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- Title
Experience of preoperative Gamma Knife radiosurgery for recurrent brain metastases.
- Authors
Verhaak, Eline; van Seeters, Tom; Ardon, Hilko; Lamers, Liselotte; Lie, Suan Te; Al-Khawaja, Hazem; Verheul, Jeroen; Verfaillie, Wouter; Brouwers, Bart; de Boer, Bart; van der Pol, Bram; De jong, Wim; van den Tillaart, Jannie Schasfoort-; Grootenboers, Diana; Hanssens, Patrick
- Abstract
Introduction: Resection of brain metastases (BM) without additional radiation therapy yields a high local failure rate. Drawbacks of postoperative stereotactic radiosurgery (SRS) include uncertainty in target delineation, potential delay in the administration of SRS and intraoperative risk of tumor spillage. Preoperative SRS might address these potential drawbacks. We present our experience with preoperative Gamma Knife radiosurgery (GKRS) for recurrent BM. Methods: Data of patients with recurrent BM treated with GKRS followed by surgical resection between June 2019 and June 2021 at the Elisabeth-TweeSteden Hospital Tilburg were retrospectively collected. Surgery was performed because of mass effect, a symptomatic lesion or a large tumor volume not eligible for salvage stereotactic radiosurgery. Pre-operative SRS was performed with GKRS followed by surgery within 24 hours. All patients had follow-up appointments with MRI scan as long as clinical meaningful. In case of new intracranial disease new treatment was offered if appropriate. Descriptive analyses were used to give an overview of the patient characteristics. Kaplan-Meier curves were used to analyze overall survival. Results: 25 patients (male 8, female 17; median age 64 years (range 20-79 years)) underwent preoperative GKRS for recurrent brain metastases. Most patients were previously treated with GKRS (68%). Most patients had non-small cell lung cancer (44%), followed by breast (12%), small cell lung cancer (12%) and melanoma (12%). The median total tumor volume of the index lesion was 22.2cc (range 6.4cc - 73.6cc). A dose of 18-22 Gy, was prescribed to the isodoseline (mean 45%; range 40- 53%) covering 99-100% of the target. The median overall survival was 18.5 months (95% CI, 4.9 to 32.1 months). Eight patients (32%) had (multiple) surgical complications, three of these patients died due to these complications. Twelve patients (48%) developed a local recurrence. The median time to local recurrence was 6.9 months (95% CI, 4.7 to 9.1 months). Of the 16 patients with a subtotal resection, 10 patients developed a local recurrence, with 6 recurrences at the place of the macroscopic residual tumor. Two patients (8%) developed leptomeningeal disease at 2.8 months and 3.9 months and two patients (8%) developed new brain metastases (distant failure) at 5.4 months and 23.8 months, respectively. Discussion: Pre-operative radiosurgery was well tolerated in a group of patients with recurrent BM who were eligible for surgery. Larger series are needed to perform multivariate analyses on predictors of local recurrence in order to evaluate for which patients this treatment option is best suited.
- Subjects
STEREOTACTIC radiosurgery; RADIOSURGERY; SMALL cell lung cancer; NON-small-cell lung carcinoma
- Publication
Journal of Radiosurgery & SBRT, 2022, Vol 8, p74
- ISSN
2156-4639
- Publication type
Article