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J Neurooncol. 2018 Dec;140(3):749-756. doi: 10.1007/s11060-018-03008-8. Epub 2018 Oct 26.

Surgical resection and postoperative radiosurgery versus staged radiosurgery for large brain metastases.

Author information

1
Department of Radiation Oncology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA. adohm@wakehealth.edu.
2
Department of Radiation Oncology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
3
Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC, USA.
4
Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
5
Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
6
Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.

Abstract

PURPOSE:

The purpose of this study was to retrospectively evaluate the new treatment paradigm of staged stereotactic radiosurgery (SRS) for the treatment of large brain metastases (BM) compared to the standard of surgical resection followed by SRS.

METHODS:

We evaluated 78 patients with large BM treated 2012-2017 with surgical resection and postoperative SRS (surgery + SRS) or staged SRS separated by 1 month. Overall survival (OS) was estimated using the Kaplan Meier method and compared across groups using the log-rank test. Cumulative incidence of neurologic death and local and distant brain failure (LF, DBF) were estimated using competing risk methodology.

RESULTS:

Forty patients were treated with surgery + SRS and 38 patients were treated with staged SRS. Median follow-up was 23.2 months (95% CI 20.5-39.3). Median OS was 13.2 months for staged SRS compared to surgery + SRS 9.7 months (p = 0.53). Cumulative incidence of neurologic death at 1 year was 23% after surgery + SRS, 27% after staged SRS (p = 0.69); cumulative incidence of LF at 1 year was 6% and 8% (p = 0.65) and 1-year DBF was 59% and 21% (p ≤ 0.01). Overall rates of leptomeningeal failure and radiation necrosis were similar between the groups (p = 0.63 and p = 1.0).

CONCLUSIONS:

Though surgery and postoperative SRS is the standard, staged SRS represents an attractive treatment paradigm for treating large BM without sacrificing LC or survival, and potentially decreases DBF. Prospective studies are needed to validate these findings.

KEYWORDS:

Distant brain failure; Large brain metastases; Leptomeningeal failure; Local control; Overall survival; Stereotactic radiosurgery; Surgery and postoperative resection

PMID:
30367382
DOI:
10.1007/s11060-018-03008-8
[Indexed for MEDLINE]

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