Abstract
BackgroundAdministering stereotactic radiotherapy to the surgical cavity and thus omitting postoperative whole brain radiotherapy (WBRT) is a favored strategy in limited metastatic brain disease. Little is known about the impact of regular magnetic resonance imaging follow-up (MRI FU) in such patient cohorts. The aim of this study is to examine the impact of regular MRI FU and to report the oncological outcomes of patients with one to three brain metastases (BMs) treated with stereotactic radiosurgery (SRS) or hypo-fractionated stereotactic radiotherapy (HFSRT) to the surgical cavity.MethodsWe retrospectively analyzed patients who received SRS or HFSRT to the surgical cavity after resection of one to two BMs. Additional, non-resected BMs were managed with SRS alone. Survival was estimated by the Kaplan-Meier method. Prognostic factors were examined with the log-rank test and Cox proportional hazards model. Regular MRI FU was defined as performing a brain MRI 3 months after radiotherapy (RT) and/or performing ≥1 brain MRI per 180 days. Primary endpoint was local control (LC). Secondary endpoints were distant brain control (DBC), overall survival (OS) and the correlation between regular MRI FU and overall survival (OS), symptom-free survival (SFS), deferment of WBRT and WBRT-free survival (WFS).ResultsOverall, 75 patients were enrolled. One, 2 and 3 BMs were seen in 63 (84%), 11 (15%) and 1 (1%) patients, respectively. Forty (53%) patients underwent MRI FU 3 months after RT and 38 (51%) patients received ≥1 brain MRI per 180 days. Median OS was 19.4 months (95% CI: 13.2–25.6 months). Actuarial LC, DBC and OS at 1 year were 72% (95% CI: 60–83%), 60% (95% CI: 48–72%) and 66% (95% CI: 53–76%), respectively. A planning target volume > 15 cm3 (p = 0.01), Graded Prognostic Assessment (GPA) score (p = 0.001) and residual tumor after surgery (p = 0.008) were prognostic for decreased OS in multivariate analysis. No significant correlation between MRI FU at 3 months and OS (p = 0.462), SFS (p = 0.536), WFS (p = 0.407) or deferment of WBRT (p = 0.955) was seen. Likewise, performing ≥1 MRI per 180 days had no significant impact on OS (p = 0.954), SFS (p = 0.196), WFS (p = 0.308) or deferment of WBRT (p = 0.268).ConclusionOur results regarding oncological outcomes consist with the current data from the literature. Surprisingly, regular MRI FU did not result in increased OS, SFS, WFS or deferment of WBRT in our cohort consisting mainly of patients with a single and resected BM. Therefore, the impact of regular MRI FU needs prospective evaluation.Trial registrationProject ID: 2017–00033, retrospectively registered.
Highlights
Brain metastases (BMs) are the most common tumors in the central nervous system (CNS) in adults [1]
There was a significant difference between groups concerning gender (p = 0.025), Initial brain metastasis velocity (iBMV) (p = 0.015) and Brain metastasis velocity (BMV) (p = 0.012) comparing patients that received ≥1 magnetic resonance imaging (MRI) vs. < 1 MRI per 180 days
With this current single-center retrospective study, we report the impact of regular magnetic resonance imaging follow-up (MRI FU) for patients with 1 to 3 brain metastases (BMs) treated with surgery followed by stereotactic radiosurgery (SRS) or hypo-fractionated stereotactic radiotherapy (HFSRT) to the surgical cavity
Summary
Brain metastases (BMs) are the most common tumors in the central nervous system (CNS) in adults [1]. Since the past two decades the incidence of BM is rising as a consequence of increased availability of magnetic resonance imaging (MRI) [4] and longer survival from primary cancers, due to new and more effective systemic therapy options [2]. Most patients present with oligometastatic brain disease, which is defined as a limited number (usually 1 to 3) of intracranial metastases [6]. Little is known about the impact of regular magnetic resonance imaging follow-up (MRI FU) in such patient cohorts. The aim of this study is to examine the impact of regular MRI FU and to report the oncological outcomes of patients with one to three brain metastases (BMs) treated with stereotactic radiosurgery (SRS) or hypo-fractionated stereotactic radiotherapy (HFSRT) to the surgical cavity
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