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HFSRT of the resection cavity in patients with brain metastases

HFSRT der Resektionshöhle bei Patienten mit Hirnmetastasen

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Abstract

Purpose

Aim of this single center, retrospective study was to assess the efficacy and safety of linear accelerator-based hypofractionated stereotactic radiotherapy (HFSRT) to the resection cavity of brain metastases after surgical resection. Local control (LC), locoregional control (LRC = new brain metastases outside of the treatment volume), overall survival (OS) as well as acute and late toxicity were evaluated.

Patients and methods

46 patients with large (> 3 cm) or symptomatic brain metastases were treated with HFSRT. Median resection cavity volume was 14.16 cm3 (range 1.44–38.68 cm3) and median planning target volume (PTV) was 26.19 cm3 (range 3.45–63.97 cm3). Patients were treated with 35 Gy in 7 fractions prescribed to the 95–100 % isodose line in a stereotactic treatment setup. LC and LRC were assessed by follow-up magnetic resonance imaging.

Results

The 1-year LC rate was 88 % and LRC was 48 %; 57% of all patients showed cranial progression after HFSRT (4% local, 44% locoregional, 9% local and locoregional). The median follow-up was 19 months; median OS for the whole cohort was 25 months. Tumor histology and recursive partitioning analysis score were significant predictors for OS. HFSRT was tolerated well without any severe acute side effects > grade 2 according to CTCAE criteria.

Conclusion

HFSRT after surgical resection of brain metastases was tolerated well without any severe acute side effects and led to excellent LC and a favorable OS. Since more than half of the patients showed cranial progression after local irradiation of the resection cavity, close patient follow-up is warranted. A prospective evaluation in clinical trials is currently being performed.

Zusammenfassung

Ziel

Ziel dieser monozentrischen, retrospektiven Studie war es, die Effektivität und Sicherheit einer hypofraktionierter stereotaktischer Radiotherapie (HFSRT) nach chirurgischer Resektion von Hirnmetastasen zu untersuchen. Neben der lokalen Kontrolle (LC), der lokoregionären Kontrolle (LRC = neue Hirnmetastasen außerhalb des Behandlungsvolumens) und dem Gesamtüberleben (OS) wurden die akute und späte Toxizität analysiert.

Patienten und Methoden

46 Patienten wurden nach chirurgischer Resektion von großen (> 3 cm) oder symptomatischen Hirnmetastasen mit HFSRT behandelt. Das mediane Volumen der Resektionshöhle betrug 14,16 cm3 (Spanne 1,44–38,68 cm3), das mediane Planungszielvolumen (PTV) 26,19 cm3 (Spanne 3,45–63,97 cm3). Die Therapie erfolgte mit 35 Gy in 7 Fraktionen in einem stereotaktischem Setup. LC und LRC wurden mit Hilfe von Magnetresonanztomographie bewertet.

Ergebnisse

Nach einem Jahr betrug die LC 88% und die LRC 48%; 57% aller Patienten entwickelten eine intrakranielle Tumorprogression nach HFSRT (4% lokal, 44% lokoregionär, 9% lokal und lokoregionär). Das mediane Follow-up betrug 19 Monate; das mediane OS des gesamten Kollektivs lag bei 25 Monaten. Tumorhistologie und rekursiver Partitionierungsanalyse-Score waren signifikante Prädiktoren für das OS. Es traten keine höhergradigen akuten Nebenwirkungen (>Grad 2 gemäß der CTCAE-Kriterien) auf.

Schlussfolgerung

HFSRT nach chirurgischer Resektion von Hirnmetastasen führt zu einer exzellenten LC und positivem OS ohne höhergradige akute Nebenwirkungen. Da mehr als die Hälfte der Patienten einen intracraniellen Progress zeigten ist eine engmaschige Nachsorge zu empfehlen. Prospektive Evaluationen im Rahmen von klinischen Studien werden derzeit durchgeführt.

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Authors and Affiliations

  1. Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany

    Hanno M. Specht, Kerstin A. Kessel, Markus Oechsner &  Stephanie E. Combs

  2. Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, 81675, Munich, Germany

    Bernhard Meyer

  3. Abteilung Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, 81675, Munich, Germany

    Claus Zimmer

  4. Institut für Innovative Radiotherapie, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany

    Kerstin A. Kessel &  Stephanie E. Combs

  5. Deutsches Konsortium für Translationale Krebsforschung, Technische Universität München, 81675, Munich, Germany

    Claus Zimmer &  Stephanie E. Combs

Authors
  1. Hanno M. Specht
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  2. Kerstin A. Kessel
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  3. Markus Oechsner
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  4. Bernhard Meyer
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  5. Claus Zimmer
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  6. Stephanie E. Combs
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Corresponding author

Correspondence to Stephanie E. Combs.

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Conflict of interest

H.M. Specht, K.A. Kessel, M. Oechsner, B. Meyer, C. Zimmer, and S.E. Combs state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Specht, H.M., Kessel, K.A., Oechsner, M. et al. HFSRT of the resection cavity in patients with brain metastases. Strahlenther Onkol 192, 368–376 (2016). https://doi.org/10.1007/s00066-016-0955-2

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  • DOI: https://doi.org/10.1007/s00066-016-0955-2

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