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Impact of adjuvant fractionated stereotactic radiotherapy dose on local control of brain metastases

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Abstract

Purpose

The aim of this study was to determine whether a higher biological effective dose (BED) would result in improved local control in patients treated with fractionated stereotactic radiotherapy (FSRT) for their resected brain metastases.

Methods

Patients with newly diagnosed brain metastases without previous brain radiotherapy were retrospectively reviewed. Patients underwent surgical resection of at least one brain metastasis and were treated with adjuvant FSRT, delivering 25–36 Gy in 5–6 fractions. Outcomes were computed using Kaplan–Meier survival analysis and univariate analysis.

Results

Fifty-four patients with 63 post-operative cavities were included. Median follow-up was 16 months (3–60). Median metastasis size at diagnosis was 2.9 cm (0.6–8.1) and median planning target volume was 19.7 cm3 (6.3–68.1). Two-year local control (LC) was 83%. When stratified by dose, 2 years LC rate was 95.1% in those treated with 30–36 Gy in 5–6 fractions (BED10 of 48–57.6 Gy10) versus 59.1% lesions treated with 25 Gy in 5 fractions (BED10 of 37.5 Gy10) (p < 0.001). LC was not associated with resection cavity size. One year overall survival was 68.7%, and was independent of BED10. Symptomatic radiation necrosis occurred in 7.9% of patients and was not associated with dose.

Conclusion

In the post-operative setting, high-dose FSRT (BED10 > 37.5 Gy10) were associated with a significantly higher rate of LC compared to lower BED regimens. Overall, 25 Gy in 5 fractions is not an adequate dose to control microscopic disease. If selecting a 5-fraction regimen, 30 Gy in five fractions appears to provide excellent tumor bed control.

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Author notes

  1. Hima B. Musunuru and Jacob S. Witt are co-primary authors.

Authors and Affiliations

  1. Department of Human Oncology, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA

    Hima B. Musunuru, Jacob S. Witt, Poonam Yadav, David M. Francis, Aleksandra Kuczmarska-Haas, Zacariah E. Labby, Michael F. Bassetti, Steven P. Howard & Andrew M. Baschnagel

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  1. Hima B. Musunuru
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  2. Jacob S. Witt
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Correspondence to Andrew M. Baschnagel.

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Musunuru, H.B., Witt, J.S., Yadav, P. et al. Impact of adjuvant fractionated stereotactic radiotherapy dose on local control of brain metastases. J Neurooncol 145, 385–390 (2019). https://doi.org/10.1007/s11060-019-03308-7

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  • DOI: https://doi.org/10.1007/s11060-019-03308-7

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