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Journal of Neuro-Oncology

Published in:

01-11-2018 | Clinical Study

Feasibility of dose escalation using intraoperative radiotherapy following resection of large brain metastases compared to post-operative stereotactic radiosurgery

Authors: John A. Vargo, Kristie M. Sparks, Rahul Singh, Geraldine M. Jacobson, Joshua D. Hack, Christopher P. Cifarelli

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

Abstract

Background and purpose

Post-operative SRS (stereotactic radiosurgery) for large brain metastases is challenged by risks of radiation necrosis that limit SRS dose. Intraoperative radiotherapy (IORT) is a potential alternative, however standard dose recommendations are lacking.

Methods and materials

Twenty consecutive brain metastases treated with post-operative SRS were retrospectively compared to IORT plans generated for 10–30 Gy in 1 fraction to 0–5 mm by estimating the applicator size and distance from critical organs using pre-operative and post-operative MRI. Additionally, 7 consecutive patients treated with IORT 30 Gy to surface were compared to retrospectively generated SRS plans using the post-operative MRI to 15–20 Gy and 30 Gy in 1 fraction marginal dose.

Results

For the 20 resection cavities treated with SRS and retrospectively compared to IORT, IORT from 10 to 30Gy resulted in lower or not significantly different doses to the optic apparatus and brainstem. Comparatively for the 7 patients treated with IORT 30 Gy to retrospective SRS plans to standard 15–20 Gy and 30 Gy marginal dose, IORT resulted in significantly lower doses to the optic apparatus and brainstem. At a median follow-up of 6.2 months, 86% of patients treated with surgery and IORT achieved local control and 0% developed radiographic or symptomatic radiation necrosis.

Conclusions

Critical organ dosimetry for IORT remains generally lower than that achieved with single fraction SRS following resection of large brain metastases. We recommend 30 Gy to surface as the preferred prescription, consistent with the dose recommendation for IORT in glioblastoma used in the ongoing INTRAGO-II phase-III trial. Early clinical outcomes appear promising for surgery and IORT.

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Title: Feasibility of dose escalation using intraoperative radiotherapy following resection of large brain metastases compared to post-operative stereotactic radiosurgery
Authors: John A. Vargo
Kristie M. Sparks
Rahul Singh
Geraldine M. Jacobson
Joshua D. Hack
Christopher P. Cifarelli
Publication date: 01-11-2018
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/s11060-018-2968-4

At a glance: The STEP trials

Springer Medicine

Feasibility of dose escalation using intraoperative radiotherapy following resection of large brain metastases compared to post-operative stereotactic radiosurgery

Abstract

Background and purpose

Methods and materials

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background and purpose

Methods and materials

Results

Conclusions

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