Abstract
PurposeExternal-beam radiotherapy (EBRT) is the predominant method for localized brain radiotherapy (LBRT) after resection of brain metastases (BM). Intraoperative radiotherapy (IORT) with 50-kV x‑rays is an alternative way to focally irradiate the resection cavity after BM surgery, with the option of shortening the overall treatment time and limiting normal tissue irradiation.MethodsWe retrospectively analyzed the outcomes of all patients who underwent neurosurgical resection of BM and 50-kV x‑ray IORT between 2013 and 2020 at Augsburg University Medical Center.ResultsWe identified 40 patients with 44 resected BM treated with 50-kV x‑ray IORT. Median diameter of the resected metastases was 2.8 cm (range 1.5–5.9 cm). Median applied dose was 20 Gy. All patients received standardized follow-up (FU) including 3‑monthly MRI of the brain. Mean FU was 14.4 months, with a median MRI FU for alive patients of 12.2 months. Median overall survival (OS) of all treated patients was 26.4 months (estimated 1‑year OS 61.6%). The observed local control (LC) rate of the resection cavity was 88.6% (estimated 1‑year LC 84.3%). Distant brain control (DC) was 47.5% (estimated 1‑year DC 33.5%). Only 25% of all patients needed WBI in the further course of disease. The observed radionecrosis rate was 2.5%.ConclusionIORT with 50-kV x‑rays is a safe and appealing way to apply LBRT after neurosurgical resection of BM, with low toxicity and excellent LC. Close MRI FU is paramount to detect distant brain failure (DBF) early.
Highlights
IntroductionIn recent decades, improved systemic treatment options have led to prolonged survival of patients suffering from metastatic cancer of many tumor entities (e.g., malignant melanoma, colorectal carcinoma, lung cancer), including patients with brain metastases (BM)
In recent decades, improved systemic treatment options have led to prolonged survival of patients suffering from metastatic cancer of many tumor entities, including patients with brain metastases (BM)
We identified 40 patients (22 female/18 male) with 44 resected BM who had been treated with 50-kV x-ray Intraoperative radiotherapy (IORT)
Summary
In recent decades, improved systemic treatment options have led to prolonged survival of patients suffering from metastatic cancer of many tumor entities (e.g., malignant melanoma, colorectal carcinoma, lung cancer), including patients with BM. In the early 1990s, the median survival of highly selected patients treated with resection of single BM and whole-brain radiotherapy (WBI) was 9.2 months [1]. In recent series of patients undergoing surgery and focal radiotherapy for BM, median survival even exceeds 24 months [2, 3]. Several trials have shown the detrimental effect of WBI on neurocognitive functioning [4,5,6,7,8].
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