Feasibility and safety of cavity-directed stereotactic radiosurgery for brain metastases at a high-volume medical center

Paul Rava, Jennifer Rosenberg, Daniel Jamorabo, Shirin Sioshansi, Thomas DiPetrillo, David E. Wazer, Jaroslaw Hepel

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective Our objective was to report safety and efficacy of stereotactic radiosurgery (SRS) to the surgical bed following resection of brain metastases. Methods Eighty-seven consecutive patients who underwent cavity-directed SRS to the operative bed for the treatment of brain metastases between 2002 and 2010 were evaluated. SRS required a gadolinium-enhanced, high-resolution, T1-weighted magnetic resonance imaging for tumor targeting and delivered a median dose of 18 Gy (14-22 Gy) prescribed to encompass the entire resection cavity. Whole brain irradiation was reserved for salvage. Patients were followed every 3 months with clinical examination and magnetic resonance imaging. Overall survival, local and regional recurrence, and factors affecting these outcomes were evaluated using Kaplan-Meier and log-rank analyses. Results The median imaging follow-up was 7.1 months, with >40% of patients having imaging for ≥1 year. Local control at 1 and 2 years was 82% and 75%, respectively. Cavity recurrence was more common with a tumor diameter >3 cm (P <.020) or resection cavity volume >14 mL (P < .050). One-year local control for tumors <2 cm, 2 cm to 3 cm, and >3 cm were 100%, 86%, and 72%, respectively. Neither subtotal resection nor target margins >2 mm to 3 mm affected local control. The median overall survival was 14.3 months with actuarial 5-year survival of 20%. Actuarial regional central nervous system recurrence was 44% at 1 year. On univariate analysis, only the presence of extracranial disease was associated with survival (P <.001) and central nervous system failure (P <.030). Conclusions Excellent local control is achievable with cavity-directed SRS in well-selected patients, particularly for lesions with diameter <3 cm and resection cavity volumes <14 mL. Long-term survival is possible for select patients.

Original languageEnglish (US)
Pages (from-to)141-147
Number of pages7
JournalAdvances in Radiation Oncology
Volume1
Issue number3
DOIs
StatePublished - Jul 1 2016

Fingerprint

Radiosurgery
Neoplasm Metastasis
Safety
Survival
Brain
Recurrence
Central Nervous System
Magnetic Resonance Imaging
Gadolinium
Neoplasms

All Science Journal Classification (ASJC) codes

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Rava, Paul ; Rosenberg, Jennifer ; Jamorabo, Daniel ; Sioshansi, Shirin ; DiPetrillo, Thomas ; Wazer, David E. ; Hepel, Jaroslaw. / Feasibility and safety of cavity-directed stereotactic radiosurgery for brain metastases at a high-volume medical center. In: Advances in Radiation Oncology. 2016 ; Vol. 1, No. 3. pp. 141-147.
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title = "Feasibility and safety of cavity-directed stereotactic radiosurgery for brain metastases at a high-volume medical center",
abstract = "Objective Our objective was to report safety and efficacy of stereotactic radiosurgery (SRS) to the surgical bed following resection of brain metastases. Methods Eighty-seven consecutive patients who underwent cavity-directed SRS to the operative bed for the treatment of brain metastases between 2002 and 2010 were evaluated. SRS required a gadolinium-enhanced, high-resolution, T1-weighted magnetic resonance imaging for tumor targeting and delivered a median dose of 18 Gy (14-22 Gy) prescribed to encompass the entire resection cavity. Whole brain irradiation was reserved for salvage. Patients were followed every 3 months with clinical examination and magnetic resonance imaging. Overall survival, local and regional recurrence, and factors affecting these outcomes were evaluated using Kaplan-Meier and log-rank analyses. Results The median imaging follow-up was 7.1 months, with >40{\%} of patients having imaging for ≥1 year. Local control at 1 and 2 years was 82{\%} and 75{\%}, respectively. Cavity recurrence was more common with a tumor diameter >3 cm (P <.020) or resection cavity volume >14 mL (P < .050). One-year local control for tumors <2 cm, 2 cm to 3 cm, and >3 cm were 100{\%}, 86{\%}, and 72{\%}, respectively. Neither subtotal resection nor target margins >2 mm to 3 mm affected local control. The median overall survival was 14.3 months with actuarial 5-year survival of 20{\%}. Actuarial regional central nervous system recurrence was 44{\%} at 1 year. On univariate analysis, only the presence of extracranial disease was associated with survival (P <.001) and central nervous system failure (P <.030). Conclusions Excellent local control is achievable with cavity-directed SRS in well-selected patients, particularly for lesions with diameter <3 cm and resection cavity volumes <14 mL. Long-term survival is possible for select patients.",
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Feasibility and safety of cavity-directed stereotactic radiosurgery for brain metastases at a high-volume medical center. / Rava, Paul; Rosenberg, Jennifer; Jamorabo, Daniel; Sioshansi, Shirin; DiPetrillo, Thomas; Wazer, David E.; Hepel, Jaroslaw.

In: Advances in Radiation Oncology, Vol. 1, No. 3, 01.07.2016, p. 141-147.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Feasibility and safety of cavity-directed stereotactic radiosurgery for brain metastases at a high-volume medical center

AU - Rava, Paul

AU - Rosenberg, Jennifer

AU - Jamorabo, Daniel

AU - Sioshansi, Shirin

AU - DiPetrillo, Thomas

AU - Wazer, David E.

AU - Hepel, Jaroslaw

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N2 - Objective Our objective was to report safety and efficacy of stereotactic radiosurgery (SRS) to the surgical bed following resection of brain metastases. Methods Eighty-seven consecutive patients who underwent cavity-directed SRS to the operative bed for the treatment of brain metastases between 2002 and 2010 were evaluated. SRS required a gadolinium-enhanced, high-resolution, T1-weighted magnetic resonance imaging for tumor targeting and delivered a median dose of 18 Gy (14-22 Gy) prescribed to encompass the entire resection cavity. Whole brain irradiation was reserved for salvage. Patients were followed every 3 months with clinical examination and magnetic resonance imaging. Overall survival, local and regional recurrence, and factors affecting these outcomes were evaluated using Kaplan-Meier and log-rank analyses. Results The median imaging follow-up was 7.1 months, with >40% of patients having imaging for ≥1 year. Local control at 1 and 2 years was 82% and 75%, respectively. Cavity recurrence was more common with a tumor diameter >3 cm (P <.020) or resection cavity volume >14 mL (P < .050). One-year local control for tumors <2 cm, 2 cm to 3 cm, and >3 cm were 100%, 86%, and 72%, respectively. Neither subtotal resection nor target margins >2 mm to 3 mm affected local control. The median overall survival was 14.3 months with actuarial 5-year survival of 20%. Actuarial regional central nervous system recurrence was 44% at 1 year. On univariate analysis, only the presence of extracranial disease was associated with survival (P <.001) and central nervous system failure (P <.030). Conclusions Excellent local control is achievable with cavity-directed SRS in well-selected patients, particularly for lesions with diameter <3 cm and resection cavity volumes <14 mL. Long-term survival is possible for select patients.

AB - Objective Our objective was to report safety and efficacy of stereotactic radiosurgery (SRS) to the surgical bed following resection of brain metastases. Methods Eighty-seven consecutive patients who underwent cavity-directed SRS to the operative bed for the treatment of brain metastases between 2002 and 2010 were evaluated. SRS required a gadolinium-enhanced, high-resolution, T1-weighted magnetic resonance imaging for tumor targeting and delivered a median dose of 18 Gy (14-22 Gy) prescribed to encompass the entire resection cavity. Whole brain irradiation was reserved for salvage. Patients were followed every 3 months with clinical examination and magnetic resonance imaging. Overall survival, local and regional recurrence, and factors affecting these outcomes were evaluated using Kaplan-Meier and log-rank analyses. Results The median imaging follow-up was 7.1 months, with >40% of patients having imaging for ≥1 year. Local control at 1 and 2 years was 82% and 75%, respectively. Cavity recurrence was more common with a tumor diameter >3 cm (P <.020) or resection cavity volume >14 mL (P < .050). One-year local control for tumors <2 cm, 2 cm to 3 cm, and >3 cm were 100%, 86%, and 72%, respectively. Neither subtotal resection nor target margins >2 mm to 3 mm affected local control. The median overall survival was 14.3 months with actuarial 5-year survival of 20%. Actuarial regional central nervous system recurrence was 44% at 1 year. On univariate analysis, only the presence of extracranial disease was associated with survival (P <.001) and central nervous system failure (P <.030). Conclusions Excellent local control is achievable with cavity-directed SRS in well-selected patients, particularly for lesions with diameter <3 cm and resection cavity volumes <14 mL. Long-term survival is possible for select patients.

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