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

We expanded upon our previous experience using involved-field fractionated radiotherapy (IFRT) as an alternative to whole brain radiotherapy or stereotactic radiosurgery for patients with surgically resected brain metastases (BM). All patients with single BM who underwent surgical resection followed...

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Published in:	Frontiers in oncology Vol. 5; p. 206
Main Authors:	Shin, Samuel M, Vatner, Ralph E, Tam, Moses, Golfinos, John G, Narayana, Ashwatha, Kondziolka, Douglas, Silverman, Joshua Seth
Format:	Journal Article
Language:	English
Published:	Switzerland Frontiers Media S.A 22-09-2015
Subjects:	brain metastases Involved-field fractionated radiotherapy Oncology Single brain metastasis Stereotactic radiosurgery surgical resection involved-field fractionated radiotherapy surgical resection brain metastases stereotactic radiosurgery
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Abstract	We expanded upon our previous experience using involved-field fractionated radiotherapy (IFRT) as an alternative to whole brain radiotherapy or stereotactic radiosurgery for patients with surgically resected brain metastases (BM). All patients with single BM who underwent surgical resection followed by IFRT at our institution from 2006 to 2013 were evaluated. Local recurrence (LR)-free survival, distant failure (DF)-free survival, and overall survival (OS) were determined. Analyses were performed associating clinical variables with LR and DF. Salvage approaches and toxicity of treatment for each patient were also assessed. 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. LR-free survival was 91.4%, DF-free survival was 68.4%, and OS was 77.7% at 12 months. No variables were associated with increased LR; however, melanoma histopathology and infratentorial location were associated with DF on multivariate analysis. LRs were salvaged in 5/8 patients, and DFs were salvaged in 24/29 patients. Two patients developed radionecrosis. Adjuvant IFRT is feasible and safe for well-selected patients with surgically resected single BM. Acceptable rates of local control and salvage of distal intracranial recurrences continue to be achieved with continued follow-up.
AbstractList	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. INTRODUCTIONWe expanded upon our previous experience using involved-field fractionated radiotherapy (IFRT) as an alternative to whole brain radiotherapy or stereotactic radiosurgery for patients with surgically resected brain metastases (BM). MATERIALS AND METHODSAll patients with single BM who underwent surgical resection followed by IFRT at our institution from 2006 to 2013 were evaluated. Local recurrence (LR)-free survival, distant failure (DF)-free survival, and overall survival (OS) were determined. Analyses were performed associating clinical variables with LR and DF. Salvage approaches and toxicity of treatment for each patient were also assessed. RESULTSMedian 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. LR-free survival was 91.4%, DF-free survival was 68.4%, and OS was 77.7% at 12 months. No variables were associated with increased LR; however, melanoma histopathology and infratentorial location were associated with DF on multivariate analysis. LRs were salvaged in 5/8 patients, and DFs were salvaged in 24/29 patients. Two patients developed radionecrosis. CONCLUSIONAdjuvant IFRT is feasible and safe for well-selected patients with surgically resected single BM. Acceptable rates of local control and salvage of distal intracranial recurrences continue to be achieved with continued follow-up. We expanded upon our previous experience using involved-field fractionated radiotherapy (IFRT) as an alternative to whole brain radiotherapy or stereotactic radiosurgery for patients with surgically resected brain metastases (BM). All patients with single BM who underwent surgical resection followed by IFRT at our institution from 2006 to 2013 were evaluated. Local recurrence (LR)-free survival, distant failure (DF)-free survival, and overall survival (OS) were determined. Analyses were performed associating clinical variables with LR and DF. Salvage approaches and toxicity of treatment for each patient were also assessed. 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. LR-free survival was 91.4%, DF-free survival was 68.4%, and OS was 77.7% at 12 months. No variables were associated with increased LR; however, melanoma histopathology and infratentorial location were associated with DF on multivariate analysis. LRs were salvaged in 5/8 patients, and DFs were salvaged in 24/29 patients. Two patients developed radionecrosis. Adjuvant IFRT is feasible and safe for well-selected patients with surgically resected single BM. Acceptable rates of local control and salvage of distal intracranial recurrences continue to be achieved with continued follow-up.
Author	Vatner, Ralph E Golfinos, John G Kondziolka, Douglas Shin, Samuel M Narayana, Ashwatha Silverman, Joshua Seth Tam, Moses
AuthorAffiliation	2 Department of Neurosurgery, New York University Langone Medical Center , New York, NY , USA 3 Department of Radiation Oncology, Greenwich Hospital , Greenwich, CT , USA 1 Department of Radiation Oncology, New York University Langone Medical Center , New York, NY , USA
AuthorAffiliation_xml	– name: 2 Department of Neurosurgery, New York University Langone Medical Center , New York, NY , USA – name: 3 Department of Radiation Oncology, Greenwich Hospital , Greenwich, CT , USA – name: 1 Department of Radiation Oncology, New York University Langone Medical Center , New York, NY , USA
Author_xml	– sequence: 1 givenname: Samuel M surname: Shin fullname: Shin, Samuel M organization: Department of Radiation Oncology, New York University Langone Medical Center , New York, NY , USA – sequence: 2 givenname: Ralph E surname: Vatner fullname: Vatner, Ralph E organization: Department of Radiation Oncology, New York University Langone Medical Center , New York, NY , USA – sequence: 3 givenname: Moses surname: Tam fullname: Tam, Moses organization: Department of Radiation Oncology, New York University Langone Medical Center , New York, NY , USA – sequence: 4 givenname: John G surname: Golfinos fullname: Golfinos, John G organization: Department of Neurosurgery, New York University Langone Medical Center , New York, NY , USA – sequence: 5 givenname: Ashwatha surname: Narayana fullname: Narayana, Ashwatha organization: Department of Radiation Oncology, Greenwich Hospital , Greenwich, CT , USA – sequence: 6 givenname: Douglas surname: Kondziolka fullname: Kondziolka, Douglas organization: Department of Neurosurgery, New York University Langone Medical Center , New York, NY , USA – sequence: 7 givenname: Joshua Seth surname: Silverman fullname: Silverman, Joshua Seth organization: Department of Radiation Oncology, New York University Langone Medical Center , New York, NY , USA
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Copyright	Copyright © 2015 Shin, Vatner, Tam, Golfinos, Narayana, Kondziolka and Silverman. 2015 Shin, Vatner, Tam, Golfinos, Narayana, Kondziolka and Silverman
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Keywords	involved-field fractionated radiotherapy surgical resection brain metastases stereotactic radiosurgery
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Snippet	We expanded upon our previous experience using involved-field fractionated radiotherapy (IFRT) as an alternative to whole brain radiotherapy or stereotactic... INTRODUCTIONWe expanded upon our previous experience using involved-field fractionated radiotherapy (IFRT) as an alternative to whole brain radiotherapy or... Introduction: We expanded upon our previous experience using involved-field fractionated radiotherapy (IFRT) as an alternative to whole brain radiotherapy...
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SubjectTerms	brain metastases Involved-field fractionated radiotherapy Oncology Single brain metastasis Stereotactic radiosurgery surgical resection
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Title	Resection Followed by Involved-Field Fractionated Radiotherapy in the Management of Single Brain Metastasis
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