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Postoperative Treatment for Brain Metastasis

  • G. Laura Masucci
  • David Roberge
Chapter

Abstract

With the advancement of systemic therapies leading to an increase in survival, and the improvement in imaging’s ability to detect smaller lesions, the incidence of brain metastases is expected to rise. Surgery and radiation remain the main tools in the treatment of brain metastases. In the postoperative setting, the latter can be administered to the whole brain (i.e. WBRT) or in one or few high-dose fractions to the surgical cavity (i.e. radiosurgery). This addition of radiation to the surgical cavity, whether by WBRT or radiosurgery, has been shown to improve local control. However, both adjuvant treatments have been associated with very different side effect profiles. WBRT has been associated with global neurotoxicity, while radiosurgery (SRS) is associated with a risk of local radionecrosis. Decisions regarding adjuvant treatment thus have important consequences.

Keywords

Radiosurgery Brain metastasis Postoperative radiation Cavity radiosurgery 

References

  1. 1.
    Barnholtz-Sloan JS, Sloan AE, Davis FG, et al. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol. 2004;22:2865–72.CrossRefPubMedGoogle Scholar
  2. 2.
    Schouten LJ, Rutten J, Huveneers HA, et al. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer. 2002;94:2698–705.CrossRefPubMedGoogle Scholar
  3. 3.
    Lassman AB, DeAngelis LM. Brain metastases. Neurol Clin. 2003;21:1–23. viiCrossRefPubMedGoogle Scholar
  4. 4.
    Gavrilovic IT, Posner JB. Brain metastases: epidemiology and pathophysiology. J Neurooncol. 2005;75:5–14.CrossRefPubMedGoogle Scholar
  5. 5.
    Patel AJ, Suki D, Hatiboglu MA, et al. Factors influencing the risk of local recurrence after resection of a single brain metastasis. J Neurosurg. 2010;113:181–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Quattrocchi CC, Errante Y, Gaudino C, et al. Spatial brain distribution of intra-axial metastatic lesions in breast and lung cancer patients. J Neurooncol. 2012;110:79–87.CrossRefPubMedGoogle Scholar
  7. 7.
    Delattre JY, Krol G, Thaler HT, et al. Distribution of brain metastases. Arch Neurol. 1988;45:741–4.Google Scholar
  8. 8.
    Patchell RA, Regine W, Dempsey R, et al. Postoperative radiotherapy in the treatment of single metastases to the brain. JAMA. 1998;290:1485–9.Google Scholar
  9. 9.
    Chang EL, Wefel JS, Hess KR, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009;10:1037–44.CrossRefPubMedGoogle Scholar
  10. 10.
    Hwang SW, Abozed MM, Hale A, et al. Adjuvant Gamma Knife radiosurgery following surgical resection of brain metastases: a 9-year retrospective cohort study. J Neurooncol. 2010;98:77–82.CrossRefPubMedGoogle Scholar
  11. 11.
    Brian J, Karlovits Do B, Quigley M, et al. Stereotactic radiosurgery boost to the resection bed for oligometastatic brain disease: challenging the tradition of adjuvant whole-brain radiotherapy. Neurosurg Focus. 2009;27:1–6.Google Scholar
  12. 12.
    Jensen CA, Chan MD, McCoy TP, et al. Cavity-directed radiosurgery as adjuvant therapy after resection of a brain metastasis. J Neurosurg. 2011;114:1585–91.CrossRefPubMedGoogle Scholar
  13. 13.
    Narayana A, Chang J, Yenice K, et al. Hypofractionated stereotactic radiotherapy using intensity-modulated radiotherapy in patients with one or two brain metastases. Stereotact Funct Neurosurg. 2007;85:82–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Soltys SG, Adler JR, Lipani JD, et al. Stereotactic radiosurgery of the postoperative resection cavity for brain metastases. Int J Radiat Oncol Biol Phys. 2008;70:187–93.CrossRefPubMedGoogle Scholar
  15. 15.
    Brown P, Cerhan JH, Anderson SK, et al. N107C/CEC·3 (alliance for clinical trials in oncology/Canadian Cancer Trials Group): phase III trial of post-operative stereotactic radiosurgery (SRS) compared with whole brain radiotherapy (WBRT) for resected metastatic brain disease. Lancet Oncol. 2017;18(8):1049–60Google Scholar
  16. 16.
    Bilgera A, Milanovica D ,Lorenza H, et al. Stereotactic fractionated radiotherapy of the resection cavity in patients with one to three brain metastases. Clin Neurol Neurosurg 2016;142:81–86.Google Scholar
  17. 17.
    Brennan C, Yang TJ, Hilden P, et al. A phase 2 trial of stereotactic radiosurgery boost after surgical resection for brain metastases. Int J Radiat Oncol Biol Phys. 2014;88:130–6.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Choi CY, Chang SD, Gibbs IC, et al. Stereotactic radiosurgery of the postoperative resection cavity for brain metastases: prospective evaluation of target margin on tumor control. Int J Radiat Oncol Biol Phys. 2012;84:336–42.CrossRefPubMedGoogle Scholar
  19. 19.
    Dore M, Martin S, Delpon G, et al. Stereotactic radiotherapy following surgery for brain metastasis: predictive factors for local control and radionecrosis. Cancer Radiother. 2017;21(1):4–9.Google Scholar
  20. 20.
    Hartford AC, Paravati AJ, Spire WJ, et al. Postoperative stereotactic radiosurgery without whole-brain radiation therapy for brain metastases: potential role of preoperative tumor size. Int J Radiat Oncol Biol Phys. 2013;85:650–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Iorio-Morin C, Masson-Cote L, Ezahr Y, et al. Early gamma knife stereotactic radiosurgery to the tumor bed of resected brain metastasis for improved local control. J Neurosurg. 2014;121(Suppl):69–74.PubMedGoogle Scholar
  22. 22.
    Iwai Y, Yamanaka K, Yasui T, et al. Boost radiosurgery for treatment of brain metastases after surgical resections. Surg Neurol. 2008;69:181–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Jagannathan J, Yen C-P, Ray DK, et al. Gamma knife radiosurgery to the surgical cavity following resection of brain metastases. J Neurosurg. 2009;111:431–8.Google Scholar
  24. 24.
    Mathieu D, Kondziolka D, Flickinger JC, et al. Tumor bed radiosurgery after resection of cerebral metastases. Neurosurgery. 2008;62:817–23. discussion 23–4CrossRefPubMedGoogle Scholar
  25. 25.
    OjErholm E, Lee JY, Thawani JP, et al. Stereotactic radiosurgery to the resection bed for intracranial metastases and risk of leptomeningeal carcinomatosis. J Neurosurg. 2014;121:75–83.CrossRefPubMedGoogle Scholar
  26. 26.
    Roshan Prabhu R, Shu H-K, Hadjipanayis C, et al. Current dosing paradigm for stereotactic radiosurgery alone after surgical resection of brain metastases needs to be optimized for improved local control. Int J Radiat Oncol Biol Phys. 2011;83:e61–6.CrossRefGoogle Scholar
  27. 27.
    Rwigema JC, Wegner RE, Mintz AH, et al. Stereotactic radiosurgery to the resection cavity of brain metastases: a retrospective analysis and literature review. Stereotact Funct Neurosurg. 2011;89:329–37.CrossRefPubMedGoogle Scholar
  28. 28.
    Ogiwara H, Kalakota K, Rakhra SS, et al. Intracranial relapse rates and patterns, and survival trends following post-resection cavity radiosurgery for patients with single intracranial metastases. J Neurooncol. 2012;108:141–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Suki D, Abouassi H, Patel AJ, et al. Comparative risk of leptomeningeal disease after resection or stereotactic radiosurgery for solid tumor metastasis to the posterior fossa. J Neurosurg. 2008;108:248–57.Google Scholar
  30. 30.
    Mahajan A, Ahmed S, McAleer MF, et al. Postoperative stereotactic radiosurgery versus observation for completely resected brain metastases: results of a prospective randomized study. Lancet Oncol. 2017;18(8):1049–60Google Scholar
  31. 31.
    Jarvis LA, Simmons NE, Bellerive M, et al. Tumor bed dynamics after surgical resection of brain metastases: implications for postoperative radiosurgery. Int J Radiat Oncol Biol Phys. 2012;84:943–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Suki D, Hatiboglu MA, Patel AJ, et al. Comparative risk of leptomeningeal dissemination of cancer after surgery or stereotactic radiosurgery for a single supratentorial solid tumor metastasis. Neurosurgery. 2009;64:664–74. discussion 74–6CrossRefPubMedGoogle Scholar
  33. 33.
    Johnson MD, Avkshtol V, Baschnagel AM, et al. Surgical resection of brain metastases and the risk of leptomeningeal recurrence in patients treated with stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2016;94:537–43.CrossRefPubMedGoogle Scholar
  34. 34.
    Atalar B, Modlin LA, Choi CY, et al. Risk of leptomeningeal disease in patients treated with stereotactic radiosurgery targeting the postoperative resection cavity for brain metastases. Int J Radiat Oncol Biol Phys. 2013;87:713–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Gaspar L, Scott C, Rotman M, et al. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997;37:745–51.CrossRefPubMedGoogle Scholar
  36. 36.
    Tendulkar R, Liu SW, Barnett G, et al. RPA Classification has prognostic significance for surgically resected single brain metastasis. Int J Radiat Oncol Biol Phys. 2006;66:810–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Meyers CA, Smith JA, Bezjak A, et al. Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial. J Clin Oncol. 2004;22:157–65.CrossRefPubMedGoogle Scholar
  38. 38.
    Patchell RA, Tibbs PA, Regine WF, et al. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA. 1998;280:1485–9.CrossRefPubMedGoogle Scholar
  39. 39.
    McPherson CM, Suki D, Feiz-Erfan I, et al. Adjuvant whole-brain radiation therapy after surgical resection of single brain metastases. Neuro Oncol. 2010;12:711–9.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Kocher M, Soffietti R, Abacioglu U, et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol. 2011;29:134–41.CrossRefPubMedGoogle Scholar
  41. 41.
    Nieder C, Schwerdtfeger K, Steudel WI, et al. Patterns of relapse and late toxicity after resection and whole-brain radiotherapy for solitary brain metastases. Strahlenther Onkol. 1998;174:275–8.Google Scholar
  42. 42.
    Muacevic A, Wowra B, Siefert A, et al. 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. 2008;87:299–307.Google Scholar
  43. 43.
    Broemme J, Abu-Isa J, Kottke R, et al. Adjuvant therapy after resection of brain metastases. Frameless image-guided LINAC-based radiosurgery and stereotactic hypofractionated radiotherapy. Strahlenther Onkol. 2013;189:765–70.CrossRefPubMedGoogle Scholar
  44. 44.
    Do L, Pezner R, Radany E, et al. Resection followed by stereotactic radiosurgery to resection cavity for intracranial metastases. Int J Radiat Oncol Biol Phys. 2009;73:486–91.Google Scholar
  45. 45.
    Kalani MY, Filippidis AS, Kalani MA, et al. Gamma Knife surgery combined with resection for treatment of a single brain metastasis: preliminary results. J Neurosurg. 2010;113(Suppl):90–6.PubMedGoogle Scholar
  46. 46.
    Roberge D, Parney I, Brown PD. Radiosurgery to the postoperative surgical cavity: who needs evidence? Int J Radiat Oncol Biol Phys. 2012;83:486–93.CrossRefPubMedGoogle Scholar
  47. 47.
    Shaw E, Scott C, Souhami L, et al. Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys. 2000;47:291–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Wang C-C, Floyd S, Chang C-C, et al. Cyberknife hypofractionated stereotactic radiosurgery (HSRS) of resection cavity after excision of large cerebral metastasis: efficacy and safety of an 800 cGy 3 3 daily fractions regimen. J Neurooncol. 2012;106:601–10.CrossRefPubMedGoogle Scholar
  49. 49.
    Minniti G, Esposito V, Clarke E, et al. Multidose stereotactic radiosurgery (9 Gy × 3) of the postoperative resection cavity for treatment of large brain metastases. Int J Radiat Oncol Biol Phys. 2013;86:623–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Choi CY, Chang SD, Gibbs IC, et al. What is the optimal treatment of large brain metastases? An argument for a multidisciplinary approach. Int J Radiat Oncol Biol Phys. 2012;84:688–93.CrossRefPubMedGoogle Scholar
  51. 51.
    Al-Omair A, Soliman H, Xu W, et al. Hypofractionated stereotactic radiotherapy in five daily fractions for post-operative surgical cavities in brain metastases patients with and without prior whole brain radiation. Technol Cancer Res Treat. 2013;12:493–9.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Vogel J, Ojerholm E, Hollander A, et al. Intracranial control after Cyberknife radiosurgery to the resection bed for large brain metastases. Radiat Oncol. 2015;10:221.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Connolly EP, Mathew M, Tam M, et al. Involved field radiation therapy after surgical resection of solitary brain metastases—mature results. Neuro-Oncology. 2013;15:589–94.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Kim PK, Ellis T, Stieber VW, et al. Gamma Knife surgery targeting the resection cavity of brain metastasis that has progressed after whole-brain radiotherapy. J Neurosurg. 2006;105(Suppl):75–8.PubMedGoogle Scholar
  55. 55.
    Eaton BR, LaRiviere MJ, Kim S, et al. Hypofractionated radiosurgery has a better safety profile than single fraction radiosurgery for large resected brain metastases. J Neurooncol. 2015;123:103–11.CrossRefPubMedGoogle Scholar
  56. 56.
    Jeong WJ, Park JH, Lee EJ, et al. Efficacy and safety of fractionated stereotactic radiosurgery for large brain metastases. J Korean Neurosurg Soc. 2015;58:217–24.Google Scholar
  57. 57.
    Luther N, Kondziolka D, Kano H, et al. Predicting tumor control after resection bed radiosurgery of brain metastases. Neurosurgery. 2013;73:1001–6. discussion 6CrossRefPubMedGoogle Scholar
  58. 58.
    Asher AL, Burri SH, Wiggins WF, et al. A new treatment paradigm: neoadjuvant radiosurgery before surgical resection of brain metastases with analysis of local tumor recurrence. Int J Radiat Oncol Biol Phys. 2014;88:899–906.CrossRefPubMedGoogle Scholar
  59. 59.
    Patel KR, Burri SH, Asher AL, et al. Comparing preoperative with postoperative stereotactic radiosurgery for resectable brain metastases: a multi-institutional analysis. Neurosurgery. 2016;79:279–85.CrossRefPubMedGoogle Scholar
  60. 60.
    Atalar B, Choi CY, Harsh GR, et al. Cavity volume dynamics after resection of brain metastases and timing of postresection cavity stereotactic radiosurgery. Neurosurgery. 2013;72:180–5. discussion 5CrossRefPubMedGoogle Scholar
  61. 61.
    Kondziolka D, Lunsford LD, Flickinger JC. The application of stereotactic radiosurgery to disorders of the brain. Neurosurgery. 2008;62(Suppl 2):707–19. discussion 19–20CrossRefPubMedGoogle Scholar
  62. 62.
    Strauss I, Corn BW, Krishna V, et al. Patterns of failure after stereotactic radiosurgery of the resection cavity following surgical removal of brain metastases. World Neurosurg. 2015;84:1825–31.CrossRefPubMedGoogle Scholar
  63. 63.
    Berghoff AS, Preusser M. The future of targeted therapies for brain metastases. Future Oncol. 2015;11:2315–27.CrossRefPubMedGoogle Scholar
  64. 64.
    Ewend MG, Brem S, Gilbert M, et al. Treatment of single brain metastasis with resection, intracavity carmustine polymer wafers, and radiation therapy is safe and provides excellent local control. Clin Cancer Res. 2007;13:3637–41.CrossRefPubMedGoogle Scholar
  65. 65.
    Dagnew E, Kanski J, McDermott MW, et al. Management of newly diagnosed single brain metastasis using resection and permanent iodine-125 seeds without initial whole-brain radiotherapy: a two institution experience. Neurosurg Focus. 2007;22:E3.CrossRefPubMedGoogle Scholar
  66. 66.
    Rogers LR, Rock JP, Sills AK, et al. Results of a phase II trial of the GliaSite radiation therapy system for the treatment of newly diagnosed, resected single brain metastases. J Neurosurg. 2006;105:375–84.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiation OncologyCentre Hospitalier de l’Universite de Montreal (CHUM)MontrealCanada

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