain disease. J Neurooncol 87(3):327–332CrossRefPubMed

16.

Robbins JR, Ryu S, Kalkanis S, Cogan C, Rock J, Movsas B et al (2012) Radiosurgery to the surgical cavity as adjuvant therapy for resected brain metastasis. Neurosurgery 71(5):937–943CrossRefPubMed

17.

Rwigema J, Wegner RE, Mintz AH, Paravati AJ, Burton SA, Ozhasoglu C et al (2011) Stereotactic radiosurgery to the resection cavity of brain metastases: a retrospective analysis and literature review. Stereotact Funct Neurosurg 89(6):329–337CrossRefPubMed

18.

Soltys SG, Adler JR, Lipani JD, Jackson PS, Choi CY, Puataweepong P, White S, Gibbs IC, Chang SD (2008) Stereotactic radiosurgery of the postoperative resection cavity for brain metastases. Int J Radiat Oncol Biol Phys 70(1):187–193CrossRefPubMed

19.

Plowman PN (1999) Stereotactic radiosurgery VIII: the classification of postradiation reactions. Br J Neurosurg 13(3):256–264CrossRefPubMed

20.

Yaeh A, Nanda T, Jani A, Rozenblat T, Qureshi Y, Saad S, et al (2015) Control of brain metastases from radioresistant tumors treated by stereotactic radiosurgery. J Neurooncol 124(3):507–514CrossRefPubMed

21.

Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, Markesbery WR, Foon KA, Young B (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280(17):1485–1489CrossRefPubMed

22.

Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG et al (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10(11):1037–1044CrossRefPubMed

23.

Nieder C, Grosu AL, Gaspar LE (2014) Stereotactic radiosurgery (SRS) for brain metastases: a systematic review. Radiat Oncol 9(1):155CrossRefPubMedPubMedCentral

24.

Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K et al (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 295(21):2483–2491CrossRefPubMed

25.

Mahajan A, Ahmed S, Li J, McAleer MF, Weinberg J, Brown PD et al (2006) Postoperative stereotactic radiosurgery versus observation for completely resected brain metastases: results of a prospective randomized study. Int J Radiat Oncol Biol Phys 96(2):S2CrossRef

26.

Mansur DB, Hekmatpanah J, Wollman R, Macdonald L, Nicholas K, Beckmann E et al (2000) Low grade gliomas treated with adjuvant radiation therapy in the modern imaging era. Am J Clin Oncol 23(3):222–226CrossRefPubMed

27.

Morris MM, Dallow KC, Zietman AL, Park J, Althausen A, Heney NM et al (1997) Adjuvant and salvage irradiation following radical prostatectomy for prostate cancer. Int J Radiat Oncol Biol Phys Jul 1;38(4):731–736CrossRefPubMed

28.

Thompson IM, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D et al (2009) Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol 181(3):956–962CrossRefPubMedPubMedCentral

29.

Catton C, Gospodarowicz M, Warde P, Panzarella T, Catton P, McLean M et al (2001) Adjuvant and salvage radiation therapy after radical prostatectomy for adenocarcinoma of the prostate. Radiother Oncol 59(1):51–60CrossRefPubMed

30.

Atalar B, Modlin LA, Choi CY, Adler JR, Gibbs IC, Chang SD et al (2013) Risk of leptomeningeal disease in patients treated with stereotactic radiosurgery targeting the postoperative resection cavity for brain metastases. Int J Radiat Oncol Biol Phys 87(4):713–718CrossRefPubMed

31.

Leal T, Chang JE, Mehta M, Ian Robins H (2011) Leptomeningeal metastasis: challenges in diagnosis and treatment. Curr Cancer Ther Rev 7(4):319–327CrossRefPubMedPubMedCentral

32.

Werner-Wasik M, Rudoler S, Preston PE, Hauck WW, Downes BM, Leeper D et al (1999) Immediate side effects of stereotactic radiotherapy and radiosurgery. Int J Radiat Oncol Biol Phys 43(2):299–304CrossRefPubMed

33.

Shaw E, Arusell R, Scheithauer B, O’Fallon J, O’Neill B, Dinapoli R et al (2002) Prospective randomized trial of low-versus high-dose radiation therapy in adults with supratentorial low-grade glioma: initial report of a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group study. J Clin Oncol 20(9):2267–2276CrossRefPubMed

34.

Ruben JD, Dally M, Bailey M, Smith R, McLean CA, Fedele P (2006) Cerebral radiation necrosis: Incidence, outcomes, and risk factors with emphasis on radiation parameters and chemotherapy. Int J Radiat Oncol Biol Phys 65(2):499–508CrossRefPubMed

35.

Chang JH, Chang JW, Choi JY, Park YG, Chung SS (2003) Complications after gamma knife radiosurgery for benign meningiomas. J Neurol Neurosurg Psychiatry 74(2):226–230CrossRefPubMedPubMedCentral

36.

Suh JH (2010) Stereotactic radiosurgery for the management of brain metastases. N Engl J Med 362(12):1119–1127CrossRefPubMed

37.

Asher AL, Burri SH, Wiggins WF, Kelly RP, Boltes MO, Mehrlich M et al (2014) A new treatment paradigm: neoadjuvant radiosurgery before surgical resection of brain metastases with analysis of local tumor recurrence. Int J Radiat Oncol Biol Phys 88(4):899–906CrossRefPubMed

Title: Local control and overall survival for adjuvant stereotactic radiosurgery in patients with residual or recurrent disease
Authors: Tavish Nanda
Andrew Yaeh
Cheng-Chia Wu
Ashish Jani
Shumaila Saad
Yasir H. Qureshi
Keith A. Cauley
Jeraldine Lesser
Simon K. Cheng
Steven R. Isaacson
Michael B. Sisti
Jeffrey N. Bruce
Guy M. McKhann
Sameer A. Sheth
Andrew B. Lassman
Tony J. C. Wang
Publication date: 01-01-2018
Publisher: Springer US
Published in: Journal of Neuro-Oncology / Issue 2/2018
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-017-2651-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Local control and overall survival for adjuvant stereotactic radiosurgery in patients with residual or recurrent disease

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2018

Efficacy and safety of Levetiracetam vs. other antiepileptic drugs in Hispanic patients with glioblastoma

Suppression of glioblastoma growth and angiogenesis through molecular targeting of methionine aminopeptidase-2

Myo-inositol concentration in MR spectroscopy for differentiating high grade glioma from primary central nervous system lymphoma

Prevalence, risk factors, and response to treatment for hypersomnia of central origin in survivors of childhood brain tumors

Progesterone-only contraception is associated with a shorter progression-free survival in premenopausal women with WHO Grade I meningioma

An immune-related lncRNA signature for patients with anaplastic gliomas