BACKGROUND: Optimal postoperative management paradigm for brain metastases remains controversial. OBJECTIVE: To conduct a systematic review of the literature to understand the role of postoperative stereotactic radiosurgery after resection of brain metastases. METHODS: We performed a MEDLINE search of the literature to identify series of patients with brain metastases treated with stereotactic radiosurgery after surgical resection. Outcomes including overall survival, local control, distant intracranial failure, and salvage therapy use were recorded. Patient, tumor, and treatment factors were correlated with outcomes through the use of the Pearson correlation and 2-way Student t test as appropriate. RESULTS: Fourteen studies involving 629 patients were included. Median survival for all studies was 14 months. Local control was correlated with the median volume treated with radiosurgery (r = -0.766, P < .05) and with the rate of gross total resection (r = .728, P < .03). Mean crude local control was 83%; 1-year local control was 85%. Distant intracranial failure occurred in 49% of cases, and salvage whole-brain radiation therapy was required in 29% of cases. Use of a radiosurgical margin did not lead to increased local control or overall survival. CONCLUSION: Our systematic review supports the use of radiosurgery as a safe and effective strategy for adjuvant treatment of brain metastases, particularly when gross total resection has been achieved. With all limitations of comparisons between studies, no increase in local recurrence or decrease in overall survival compared with rates with adjuvant whole-brain radiation therapy was found.
BACKGROUND: Optimal postoperative management paradigm for brain metastases remains controversial. OBJECTIVE: To conduct a systematic review of the literature to understand the role of postoperative stereotactic radiosurgery after resection of brain metastases. METHODS: We performed a MEDLINE search of the literature to identify series of patients with brain metastases treated with stereotactic radiosurgery after surgical resection. Outcomes including overall survival, local control, distant intracranial failure, and salvage therapy use were recorded. Patient, tumor, and treatment factors were correlated with outcomes through the use of the Pearson correlation and 2-way Student t test as appropriate. RESULTS: Fourteen studies involving 629 patients were included. Median survival for all studies was 14 months. Local control was correlated with the median volume treated with radiosurgery (r = -0.766, P < .05) and with the rate of gross total resection (r = .728, P < .03). Mean crude local control was 83%; 1-year local control was 85%. Distant intracranial failure occurred in 49% of cases, and salvage whole-brain radiation therapy was required in 29% of cases. Use of a radiosurgical margin did not lead to increased local control or overall survival. CONCLUSION: Our systematic review supports the use of radiosurgery as a safe and effective strategy for adjuvant treatment of brain metastases, particularly when gross total resection has been achieved. With all limitations of comparisons between studies, no increase in local recurrence or decrease in overall survival compared with rates with adjuvant whole-brain radiation therapy was found.
Authors: Ahmad Walid Ayas; Stefan Grau; Karolina Jablonska; Daniel Ruess; Maximilian Ruge; Simone Marnitz; Roland Goldbrunner; Martin Kocher Journal: Strahlenther Onkol Date: 2018-09-14 Impact factor: 3.621
Authors: Douglas Kondziolka; Samuel M Shin; Andrew Brunswick; Irene Kim; Joshua S Silverman Journal: Neuro Oncol Date: 2014-09-28 Impact factor: 12.300
Authors: A Gabriella Wernicke; Menachem Z Yondorf; Bhupesh Parashar; Dattatreyudu Nori; K S Clifford Chao; John A Boockvar; Susan Pannullo; Philip Stieg; Theodore H Schwartz Journal: J Neurooncol Date: 2016-01-02 Impact factor: 4.130
Authors: Tae Hoon Roh; Mi Sun Choi; Namkyu You; Donghwan Jeong; Ae Hwa Jang; Mi Ra Seo; Sang Ryul Lee; Se-Hyuk Kim Journal: J Neurooncol Date: 2018-01-11 Impact factor: 4.130
Authors: A Gabriella Wernicke; Menachem Z Yondorf; Luke Peng; Samuel Trichter; Lucy Nedialkova; Albert Sabbas; Fridon Kulidzhanov; Bhupesh Parashar; Dattatreyudu Nori; K S Clifford Chao; Paul Christos; Ilhami Kovanlikaya; Susan Pannullo; John A Boockvar; Philip E Stieg; Theodore H Schwartz Journal: J Neurosurg Date: 2014-05-02 Impact factor: 5.115
Authors: Michela Buglione; Sara Pedretti; Stefano Gipponi; Luciano Buttolo; Paolo Panciani; Pietro Luigi Poliani; Roberto Liserre; Paolo Borghetti; Ludovica Pegurri; Loredana Costa; Luca Triggiani; Nadia Pasinetti; Paolo Ghirardelli; Sara Pandini; Alessandro Padovani; Stefano Maria Magrini Journal: Radiol Med Date: 2015-04-28 Impact factor: 3.469