Kristin J Redmond1, Antonio Af De Salles2, Laura Fariselli3, Marc Levivier4, Lijun Ma5, Ian Paddick6, Bruce E Pollock7, Jean Regis8, Jason Sheehan9, John Suh10, Shoji Yomo11, Arjun Sahgal12. 1. Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, MD. Electronic address: kjanson3@jhmi.edu. 2. HCor Neuroscience Institute, Heart Hospital (HCor), São Paulo, São Paulo, Brazil. 3. Department of Neurosurgery, Unit of Radiotherapy, Fondazione IRCCS Istituto Neurologico C Besta, Milano, Italia. 4. Neurosurgery Service and Gamma Knife Center Centre Hospitalier Universitaire Vaudois (CHUV) Lausanne, Switzerland; Faculty of Biology and Medicine (FBM) University of Lausanne (UNIL) Lausanne, Switzerland. 5. Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA. 6. Medical Physics Ltd, Queen Square Radiosurgery Centre, London, United Kingdom. 7. Department of Radiation Oncology and Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA. 8. Aix-Marseille University, INSERM, UMR 1106; Timone University Hospital, Functional Neurosurgery and Radiosurgery Department, Marseille, France. 9. Department of Neurosurgery, University of Virginia, Charlottesville, VA, US. 10. Department of Radiation Oncology, Taussing Cancer Institute Cleveland Clinic, Cleveland, OH, USA. 11. Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Japan. 12. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
Abstract
PURPOSE: The purpose of this critical review is to summarize the literature specific to single fraction stereotactic radiosurgery (SRS) and multiple fraction stereotactic radiotherapy (SRT) for post-operative brain metastases resection cavities and present practice recommendations on behalf of the ISRS. METHODS AND MATERIALS: Medline and Embase databases were used to apply the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) approach to search for manuscripts reporting SRS/SRT outcomes for post-operative brain metastases tumor bed resection cavities with a search end date of July 20, 2018. Prospective studies, consensus guidelines, and retrospective series that included exclusively post-operative brain metastases and had at minimum 100 patients were considered eligible. RESULTS: The Embase and Pubmed search revealed a total of 157 manuscripts of which 77 were selected, and 55 manuscripts of which 23 were selected, for full text screening, respectively. Eight retrospective series, 1 phase II prospective study, 3 randomized controlled trials, and 1 consensus contouring paper were deemed appropriate for inclusion. The data suggest that SRS/SRT to surgical cavities with prescription doses 30-50 Gy EQD210, 50-70 Gy EQD25, and 70-90 EQD22 are associated with rates of local control ranging from 60.5% to 91% (median 80.5%). Randomized data suggests improved local control with single fraction SRS compared to observation and improved cognitive outcomes as compared to WBRT. Toxicity of SRS/SRT in the post-operative setting were limited and reviewed herein. CONCLUSIONS: Although randomized data raise concern for poorer local control following resection cavity SRS than WBRT, these findings may be driven by factors such as conservative prescription doses utilized in the SRS arm. Retrospective studies suggest high rates of local control following single fraction SRS and hypofractionated SRT for post-operative brain metastases. With a superior neurocognitive profile and no survival disadvantage to withholding WBRT, the ISRS recommends SRS as first-line treatment for eligible post-operative patients. Emerging data suggests that fractionated SRT may provide superior local control compared to single fraction SRS, in particular, for large tumor cavity volumes/diameters and potentially for patients with a pre-operative diameter greater than 2.5 cm.
PURPOSE: The purpose of this critical review is to summarize the literature specific to single fraction stereotactic radiosurgery (SRS) and multiple fraction stereotactic radiotherapy (SRT) for post-operative brain metastases resection cavities and present practice recommendations on behalf of the ISRS. METHODS AND MATERIALS: Medline and Embase databases were used to apply the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) approach to search for manuscripts reporting SRS/SRT outcomes for post-operative brain metastasestumor bed resection cavities with a search end date of July 20, 2018. Prospective studies, consensus guidelines, and retrospective series that included exclusively post-operative brain metastases and had at minimum 100 patients were considered eligible. RESULTS: The Embase and Pubmed search revealed a total of 157 manuscripts of which 77 were selected, and 55 manuscripts of which 23 were selected, for full text screening, respectively. Eight retrospective series, 1 phase II prospective study, 3 randomized controlled trials, and 1 consensus contouring paper were deemed appropriate for inclusion. The data suggest that SRS/SRT to surgical cavities with prescription doses 30-50 Gy EQD210, 50-70 Gy EQD25, and 70-90 EQD22 are associated with rates of local control ranging from 60.5% to 91% (median 80.5%). Randomized data suggests improved local control with single fraction SRS compared to observation and improved cognitive outcomes as compared to WBRT. Toxicity of SRS/SRT in the post-operative setting were limited and reviewed herein. CONCLUSIONS: Although randomized data raise concern for poorer local control following resection cavity SRS than WBRT, these findings may be driven by factors such as conservative prescription doses utilized in the SRS arm. Retrospective studies suggest high rates of local control following single fraction SRS and hypofractionated SRT for post-operative brain metastases. With a superior neurocognitive profile and no survival disadvantage to withholding WBRT, the ISRS recommends SRS as first-line treatment for eligible post-operative patients. Emerging data suggests that fractionated SRT may provide superior local control compared to single fraction SRS, in particular, for large tumor cavity volumes/diameters and potentially for patients with a pre-operative diameter greater than 2.5 cm.
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: Alyssa Y Li; Karolina Gaebe; Katarzyna J Jerzak; Parneet K Cheema; Arjun Sahgal; Sunit Das Journal: Front Oncol Date: 2022-03-07 Impact factor: 6.244