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Journal of Neuro-Oncology

, Volume 95, Issue 1, pp 95–99 | Cite as

Whole-brain radiotherapy and tumor bed radiosurgery following resection of solitary brain metastases

  • David RobergeEmail author
  • Kevin Petrecca
  • Munir El Refae
  • Luis Souhami
Clinical Study - Patient Study

Abstract

A standard approach to solitary brain metastases is resection followed by whole-brain radiation therapy (WBRT). Despite WBRT, the tumor bed remains a common site of failure. We reviewed outcomes following adjuvant WBRT with tumor bed radiosurgery (SRS). We retrospectively identified patients having undergone neurosurgical resection of a single brain metastasis followed by adjuvant WBRT and tumor bed SRS. SRS dose selection was independent of target volume (10 Gy peripheral dose). Outcomes were calculated actuarially. Patients were censured for local control at the time of last imaging. From 2005 to 2008, 27 patients were treated with WBRT and tumor bed SRS. Median age was 58.7 years, median KPS 80%. The primary malignancy was non-small cell lung cancer in 70%. Median follow-up was 9.7 months. Following the combination of surgery, WBRT and SRS the median overall survival was 17.6 months. Actuarial 2-year local control was 94%. The SRS boost was well tolerated with one patient (4%) requiring reoperation for symptomatic radiation necrosis 16 months post treatment. Radiosurgery can be safely added to WBRT as an adjuvant treatment following resection of a single brain metastasis. In our retrospective series, this combination treatment produced a high rate of local control.

Keywords

Brain metastases Radiosurgery Whole-brain radiation therapy 

References

  1. 1.
    Johnson JD, Young B (1996) Demographics of brain metastasis. Neurosurg Clin N Am 7:337–344PubMedGoogle Scholar
  2. 2.
    Posner JB (1992) Management of brain metastases. Rev Neurol (Paris) 148:477–487Google Scholar
  3. 3.
    Mintz AH, Kestle J, Rathbone MP, Gaspar L, Hugenholtz H, Fisher B, Duncan G, Skingley P, Foster G, Levine M (1996) A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis. Cancer 78:1470–1476. doi: 10.1002/(SICI)1097-0142(19961001)78:7<1470::AID-CNCR14>3.0.CO;2-X CrossRefPubMedGoogle Scholar
  4. 4.
    Noordijk EM, Vecht CJ, Haaxma-Reiche H, Padberg GW, Voormolen JH, Hoekstra FH, Tans JT, Lambooij N, Metsaars JA, Wattendorff AR et al (1994) The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys 29:711–717CrossRefPubMedGoogle Scholar
  5. 5.
    Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, Markesbery WR, Macdonald JS, Young B (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494–500CrossRefPubMedGoogle Scholar
  6. 6.
    Nieder C, Astner ST, Grosu AL, Andratschke NH, Molls M (2007) The role of postoperative radiotherapy after resection of a single brain metastasis. Combined analysis of 643 patients. Strahlenther Onkol 183:576–580. doi: 10.1007/s00066-007-1756-4 CrossRefPubMedGoogle Scholar
  7. 7.
    Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, Markesbery WR, Foon KA, Young B (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280:1485–1489. doi: 10.1001/jama.280.17.1485 CrossRefPubMedGoogle Scholar
  8. 8.
    Rades D, Kieckebusch S, Haatanen T, Lohynska R, Dunst J, Schild SE (2008) Surgical resection followed by whole brain radiotherapy versus whole brain radiotherapy alone for single brain metastasis. Int J Radiat Oncol Biol Phys 70:1319–1324. doi: 10.1016/j.ijrobp.2007.08.009 CrossRefPubMedGoogle Scholar
  9. 9.
    Rades D, Pluemer A, Veninga T, Dunst J, Schild SE (2007) A boost in addition to whole-brain radiotherapy improves patient outcome after resection of 1 or 2 brain metastases in recursive partitioning analysis class 1 and 2 patients. Cancer 110:1551–1559. doi: 10.1002/cncr.22960 CrossRefPubMedGoogle Scholar
  10. 10.
    Patchell RA, Posner JB (1985) Neurologic complications of systemic cancer. Neurol Clin 3:729–750PubMedGoogle Scholar
  11. 11.
    Smigal C, Jemal A, Ward E, Cokkinides V, Smith R, Howe HL, Thun M (2006) Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin 56:168–183. doi: 10.3322/canjclin.56.3.168 CrossRefPubMedGoogle Scholar
  12. 12.
    Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ (2006) Cancer statistics, 2006. CA Cancer J Clin 56:106–130. doi: 10.3322/canjclin.56.2.106 CrossRefPubMedGoogle Scholar
  13. 13.
    Muacevic A, Wowra B, Siefert A, Tonn JC, Steiger HJ, Kreth FW (2008) Microsurgery plus whole brain irradiation versus Gamma Knife surgery alone for treatment of single metastases to the brain: a randomized controlled multicentre phase III trial. J Neurooncol 87:299–307. doi: 10.1007/s11060-007-9510-4 CrossRefPubMedGoogle Scholar
  14. 14.
    Vogelbaum MA, Angelov L, Lee SY, Li L, Barnett GH, Suh JH (2006) Local control of brain metastases by stereotactic radiosurgery in relation to dose to the tumor margin. J Neurosurg 104:907–912. doi: 10.3171/jns.2006.104.6.907 CrossRefPubMedGoogle Scholar
  15. 15.
    Soltys SG, Adler JR, Lipani JD, Jackson PS, Choi CY, Puataweepong P, White S, Gibbs IC, Chang SD (2008) Stereotactic radiosurgery of the postoperative resection cavity for brain metastases. Int J Radiat Oncol Biol Phys 70:187–193. doi: 10.1016/j.ijrobp.2007.06.068 CrossRefPubMedGoogle Scholar
  16. 16.
    Mathieu D, Kondziolka D, Flickinger JC, Fortin D, Kenny B, Michaud K, Mongia S, Niranjan A, Lunsford LD (2008) Tumor bed radiosurgery after resection of cerebral metastases. Neurosurgery [Epub ahead of print]Google Scholar
  17. 17.
    Rubin P, Brasacchio R, Katz A (2006) Solitary metastases: illusion versus reality. Semin Radiat Oncol 16:120–130. doi: 10.1016/j.semradonc.2005.12.007 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2009

Authors and Affiliations

  • David Roberge
    • 1
    Email author
  • Kevin Petrecca
    • 2
  • Munir El Refae
    • 3
  • Luis Souhami
    • 1
  1. 1.Department of Radiation OncologyMcGill University Health Centre/Montreal General HospitalMontrealCanada
  2. 2.Department of NeurosurgeryMcGill University Health CentreMontrealCanada
  3. 3.Department of Medicine, Division of Medical OncologyMcGill University Health CentreMontrealCanada

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