Skip to main content

Hypofractionated stereotactic radiotherapy (hfSRT) after tumour resection of a single brain metastasis: report of a single-centre individualized treatment approach

Journal of Cancer Research and Clinical Oncology volume 138, pages 1523–1529 (2012)Cite this article

Abstract

Purpose

Standard treatment of single brain metastases so far is tumour resection in combination with postoperative whole-brain radiotherapy or stereotactic radiosurgery. Here, we report retrospectively our first experience with postoperative hypofractionated stereotactic radiotherapy (hfSRT) to the resection cavity in order to replace upfront WBRT with respect to treatment efficacy and safety.

Methods

Between March 2006 and October 2011, 33 patients with a single newly diagnosed intracranial metastasis were treated with hfSRT following microsurgical resection. Fractionation concepts were 10 × 4 Gy (n = 22), 7 × 5 Gy (n = 7) and 5 × 6 Gy (n = 4). Planning target volume enclosed the tumour resection cavity with a safety margin of 4 mm.

Results

No patient demonstrated toxicity grade 2 or higher. Actuarial median overall survival summed up to 20.2 months, and 12-month survival was 64 %. Actuarial mean local brain control was 30.6 months, median distant brain control 12.4 months and intracranial control 8.8 months, respectively. Actuarial 1-year rates of local, distant brain and intracranial control were 71, 57 and 43 %. Salvage whole-brain radiotherapy due to recurrent brain metastases was performed in 13 patients (39 %).

Conclusion

Postoperative hfSRT appears to be a feasible treatment option in patients with a single newly diagnosed brain metastasis. Replacing the standard postoperative whole-brain radiotherapy necessitates compliant patients and regular MRI follow-up analysis.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  • Aoki M, Abe Y, Hatayama Y, Kondo H, Basaki K (2006) Clinical outcome of hypofractionated conventional conformation radiotherapy for patients with single and no more than three metastatic brain tumors, with noninvasive fixation of the skull without whole brain irradiation. Int J Radiat Oncol Biol Phys 64(2):414–418. doi:10.1016/j.ijrobp.2005.03.017

    PubMed  Article  Google Scholar 

  • Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, Kenjyo M, Oya N, Hirota S, Shioura H, Kunieda E, Inomata T et al (2006) Stereotactic radiosurgery plus whole-brain radiation therapy versus stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 295:2483–2491. doi:10.1001/jama.295.21.2483

    PubMed  Article  CAS  Google Scholar 

  • Borgelt B, Gelber R, Kramer S, Brady LW, Chang CH, Davis LW, Perez CA, Hendrickson FR (1980) The palliation of brain metastases: final results of the first two studies by the radiation therapy oncology group. Int J Radiat Oncol Biol Phys 6:1–9

    PubMed  Article  CAS  Google Scholar 

  • Bradley KA, Mehta MP (2004) Management of brain metastases. Semin Oncol 31(5):693–701

    PubMed  Article  Google Scholar 

  • Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, Arbuckle RB, Swint JM, Shiu AS, Maor MH, Meyers CA (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10(11):1037–1044. doi:10.1016/S1470-2045(09)70263-3

    PubMed  Article  Google Scholar 

  • DeAngelis LM, Delattre JY, Posner JB (1989) Radiation-induced dementia in patients cured of brain metastases. Neurology 39:789–796

    PubMed  Article  CAS  Google Scholar 

  • Do L, Pezner R, Radany E, Liu A, Staud C, Badie B (2009) Resection followed by stereotactic radiosurgery to resection cavity for intracranial metastases. Int J Radiat Oncol Biol Phys 73:486–491. doi:10.1016/j.ijrobp.2008.04.070

    PubMed  Article  Google Scholar 

  • Ernst-Stecken A, Ganslandt O, Lambrecht U, Sauer R, Grabenbauer G (2006) Phase II trial of hypofractionated stereotactic radiotherapy for brain metastases: results and toxicity. Radiother Oncol 81:18–24. doi:10.1016/j.radonc.2006.08.024

    PubMed  Article  Google Scholar 

  • Hall EJBD (1993) The radiobiology of radiosurgery: rationale for different treatment regimes for AVMs and malignancies. Int J Radiat Oncol Biol Phys 25:381–385

    PubMed  Article  CAS  Google Scholar 

  • Jagannathan J, Yen CP, Ray DK, Schlesinger D, Oskouian RJ, Pouratian N, Shaffrey ME, Larner J, Sheehan JP (2009) Gamma knife radiosurgery to the surgical cavity following resection of brain metastases. J Neurosurg 111(3):431–438. doi:10.3171/2008.11.JNS08818

    PubMed  Article  Google Scholar 

  • Jenkinson MD, Haylock B, Shenoy A, Husband D, Javadpour M (2011) Management of cerebral metastasis: evidence-based approach for surgery, stereotactic radiosurgery and radiotherapy. Eur J Cancer 47:649–655. doi:10.1016/j.ejca.2010.11.033

    PubMed  Article  Google Scholar 

  • Karlovits BJ, Quigley MR, Karlovits SM, Miller L, Johnson M, Gayou O, Fuhrer R (2009) Stereotactic radiosurgery boost to the resection bed for oligometastatic brain disease: challenging the tradition of adjuvant whole-brain radiotherapy. Neurosurg Focus 27(6):E7. doi:10.3171/2009.9.FOCUS09191

    PubMed  Article  Google Scholar 

  • Kocher M, Soffietti R, Abacioglu U, Villà S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Ben Hassel M, Kouri M, Valeinis E, van den Berge D, Collette S, Collette L, Mueller RP (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of 1–3 cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 29:134–141. doi:10.1200/JCO.2010.30.1655

    PubMed  Article  Google Scholar 

  • Lindvall P, Bergström P, Löfroth PO, Henriksson R, Bergenheim AT (2005) Hypofractionated conformal stereotactic radiotherapy alone or in combination with whole-brain radiotherapy in patients with cerebral metastases. Int J Radiat Oncol Biol Phys 61:1460–1466. doi:10.1016/j.ijrobp.2004.08.027

    PubMed  Article  Google Scholar 

  • Mehta M (2011) The dandelion effect: treat the whole lawn or weed selectively? J Clin Oncol 29:121–124. doi:10.1200/JCO.2010.33.3294

    PubMed  Article  Google Scholar 

  • Mori Y, Kondziolka D, Flickinger JC, Kirkwood JM, Agarwala S, Lunsford LD (1998) Stereotactic radiosurgery for cerebral metastatic melanoma: factors affecting local disease control and survival. Int J Radiat Oncol Biol Phys 42:581–589

    PubMed  Article  CAS  Google Scholar 

  • Patchell RA (2003) The management of brain metastases. Cancer Treat Rev 29(6):533–540

    PubMed  Article  Google Scholar 

  • Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ et al (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280(17):1485–1489

    PubMed  Article  CAS  Google Scholar 

  • Rades D, Hornung D, Veninga T, Schild SE, Gliemroth J (2011) Single brain metastasis: radiosurgery alone compared with radiosurgery plus up-front whole-brain radiotherapy. Cancer. doi:10.1002/cncr.26612

    Google Scholar 

  • Rades D, Kueter JD, Gliemroth J, Veninga T, Pluemer A, Schild SE (2012) Resection plus whole-brain irradiation versus resection plus whole-brain irradiation plus boost for the treatment of single brain metastasis. Strahlenther Onkol 188:143–147. doi:10.1007/s00066-011-0024-9

    PubMed  Article  CAS  Google Scholar 

  • Shiau CY, Sneed PK, Shu HK, Lamborn KR, McDermott MW, Chang S, Nowak P, Petti PL, Smith V, Verhey LJ, Ho M, Park E, Wara WM, Gutin PH, Larson DA (1997) Radiosurgery for brain metastases: relationship of dose and pattern of enhancement to local control. Int J Radiat Oncol Biol Phys 37:375–383

    PubMed  Article  CAS  Google Scholar 

  • Steinmann D, Schäfer C, van Oorschot B, Wypior HJ, Bruns F, Bölling T, Sehlen S, Hagg J, Bayerl A, Geinitz H, Hipp M, Vordermark D (2009) Effects of radiotherapy for brain metastases on quality of life (QoL). Prospective pilot study of the DEGRO QoL working party. Strahlenther Onkol 185:190–197. doi:10.1007/s00066-009-1904-0

    PubMed  Article  Google Scholar 

  • Vecht CJ, Haaxma-Reiche H, Noordijk EM, Padberg GW, Voormolen JH, Hoekstra FH, Tans JT, Lambooij N, Metsaars JA, Wattendorff AR et al (1993) Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 33:583–590

    PubMed  Article  CAS  Google Scholar 

  • Voges J, Treuer H, Sturm V, Büchner C, Lehrke R, Kocher M, Staar S, Kuchta J, Müller RP (1996) Risk analysis of linear accelerator radiosurgery. Int J Radiat Oncol Biol Phys 36:1055–1063

    PubMed  Article  CAS  Google Scholar 

  • Welzel G, Fleckenstein K, Schaefer J, Hermann B, Kraus-Tiefenbacher U, Mai SK, Wenz F (2008) Memory function before and after whole brain radiotherapy in patients with and without brain metastases. Int J Radiat Oncol Biol Phys 72:1311–1318. doi:10.1016/j.ijrobp.2008.03.009

    PubMed  Article  Google Scholar 

  • Yuan J, Wang JZ, Lo S, Grecula JC, Ammirati M, Montebello JF et al (2008) Hypofractionation regimens for stereotactic radiotherapy for large brain tumors. Int J Radiat Oncol Biol Phys 72(2):390–397. doi:10.1016/j.ijrobp.2007.12.039

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

We declare that we have no conflict of interest.

Author information

Affiliations

  1. Department of Radiation Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Diana Steinmann, Bettina Maertens, Stefan Janssen, Martin Werner, Jörg Frühauf, Hans Christiansen & Michael Bremer

  2. Department of Neurosurgery, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Makoto Nakamura

Authors
  1. Diana Steinmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bettina Maertens
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefan Janssen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin Werner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jörg Frühauf
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Makoto Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hans Christiansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michael Bremer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Diana Steinmann.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Steinmann, D., Maertens, B., Janssen, S. et al. Hypofractionated stereotactic radiotherapy (hfSRT) after tumour resection of a single brain metastasis: report of a single-centre individualized treatment approach. J Cancer Res Clin Oncol 138, 1523–1529 (2012). https://doi.org/10.1007/s00432-012-1227-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-012-1227-x

Keywords

  • Brain tumours
  • hfSRT
  • SRS
  • Postoperative partial brain radiotherapy