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Five fraction stereotactic radiotherapy after brain metastasectomy: a single-institution experience and literature review

Abstract

Purpose

The outcomes of five fraction stereotactic radiotherapy (hfSRT) following brain metastasectomy were evaluated and compared with published series.

Methods

30 Gy in 5 fractions HfSRT prescribed to the surgical cavity was reduced to 25 Gy if the volume of ‘brain−GTV’ receiving 20 Gy exceeded 20 cm3. Endpoints were local recurrence, nodular leptomeningeal recurrence, new brain metastases and radionecrosis. The literature was searched for reports of clinical and dosimetric outcomes following postoperative hfSRT in 3–5 fractions.

Results

39 patients with 40 surgical cavities were analyzed. Cavity local control rate at 1 year was 33/40 (82.5%). 3 local failures followed 30 Gy/5 fractions and 4 with 25 Gy/5 fractions. The incidence of leptomeningeal disease (LMD) was 7/40 (17.5%). No grade 3–4 toxicities, particularly no radionecrosis, were reported. The incidence of distant brain metastases was 15/40 (37.5%). The median overall survival was 15 months. Across 13 published series, the weighted mean local control was 83.1% (adjusted for sample size), the mean incidence of LMD was 14.9% (7–34%) and the mean rate of radionecrosis was 10.3% (0–20.6%).

Conclusion

Postoperative hfSRT can be delivered with 25–30 Gy in 5 fractions with efficacy in excess of 82% and no significant toxicity when the dose to ‘brain−GTV’ does not exceed 20 cm3.

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Data availability

The raw data will be made available upon reasonable request.

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SR, AS, BE, SG, NL, SA, MB, TL, LS and OR. The first draft of the manuscript was written by SR and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to S. Rogers.

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There are no conflicts of interest or competing interests. SR has received Speakers’ Honoraria from Brainlab.

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EKNZ 2091-01705.

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Rogers, S., Stauffer, A., Lomax, N. et al. Five fraction stereotactic radiotherapy after brain metastasectomy: a single-institution experience and literature review. J Neurooncol 155, 35–43 (2021). https://doi.org/10.1007/s11060-021-03840-5

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Keywords

  • Brain metastases
  • Postoperative
  • Resection
  • Stereotactic
  • Radiotherapy
  • Radiosurgery