Postoperative cavity stereotactic radiosurgery for brain metastases

Eduardo M. Marchan, Jennifer Peterson, Terence T. Sio, Kaisorn L. Chaichana, Anna C. Harrell, Henry Ruiz-Garcia, Anita Mahajan, Paul D. Brown, Daniel Trifiletti

Research output: Contribution to journalShort survey

3 Citations (Scopus)

Abstract

During the past decade, tumor bed stereotactic radiosurgery (SRS) after surgical resection has been increasingly utilized in the management of brain metastases. SRS has risen as an alternative to adjuvant whole brain radiation therapy (WBRT), which has been shown in several studies to be associated with increased neurotoxicity. Multiple recent articles have shown favorable local control rates compared to those of WBRT. Specifically, improvements in local control can be achieved by adding a 2 mm margin around the resection cavity. Risk factors that have been established as increasing the risk of local recurrence after resection include: subtotal resection, larger treatment volume, lower margin dose, and a long delay between surgery and SRS ( > 3 weeks). Moreover, consensus among experts in the field have established the importance of (a) fusion of the pre-operative magnetic resonance imaging scan to aid in volume delineation (b) contouring the entire surgical tract and (c) expanding the target to include possible microscopic disease that may extend to meningeal or venous sinus territory. These strategies can minimize the risks of symptomatic radiation-induced injury and leptomeningeal dissemination after postoperative SRS. Emerging data has arisen suggesting that multifraction postoperative SRS, or alternatively, preoperative SRS could provide decreased rates of radiation necrosis and leptomeningeal disease. Future prospective randomized clinical trials comparing outcomes between these techniques are necessary in order to improve outcomes in these patients.

Original languageEnglish (US)
Article number342
JournalFrontiers in Oncology
Volume8
Issue numberAUG
DOIs
StatePublished - Aug 31 2018

Fingerprint

Radiosurgery
Neoplasm Metastasis
Brain
Radiotherapy
Radiation Injuries
Necrosis
Randomized Controlled Trials
Magnetic Resonance Imaging
Radiation
Recurrence
Neoplasms

Keywords

  • Metastasis
  • postoperative
  • Radiation
  • Radiosurgery
  • Resection

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Marchan, E. M., Peterson, J., Sio, T. T., Chaichana, K. L., Harrell, A. C., Ruiz-Garcia, H., ... Trifiletti, D. (2018). Postoperative cavity stereotactic radiosurgery for brain metastases. Frontiers in Oncology, 8(AUG), [342]. https://doi.org/10.3389/fonc.2018.00342

Postoperative cavity stereotactic radiosurgery for brain metastases. / Marchan, Eduardo M.; Peterson, Jennifer; Sio, Terence T.; Chaichana, Kaisorn L.; Harrell, Anna C.; Ruiz-Garcia, Henry; Mahajan, Anita; Brown, Paul D.; Trifiletti, Daniel.

In: Frontiers in Oncology, Vol. 8, No. AUG, 342, 31.08.2018.

Research output: Contribution to journalShort survey

Marchan, EM, Peterson, J, Sio, TT, Chaichana, KL, Harrell, AC, Ruiz-Garcia, H, Mahajan, A, Brown, PD & Trifiletti, D 2018, 'Postoperative cavity stereotactic radiosurgery for brain metastases', Frontiers in Oncology, vol. 8, no. AUG, 342. https://doi.org/10.3389/fonc.2018.00342
Marchan EM, Peterson J, Sio TT, Chaichana KL, Harrell AC, Ruiz-Garcia H et al. Postoperative cavity stereotactic radiosurgery for brain metastases. Frontiers in Oncology. 2018 Aug 31;8(AUG). 342. https://doi.org/10.3389/fonc.2018.00342
Marchan, Eduardo M. ; Peterson, Jennifer ; Sio, Terence T. ; Chaichana, Kaisorn L. ; Harrell, Anna C. ; Ruiz-Garcia, Henry ; Mahajan, Anita ; Brown, Paul D. ; Trifiletti, Daniel. / Postoperative cavity stereotactic radiosurgery for brain metastases. In: Frontiers in Oncology. 2018 ; Vol. 8, No. AUG.
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