Current Oncology (Dec 2021)

Salvage Surgical Resection after Linac-Based Stereotactic Radiosurgery for Newly Diagnosed Brain Metastasis

  • Ryosuke Matsuda,
  • Takayuki Morimoto,
  • Tetsuro Tamamoto,
  • Nobuyoshi Inooka,
  • Tomoko Ochi,
  • Toshiteru Miyasaka,
  • Shigeto Hontsu,
  • Kaori Yamaki,
  • Sachiko Miura,
  • Yasuhiro Takeshima,
  • Kentaro Tamura,
  • Shuichi Yamada,
  • Fumihiko Nishimura,
  • Ichiro Nakagawa,
  • Yasushi Motoyama,
  • Young-Soo Park,
  • Masatoshi Hasegawa,
  • Hiroyuki Nakase

DOI
https://doi.org/10.3390/curroncol28060439
Journal volume & issue
Vol. 28, no. 6
pp. 5255 – 5265

Abstract

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Background: This study aimed to assess the clinical outcomes of salvage surgical resection (SSR) after stereotactic radiosurgery and fractionated stereotactic radiotherapy (SRS/fSRT) for newly diagnosed brain metastasis. Methods: Between November 2009 and May 2020, 318 consecutive patients with 1114 brain metastases were treated with SRS/fSRT for newly diagnosed brain metastasis at our hospital. During this study period, 21 of 318 patients (6.6%) and 21 of 1114 brain metastases (1.9%) went on to receive SSR after SRS/fSRT. Three patients underwent multiple surgical resections. Twenty-one consecutive patients underwent twenty-four SSRs. Results: The median time from initial SRS/fSRT to SSR was 14 months (range: 2–96 months). The median follow-up after SSR was 17 months (range: 2–78 months). The range of tumor volume at initial SRS/fSRT was 0.12–21.46 cm3 (median: 1.02 cm3). Histopathological diagnosis after SSR was recurrence in 15 cases, and radiation necrosis (RN) or cyst formation in 6 cases. The time from SRS/fSRT to SSR was shorter in the recurrence than in the RNs and cyst formation, but these differences did not reach statistical significance (p = 0.067). The median survival time from SSR and from initial SRS/fSRT was 17 and 74 months, respectively. The cases with recurrence had a shorter survival time from initial SRS/fSRT than those without recurrence (p = 0.061). Conclusions: The patients treated with SRS/fSRT for brain metastasis need long-term follow-up. SSR is a safe and effective treatment for the recurrence, RN, and cyst formation after SRS/fSRT for brain metastasis.

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