Postoperative stereotactic radiosurgery for patients with resected brain metastases

a volumetric analysis

Rajal A. Patel, Derrick Lock, Irene B. Helenowski, James P Chandler, Matthew Christopher Tate, Orin Bloch, Sean Sachdev, Timothy Joseph Kruser*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Purpose: Postoperative stereotactic radiosurgery (SRS) is increasingly utilized following resection of brain metastases (BM); however, there are no volumetric data guiding dose selection. We performed a volumetric analysis to guide cavity SRS dosing for resected BM. Methods: 83 consecutive patients with gross total resection who underwent postoperative SRS to 90 cavities were identified. The 12 Gy isodose lines (V12total) along with the volume of brain parenchyma receiving 12 Gy excluding cavity fluid, ventricular fluid, and calvarium (V12parenchyma) were contoured. Local recurrence (LR) and radionecrosis (RN) were calculated using cumulative incidence rates. Multivariate analysis (MVA) and cutpoint analysis were conducted. Results: Median follow-up was 12.3 months; median dose was 16 Gy. 1- and 2-year cumulative incidence rates of LR were 7.9% and 11.0%. Radiation dose [hazard ratio (HR) 2.04, p = 0.002] was significantly associated with time to LR on MVA. 1- and 2-year cumulative incidence rates of RN were 2.6% and 5.5% respectively. MVA demonstrated increased risk of RN with a larger V12parenchyma (HR 1.46, p = 0.0496). Cavities ≤ 10 cc showed a low 2-year RN risk (4.3%), but had a modest LR risk (13.9%). A radiation dose ≥ 18 Gy significantly improved LC (HR 4.79, p = 0.01). Conclusions: V12parenchyma should be examined in postoperative SRS to assess RN risk. Cavities > 10 cc treated with 16 Gy achieved excellent LC and minimal RN at 2 years. Cavities ≤ 10 cc may be better treated with a dose ≥ 18 Gy to significantly improve LC given the low RN rate observed with 16 Gy.

Original languageEnglish (US)
Pages (from-to)395-401
Number of pages7
JournalJournal of Neuro-Oncology
Volume140
Issue number2
DOIs
StatePublished - Nov 15 2018

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Radiosurgery
Neoplasm Metastasis
Recurrence
Multivariate Analysis
Brain
Incidence
Radiation
Skull

Keywords

  • Brain metastases
  • Cavity
  • Postoperative
  • Radionecrosis
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

Cite this

@article{93c272a184564ad4bf8dfd224601077b,
title = "Postoperative stereotactic radiosurgery for patients with resected brain metastases: a volumetric analysis",
abstract = "Purpose: Postoperative stereotactic radiosurgery (SRS) is increasingly utilized following resection of brain metastases (BM); however, there are no volumetric data guiding dose selection. We performed a volumetric analysis to guide cavity SRS dosing for resected BM. Methods: 83 consecutive patients with gross total resection who underwent postoperative SRS to 90 cavities were identified. The 12 Gy isodose lines (V12total) along with the volume of brain parenchyma receiving 12 Gy excluding cavity fluid, ventricular fluid, and calvarium (V12parenchyma) were contoured. Local recurrence (LR) and radionecrosis (RN) were calculated using cumulative incidence rates. Multivariate analysis (MVA) and cutpoint analysis were conducted. Results: Median follow-up was 12.3 months; median dose was 16 Gy. 1- and 2-year cumulative incidence rates of LR were 7.9{\%} and 11.0{\%}. Radiation dose [hazard ratio (HR) 2.04, p = 0.002] was significantly associated with time to LR on MVA. 1- and 2-year cumulative incidence rates of RN were 2.6{\%} and 5.5{\%} respectively. MVA demonstrated increased risk of RN with a larger V12parenchyma (HR 1.46, p = 0.0496). Cavities ≤ 10 cc showed a low 2-year RN risk (4.3{\%}), but had a modest LR risk (13.9{\%}). A radiation dose ≥ 18 Gy significantly improved LC (HR 4.79, p = 0.01). Conclusions: V12parenchyma should be examined in postoperative SRS to assess RN risk. Cavities > 10 cc treated with 16 Gy achieved excellent LC and minimal RN at 2 years. Cavities ≤ 10 cc may be better treated with a dose ≥ 18 Gy to significantly improve LC given the low RN rate observed with 16 Gy.",
keywords = "Brain metastases, Cavity, Postoperative, Radionecrosis, Stereotactic radiosurgery",
author = "Patel, {Rajal A.} and Derrick Lock and Helenowski, {Irene B.} and Chandler, {James P} and Tate, {Matthew Christopher} and Orin Bloch and Sean Sachdev and Kruser, {Timothy Joseph}",
year = "2018",
month = "11",
day = "15",
doi = "10.1007/s11060-018-2965-7",
language = "English (US)",
volume = "140",
pages = "395--401",
journal = "Journal of Neuro-Oncology",
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publisher = "Kluwer Academic Publishers",
number = "2",

}

Postoperative stereotactic radiosurgery for patients with resected brain metastases : a volumetric analysis. / Patel, Rajal A.; Lock, Derrick; Helenowski, Irene B.; Chandler, James P; Tate, Matthew Christopher; Bloch, Orin; Sachdev, Sean; Kruser, Timothy Joseph.

In: Journal of Neuro-Oncology, Vol. 140, No. 2, 15.11.2018, p. 395-401.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Postoperative stereotactic radiosurgery for patients with resected brain metastases

T2 - a volumetric analysis

AU - Patel, Rajal A.

AU - Lock, Derrick

AU - Helenowski, Irene B.

AU - Chandler, James P

AU - Tate, Matthew Christopher

AU - Bloch, Orin

AU - Sachdev, Sean

AU - Kruser, Timothy Joseph

PY - 2018/11/15

Y1 - 2018/11/15

N2 - Purpose: Postoperative stereotactic radiosurgery (SRS) is increasingly utilized following resection of brain metastases (BM); however, there are no volumetric data guiding dose selection. We performed a volumetric analysis to guide cavity SRS dosing for resected BM. Methods: 83 consecutive patients with gross total resection who underwent postoperative SRS to 90 cavities were identified. The 12 Gy isodose lines (V12total) along with the volume of brain parenchyma receiving 12 Gy excluding cavity fluid, ventricular fluid, and calvarium (V12parenchyma) were contoured. Local recurrence (LR) and radionecrosis (RN) were calculated using cumulative incidence rates. Multivariate analysis (MVA) and cutpoint analysis were conducted. Results: Median follow-up was 12.3 months; median dose was 16 Gy. 1- and 2-year cumulative incidence rates of LR were 7.9% and 11.0%. Radiation dose [hazard ratio (HR) 2.04, p = 0.002] was significantly associated with time to LR on MVA. 1- and 2-year cumulative incidence rates of RN were 2.6% and 5.5% respectively. MVA demonstrated increased risk of RN with a larger V12parenchyma (HR 1.46, p = 0.0496). Cavities ≤ 10 cc showed a low 2-year RN risk (4.3%), but had a modest LR risk (13.9%). A radiation dose ≥ 18 Gy significantly improved LC (HR 4.79, p = 0.01). Conclusions: V12parenchyma should be examined in postoperative SRS to assess RN risk. Cavities > 10 cc treated with 16 Gy achieved excellent LC and minimal RN at 2 years. Cavities ≤ 10 cc may be better treated with a dose ≥ 18 Gy to significantly improve LC given the low RN rate observed with 16 Gy.

AB - Purpose: Postoperative stereotactic radiosurgery (SRS) is increasingly utilized following resection of brain metastases (BM); however, there are no volumetric data guiding dose selection. We performed a volumetric analysis to guide cavity SRS dosing for resected BM. Methods: 83 consecutive patients with gross total resection who underwent postoperative SRS to 90 cavities were identified. The 12 Gy isodose lines (V12total) along with the volume of brain parenchyma receiving 12 Gy excluding cavity fluid, ventricular fluid, and calvarium (V12parenchyma) were contoured. Local recurrence (LR) and radionecrosis (RN) were calculated using cumulative incidence rates. Multivariate analysis (MVA) and cutpoint analysis were conducted. Results: Median follow-up was 12.3 months; median dose was 16 Gy. 1- and 2-year cumulative incidence rates of LR were 7.9% and 11.0%. Radiation dose [hazard ratio (HR) 2.04, p = 0.002] was significantly associated with time to LR on MVA. 1- and 2-year cumulative incidence rates of RN were 2.6% and 5.5% respectively. MVA demonstrated increased risk of RN with a larger V12parenchyma (HR 1.46, p = 0.0496). Cavities ≤ 10 cc showed a low 2-year RN risk (4.3%), but had a modest LR risk (13.9%). A radiation dose ≥ 18 Gy significantly improved LC (HR 4.79, p = 0.01). Conclusions: V12parenchyma should be examined in postoperative SRS to assess RN risk. Cavities > 10 cc treated with 16 Gy achieved excellent LC and minimal RN at 2 years. Cavities ≤ 10 cc may be better treated with a dose ≥ 18 Gy to significantly improve LC given the low RN rate observed with 16 Gy.

KW - Brain metastases

KW - Cavity

KW - Postoperative

KW - Radionecrosis

KW - Stereotactic radiosurgery

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U2 - 10.1007/s11060-018-2965-7

DO - 10.1007/s11060-018-2965-7

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JO - Journal of Neuro-Oncology

JF - Journal of Neuro-Oncology

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