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Tumors of the Central Nervous System, Volume 4 pp 241–247Cite as

Paradigms in Tumor Bed Radiosurgery Following Resection of Brain Metastases

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Part of the book series: Tumors of the Central Nervous System ((TCNS,volume 4))

Abstract

Radiosurgery offers a mean of delivering prophylactic focused radiation to the periphery of a resection cavity where malignant cells may have been left behind at the time of tumor resection. There is now growing such use of adjuvant radiosurgery following resection of hematogenous brain metastases. Fifteen institutional series have reported on a total of 618 patients treated with radiosurgery to a tumor bed following microsurgery. These cases fall into three paradigms: adjuvant radiosurgery as an alternative to whole-brain radiotherapy (WBRT), radiosurgery as an intensification of adjuvant WBRT and adjuvant radiosurgery for patients having failed prior WBRT. For these paradigms the reported crude local control rates are 83, 95 and 95%, respectively. The procedure appears well tolerated with approximately a 5% risk of late radiation necrosis.

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References

  • Alrefae MA, Roberge D, Souhami L (2009) Short-course irradiation as adjuvant treatment of surgically resected single brain metastases. ASCO Meeting Abstracts 27:2067

    Google Scholar 

  • Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, Kenjyo M, Oya N, Hirota S, Shioura H, Kunieda E, Inomata T, Hayakawa K, Katoh N, Kobashi G (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 295:2483–2491

    Article  PubMed  CAS  Google Scholar 

  • Armstrong JG, Wronski M, Galicich J, Arbit E, Leibel SA, Burt M (1994) Postoperative radiation for lung cancer metastatic to the brain. J Clin Oncol 12:2340–2344

    PubMed  CAS  Google Scholar 

  • Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, Arbuckle RB, Swint JM, Shiu AS, Maor MH, Meyers CA (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10:1037–1044

    Article  PubMed  Google Scholar 

  • Coucke PA, Zouhair A, Ozsahin M, De Tribolet N, Mirimanoff RO (1998) Focalized external radiotherapy for resected solitary brain metastasis: does the dogma stand? Radiotherapy and oncology. J Eur Soc Ther Radiol Oncol 47:99–101

    CAS  Google Scholar 

  • Dagnew E, Kanski J, McDermott MW, Sneed PK, McPherson C, Breneman JC, Warnick RE (2007) Management of newly diagnosed single brain metastasis using resection and permanent iodine-125 seeds without initial whole-brain radiotherapy: a two institution experience. Neurosurg Focus 22:E3

    Article  PubMed  Google Scholar 

  • DeAngelis LM, Mandell LR, Thaler HT, Kimmel DW, Galicich JH, Fuks Z, Posner JB (1989) The role of postoperative radiotherapy after resection of single brain metastases. Neurosurgery 24:798–805

    Article  PubMed  CAS  Google Scholar 

  • Dilworth JT, Hurst NJ, Chen PY, Shaitelman SF, Baschnagel A, Ye H, Maitz A, Krauss DJ, Pieper D, Grills IS (2010) Outcomes of patients with resected metastatic brain lesions treated with Gamma Knife or whole brain irradiation. ASTRO 52nd Annual Meet, San Diego

    Google Scholar 

  • Do L, Pezner R, Radany E, Liu A, Staud C, Badie B (2009) Resection followed by stereotactic radiosurgery to resection cavity for intracranial metastases. Int J Radiat Oncol Biol Phys 73:486–491

    Article  PubMed  Google Scholar 

  • Hagen NA, Cirrincione C, Thaler HT, DeAngelis LM (1990) The role of radiation therapy following resection of single brain metastasis from melanoma. Neurology 40:158–160

    PubMed  CAS  Google Scholar 

  • Hartford AC, Paravati A, Spire W, Jarvis L, Erkmen K, Friedman J, Li Z, Hug E, Roberts D, Simmons N (2010) Postoperative stereotactic radiosurgery (srs) without whole-brain radiation therapy (wbrt) for brain metastases: potential role of tumor size. ASTRO 52nd Annual Meet, San Diego

    Google Scholar 

  • Iwai Y, Yamanaka K, Yasui T (2008) Boost radiosurgery for treatment of brain metastases after surgical resections. Surg Neurol 69:181–186; discussion 186

    Article  PubMed  Google Scholar 

  • Jagannathan J, Yen CP, Ray DK, Schlesinger D, Oskouian RJ, Pouratian N, Shaffrey ME, Larner J, Sheehan JP (2009) Gamma Knife radiosurgery to the surgical cavity following resection of brain metastases. J Neurosurg 111:431–438

    Article  PubMed  Google Scholar 

  • Johnson JD, Young B (1996) Demographics of brain metastasis. Neurosurg Clin N Am 7:337–344

    PubMed  CAS  Google Scholar 

  • Karlovits BJ, Quigley MR, Karlovits SM, Miller L, Johnson M, Gayou O, Fuhrer R (2009) Stereotactic radiosurgery boost to the resection bed for oligometastatic brain disease: challenging the tradition of adjuvant whole-brain radiotherapy. Neurosurg Focus 27:E7

    Article  PubMed  Google Scholar 

  • Kim PK, Ellis TL, Stieber VW, McMullen KP, Shaw EG, McCoy TP, D’Agostino RB, Bourland JD, DeGuzman AF, Ekstrand KE, Raber MR, Tatter SB (2006) Gamma Knife surgery targeting the resection cavity of brain metastasis that has progressed after whole-brain radiotherapy. J Neurosurg 105 Suppl:75–78

    PubMed  Google Scholar 

  • Kresl J, Pueschel J, Porter R, Yan E, McDermott M, Sneed P (2003) Surgical resection and postoperative radiosurgery for single brain metastases [Abstract]. Society for Neuro-Oncology Eighth Annual Meeting: 338A

    Google Scholar 

  • Limbrick Jr DD, Lusis EA, Chicoine MR, Rich KM, Dacey RG, Dowling JL, Grubb RL, Filiput EA, Drzymala RE, Mansur DB, Simpson JR (2009) Combined surgical resection and stereotactic radiosurgery for treatment of cerebral metastases. Surg Neurol 71:280–288

    Article  PubMed  Google Scholar 

  • Mathieu D, Kondziolka D, Flickinger JC, Fortin D, Kenny B, Michaud K, Mongia S, Niranjan A, Lunsford LD (2008) Tumor bed radiosurgery after resection of cerebral metastases. Neurosurgery 62:817–824

    Article  PubMed  Google Scholar 

  • Muacevic A, Wowra B, Siefert A, Tonn JC, Steiger HJ, Kreth FW (2008) Microsurgery plus whole brain irradiation versus Gamma Knife surgery alone for treatment of single metastases to the brain: a randomized controlled multicentre phase III trial. J Neurooncol 87:299–307

    Article  PubMed  Google Scholar 

  • Mueller RP, Soffietti R, Abacioglu MU, Villa S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Collette L, Kocher M (2009) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of 1-3 cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 29:134–141

    Google Scholar 

  • Narayana A, Chan K, Brennan C, Chang J, Higgins V, Lymberis S, Yamada J, Gutin PH (2006) A phase II trial of stereotactic radiosurgery boost following surgical resection for solitary brain metastases. J Clin Oncol (Meeting Abstracts) 24:1552

    Google Scholar 

  • Nieder C, Astner ST, Grosu AL, Andratschke NH, Molls M (2007) The role of postoperative radiotherapy after resection of a single brain metastasis. Combined analysis of 643 patients. Strahlenther Onkol 183:576–580

    Article  PubMed  Google Scholar 

  • Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, Markesbery WR, Foon KA, Young B (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280:1485–1489

    Article  PubMed  CAS  Google Scholar 

  • Pieper D, Suen AW, Grills IS, Nandalur S, Mohammed N, Mitchell C, Maitz A, Kalkanis SN, Martinez AA, Chen PY (2008) Gamma Knife stereotactic radiosurgery for resected brain metastases. Int J Radiat Oncol Biol Phys 72:S227–S228

    Article  Google Scholar 

  • Posner JB (1992) Management of brain metastases. Rev Neurol (Paris) 148:477–487

    CAS  Google Scholar 

  • Quigley M, Karlovits S, Karlovits B, MacKenzie J, Johnson M, Colonias A, Fuhrer R (2006) 2088: Stereotactic radiosurgery alone and primary resection followed by adjuvant stereotactic radiosurgery in the treatment of limited brain metastases. Int J Radiat Oncol Biol Phys 66:S258–S258

    Article  Google Scholar 

  • Rades D, Kieckebusch S, Haatanen T, Lohynska R, Dunst J, Schild SE (2008) Surgical resection followed by whole brain radiotherapy versus whole brain radiotherapy alone for single brain metastasis. Int J Radiat Oncol Biol Phys 70:1319–1324

    Article  PubMed  Google Scholar 

  • Rades D, Pluemer A, Veninga T, Dunst J, Schild SE (2007) A boost in addition to whole-brain radiotherapy improves patient outcome after resection of 1 or 2 brain metastases in recursive partitioning analysis class 1 and 2 patients. Cancer 110:1551–1559

    Article  PubMed  Google Scholar 

  • Roberge D, Petrecca K, El Refae M, Souhami L (2009) Whole-brain radiotherapy and tumor bed radiosurgery following resection of solitary brain metastases. J Neurooncol 95:95–99

    Article  PubMed  Google Scholar 

  • Rogers LR, Rock JP, Sills AK, Vogelbaum MA, Suh JH, Ellis TL, Stieber VW, Asher AL, Fraser RW, Billingsley JS, Lewis P, Schellingerhout D, Shaw EG (2006) Results of a phase II trial of the GliaSite radiation therapy system for the treatment of newly diagnosed, resected single brain metastases. J Neurosurg 105:375–384

    Article  PubMed  Google Scholar 

  • Rwigema J-C, Wegner RE, Heron DE, Mintz AH (2010) Stereotactic radiosurgery to the resection cavity of brain metastases. ASTRO 52nd Annual Meeting, San Diego

    Google Scholar 

  • Soltys SG, Adler JR, Lipani JD, Jackson PS, Choi CY, Puataweepong P, White S, Gibbs IC, Chang SD (2008) Stereotactic radiosurgery of the postoperative resection cavity for brain metastases. Int J Radiat Oncol Biol Phys 70:187–193

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, McGill University Health, Center/Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada

    David Roberge & Luis Souhami

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  1. David Roberge
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  2. Luis Souhami
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Correspondence to David Roberge .

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Editors and Affiliations

  1. , Kean University, Room 213, Library building, Morris Avenue 1000, Union, 07083, New Jersey, USA

    M.A. Hayat

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Roberge, D., Souhami, L. (2012). Paradigms in Tumor Bed Radiosurgery Following Resection of Brain Metastases. In: Hayat, M. (eds) Tumors of the Central Nervous System, Volume 4. Tumors of the Central Nervous System, vol 4. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-1706-0_24

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  • DOI: https://doi.org/10.1007/978-94-007-1706-0_24

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  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-007-1705-3

  • Online ISBN: 978-94-007-1706-0

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