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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 12/2018

01-12-2018 | Original Article

Postoperative local fractionated radiotherapy for resected single brain metastases

Authors: Ahmad Walid Ayas, Stefan Grau, Karolina Jablonska, Daniel Ruess, Maximilian Ruge, Simone Marnitz, Roland Goldbrunner, Prof. Dr. Martin Kocher

Published in: Strahlentherapie und Onkologie | Issue 12/2018

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Abstract

Purpose

Evaluation of postoperative fractionated local 3D-conformal radiotherapy (3DRT) of the resection cavity in brain metastases.

Patients and methods

Between 2011 and 2016, 57 patients underwent resection of a single, previously untreated (37/57, 65%) or recurrent (20/57, 35%) brain metastasis (median maximal diameter 3.5 cm [1.1–6.5 cm]) followed by 3DRT. For definition of the gross tumor volume (GTV), the resection cavity was used and for the clinical target volume (CTV), margins of 1.0–1.5 cm were added. Median dose was 48.0 Gy (30.0–50.4 Gy) in 25 (10–28) fractions; most patients had 36.0–42.0 Gy in 3.0 Gy fractions (n = 16, EQD210Gy 39.0–45.5 Gy) or 40.0–50.4 Gy in 1.8–2.0 Gy fractions (n = 37, EQD210Gy 39.3–50.0 Gy).

Results

Median follow-up was 18 months. Local control rates were 83% at 1 year and 78% at 2 years and were significantly influenced by histology (breast cancer 100%, non-small lung cancer 87%, melanoma 80%, colorectal cancer 26% at 2 years, p = 0.006) and resection status (p < 0.0001), but not by EQD210Gy or size of the planning target volume (median 96.7 ml [16.7–282.8 ml]). At 1 and 2 years, 74% and 52% of the patients were free from distant brain metastases. Salvage procedures were applied in 25/27 (93%) of recurrent patients. Survival was 68% at 1 year and 41% at 2 years and was significantly improved in younger patients (p = 0.006) with higher Karnofsky performance score (p < 0.0001) and without prior radiotherapy (54% vs. 9% at 2 years, p = 0.006). No cases of radiographic or symptomatic radionecrosis were observed.

Conclusion

Adjuvant fractionated local 3DRT is highly effective in radiosensitive, completely resected metastases and should be considered for treating large resection cavities as an alternative to postoperative stereotactic single dose or hypofractionated radiosurgery.
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Metadata
Title
Postoperative local fractionated radiotherapy for resected single brain metastases
Authors
Ahmad Walid Ayas
Stefan Grau
Karolina Jablonska
Daniel Ruess
Maximilian Ruge
Simone Marnitz
Roland Goldbrunner
Prof. Dr. Martin Kocher
Publication date
01-12-2018
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 12/2018
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-018-1368-1

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