Pierina Navarria1, Federico Pessina2, Elena Clerici3, Davide Franceschini3, Lorenzo Gabriel Gay4, Fiorenza De Rose3, Ilaria Renna3, Giuseppe D'Agostino3, Ciro Franzese3, Tiziana Comito3, Stefano Tomatis3, Marco Conti Nibali4, Antonella Leonetti4, Guglielmo Puglisi4, Lorenzo Bello5, Marta Scorsetti6. 1. Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Rozzano, Italy. Electronic address: pierina.navarria@humanitas.it. 2. Neurosurgical Oncology Department, Humanitas Cancer Center and Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy. 3. Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Rozzano, Italy. 4. Neurosurgical Oncology Department, Humanitas Cancer Center and Research Hospital, Rozzano, Italy. 5. Neurosurgical Oncology Department, Humanitas Cancer Center and Research Hospital, Rozzano, Italy; Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy. 6. Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
Abstract
PURPOSE: This prospective phase II study assessed safety and feasibility of surgery followed by hypofractionated radiosurgery (HSRS) on the tumor bed in oligometastatic patients with single large brain metastases (BMs). METHODS AND MATERIALS: Between June 2015 and May 2018, 101 patients were enrolled. Oligometastatic disease was defined by a maximum of 5 extracranial metastatic lesions. HSRS was performed within 1 month of surgery and consisted of 30 Gy in 3 fractions. Local control, occurrence of new BMs, overall survival, and treatment-related toxicities were assessed. RESULTS: At a median follow-up time of 26 months, local recurrence occurred in 6 patients (5.9%). Six-month, 1-year, and 2-year local control rates were 100%, 98.9% ± 1.1%, and 85.9% ± 0.6%, respectively. New BMs occurred in 39 patients (38.6%); median brain distant progression time and 6-month, 1-year, and 2-year brain distant progression rates were 39 months (95% CI, 19-39 months), 17% ± 3.7%, 31.4% ± 4.8%, and 42.5% ± 5.9%, respectively. At the last observation time, 50 patients (49.5%) were alive and 51 (50.5%) were dead; 10 patients died owing to neurologic causes and 40 as a result of systemic progression. Median overall survival time and 6-month, 1-year, and 2-year overall survival rates were 22 months (95% CI, 20-30 months), 95% ± 2.1%, 81.9% ± 3.8%, and 46.6% ± 6%, respectively. Infratentorial site, residual tumor volume, longer interval time between primary diagnosis and occurrence of BMs, and oligometastatic disease status significantly influenced outcome. Grade 2 to 3 radionecrosis occurred in 26 patients. Neurocognitive functions remained stable or, in some cases, improved. CONCLUSIONS: Surgery followed by HSRS on the tumor bed is a safe and effective approach, affording good brain control with acceptable toxicities. As for extracranial metastatic sites, patients with BMs can benefit from local ablative treatment in the context of an oligometastatic disease.
PURPOSE: This prospective phase II study assessed safety and feasibility of surgery followed by hypofractionated radiosurgery (HSRS) on the tumor bed in oligometastatic patients with single large brain metastases (BMs). METHODS AND MATERIALS: Between June 2015 and May 2018, 101 patients were enrolled. Oligometastatic disease was defined by a maximum of 5 extracranial metastatic lesions. HSRS was performed within 1 month of surgery and consisted of 30 Gy in 3 fractions. Local control, occurrence of new BMs, overall survival, and treatment-related toxicities were assessed. RESULTS: At a median follow-up time of 26 months, local recurrence occurred in 6 patients (5.9%). Six-month, 1-year, and 2-year local control rates were 100%, 98.9% ± 1.1%, and 85.9% ± 0.6%, respectively. New BMs occurred in 39 patients (38.6%); median brain distant progression time and 6-month, 1-year, and 2-year brain distant progression rates were 39 months (95% CI, 19-39 months), 17% ± 3.7%, 31.4% ± 4.8%, and 42.5% ± 5.9%, respectively. At the last observation time, 50 patients (49.5%) were alive and 51 (50.5%) were dead; 10 patients died owing to neurologic causes and 40 as a result of systemic progression. Median overall survival time and 6-month, 1-year, and 2-year overall survival rates were 22 months (95% CI, 20-30 months), 95% ± 2.1%, 81.9% ± 3.8%, and 46.6% ± 6%, respectively. Infratentorial site, residual tumor volume, longer interval time between primary diagnosis and occurrence of BMs, and oligometastatic disease status significantly influenced outcome. Grade 2 to 3 radionecrosis occurred in 26 patients. Neurocognitive functions remained stable or, in some cases, improved. CONCLUSIONS: Surgery followed by HSRS on the tumor bed is a safe and effective approach, affording good brain control with acceptable toxicities. As for extracranial metastatic sites, patients with BMs can benefit from local ablative treatment in the context of an oligometastatic disease.
Authors: S Rogers; A Stauffer; N Lomax; S Alonso; B Eberle; S Gomez Ordoñez; T Lazeroms; E Kessler; M Brendel; L Schwyzer; O Riesterer Journal: J Neurooncol Date: 2021-09-21 Impact factor: 4.130
Authors: Giuseppe Minniti; Maximilian Niyazi; Nicolaus Andratschke; Matthias Guckenberger; Joshua D Palmer; Helen A Shih; Simon S Lo; Scott Soltys; Ivana Russo; Paul D Brown; Claus Belka Journal: Radiat Oncol Date: 2021-04-15 Impact factor: 3.481
Authors: Balamurugan A Vellayappan; Tresa McGranahan; Jerome Graber; Lynne Taylor; Vyshak Venur; Richard Ellenbogen; Andrew E Sloan; Kristin J Redmond; Matthew Foote; Samuel T Chao; John H Suh; Eric L Chang; Arjun Sahgal; Simon S Lo Journal: Curr Treat Options Oncol Date: 2021-06-07