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Local control and overall survival for adjuvant stereotactic radiosurgery in patients with residual or recurrent disease

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Abstract

Prior studies of post-operative stereotactic radiosurgery (SRS) have not distinguished between Adjuvant SRS (ARS) versus Adjuvant SRS to residual/recurrent disease (ARD). In this study, we defined ARS and ARD and investigated local control (LC), overall survival (OS), distant development of brain metastases (DBF), and leptomeningeal disease (LMD). We retrospectively identified BM patients who received surgical resection and SRS for BM from an IRB approved database between Jan 2009–Aug 2015. Patients were stratified into two groups: ARS and ARD. LC was determined by follow-up MRI studies and OS was measured from the date of surgery. LC and OS were assessed using the Kaplan–Meier method. 70 cavities underwent surgical resection of BM and received SRS to the post-operative bed. 41 cavities were classified as ARS and 29 as ARD. There was no significant difference in 12-month LC between the ARS and ARD group (71.4 vs. 80.8%, respectively; p = 0.135) from the time point of SRS. The overall 1-year survival for ARS and ARD was 79.9 and 86.1%, respectively (p = 0.339). Mean time to progression was 6.45 and 8.0 months and median follow-up was 10 and 15 months for ARS and ARD, respectively. 11.8% of ARS patients and 15.4% of ARD patients developed LMD, p = 0.72. 29.4% of ARS and 48.0% of ARD patients developed DBF, p = 0.145. Our findings suggest that observation after surgical resection, with subsequent treatment with SRS after the development of local failure, may not compromise treatment efficacy. If validated, this would spare patients who do not recur post-surgically from additional treatment.

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Abbreviations

BM:

Brain metastases

WBRT:

Whole brain radiotherapy

SRS:

Stereotactic radiosurgery

GKRS:

Gamma knife radiosurgery

LC:

Local control

LF:

Local failure

OS:

Overall survival

STR:

Subtotal resection

KPS:

Karnofsky performance status

RPA:

Recursive partitioning analysis

FU:

Follow up

DBF:

Distant brain failure

LMD:

Leptomeningeal disease

RT:

Radiotherapy

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Acknowledgements

Dr. Wang reports personal fees and non-financial support from AbbVie, non-financial support from Merck, personal fees from AstraZeneca, personal fees from Doximity, non-financial support from Novocure, personal fees and non-financial support from Elekta and personal fees from Wolthers Kluwer, outside the submitted work.

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Authors and Affiliations

  1. Columbia University College of Physicians and Surgeons, New York, NY, USA

    Tavish Nanda & Andrew Yaeh

  2. Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA

    Tavish Nanda, Cheng-Chia Wu, Ashish Jani, Shumaila Saad, Jeraldine Lesser, Simon K. Cheng, Steven R. Isaacson & Tony J. C. Wang

  3. The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA

    Yasir H. Qureshi

  4. Department of Radiology, Division of Neuroradiology, Columbia University Medical Center, New York, NY, USA

    Keith A. Cauley

  5. Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA

    Steven R. Isaacson, Michael B. Sisti, Jeffrey N. Bruce, Guy M. McKhann, Sameer A. Sheth, Andrew B. Lassman & Tony J. C. Wang

  6. Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA

    Michael B. Sisti, Jeffrey N. Bruce, Guy M. McKhann & Sameer A. Sheth

  7. Department of Neurology, Columbia University Medical Center, New York, NY, USA

    Andrew B. Lassman

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  1. Tavish Nanda
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  2. Andrew Yaeh
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Correspondence to Tavish Nanda.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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As a retrospective chart review retroactive patient consent was not required per Institutional Review Board approval.

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Nanda, T., Yaeh, A., Wu, CC. et al. Local control and overall survival for adjuvant stereotactic radiosurgery in patients with residual or recurrent disease. J Neurooncol 136, 281–287 (2018). https://doi.org/10.1007/s11060-017-2651-1

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  • DOI: https://doi.org/10.1007/s11060-017-2651-1

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