Frontiers in Oncology (Sep 2015)

Resection Followed by Involved-Field Fractionated Radiotherapy in the Management of Single Brain Metastasis

  • Samuel M Shin,
  • Ralph E Vatner,
  • Moses eTam,
  • John G Golfinos,
  • Ashwatha eNarayana,
  • Douglas eKondziolka,
  • Joshua Seth Silverman

DOI
https://doi.org/10.3389/fonc.2015.00206
Journal volume & issue
Vol. 5

Abstract

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Introduction: We expanded upon our previous experience using involved-field fractionated radiotherapy (IFRT) as an alternative to whole brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS) for patients with surgically resected brain metastases.Material and Methods: All patients with single brain metastases who underwent surgical resection followed by IFRT at our institution from 2006-2013 were evaluated. Local recurrence-free survival, distant failure-free survival and overall survival were determined. Analyses were performed associating clinical variables with local recurrence and distant failure. Salvage approaches and toxicity of treatment for each patient were also assessed.Results: Median follow-up was 19.1 months. Fifty-six patients were treated with a median dose of 40.05 Gy/15 fractions with IFRT to the resection cavity. Local recurrence-free survival was 91.4%, distant failure-free survival was 68.4%, and overall survival was 77.7% at 12 months. No variables were associated with increased local recurrence, however melanoma histopathology and infratentorial location were associated with distant failure on multivariate analysis. Local recurrences were salvaged in 5/8 patients, and distant failures were salvaged in 24/29 patients. Two patients developed radionecrosis.Conclusions: Adjuvant IFRT is feasible and safe for well-selected patients with surgically resected single brain metastases. Acceptable rates of local control and salvage of distal intracranial recurrences continue to be achieved with continued follow-up.

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