Abstract
Brain metastases show a recurrence rate of about 50% after surgical resection. Adjuvant radiotherapy can prevent progression; however, whole‐brain radiotherapy (WBRT) can be associated with significant side effects. Local hypofractionated stereotactic radiotherapy (HFSRT) is a good alternative to provide local control with minimal toxicity. In this multicenter analysis, we evaluated the treatment outcome of local HFSRT after resection brain metastases in 181 patients. Patient's characteristics, treatment data as well as follow‐up data were collected and analyzed with special focus on local control, locoregional control and survival. After a median follow‐up of 12.6 months (range 0.3–80.2 months), the crude rate for local control was 80.5%; 1‐ and 2‐year local recurrence‐free survival rates were 75% and 70% (median not reached). Resection cavity size was a significant predictor for local recurrence (P = 0.033). The median overall survival was 16.0 months. Both graded prognostic assessment score and recursive partitioning analysis were accurate predictors of survival. HFSRT leads to excellent local control and has a high potential to consolidate results after surgery; acute and late toxicity is low. Distant intracerebral metastases occur frequently during follow‐up, and therefore, a close patient monitoring needs to be warranted if whole‐brain radiotherapy is omitted.
Highlights
The mainstay of radiotherapy (RT) treatment for patients with brain metastases remained whole-brain radiotherapy (WBRT) for many decades
We evaluated the treatment outcome of local hypofractionated stereotactic radiotherapy (HFSRT) after resection brain metastases in 181 patients
If symptoms such as dizziness or headache prevailed during treatment, oral steroid treatment was initiated in 20 patients (11%)
Summary
The mainstay of radiotherapy (RT) treatment for patients with brain metastases remained whole-brain radiotherapy (WBRT) for many decades. These treatments have been shown to be effective and safely applicable, clinical results highly depending on size and number of the lesions, as well as the underlying primary. Especially in long-term surviving patients, were neurocognitive sequelae; these are known to be related to the brain volume treated, and to size of single doses [1]. For patients with 1–3 lesions, no survival benefit of WBRT could be shown; in spite of reduced locoregional control, unaltered overall survival together with lower incidence of neurocognitive impairment leads to a paradigm change with reduced recommendation of WBRT
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