Abstract
The paradigm for post-operative cavity radiation therapy has shifted to more targeted, less morbid approaches. Single-fraction or hypofractionated radiation therapy is a common approach to treating the postoperative cavity but is associated with a local failure rate 20–40%. We employed an alternative treatment strategy involving fractionated partial brain radiation therapy to the surgical cavity. Patients with brain metastases who underwent radiation treatment 30–42 Gy in 3 Gy/fraction regimens to surgical cavity were retrospectively identified. The 6-month and 12-month freedom from local failure rates were 97.0% and 88.2%. Three patients (7%) experienced local failure at 4, 6, and 22 months. Of these, the histologies were colorectal adenocarcinoma (N = 1) and breast adenocarcinoma (N = 2). The 6-month and 12-month freedom from distant brain metastases rates were 74.1% and 68.8%, respectively, and the 6-month and 12-month overall survival rates were 84.9% and 64.3% respectively. The median overall survival was 39 months, and there were no events of late radionecrosis. Fractionated partial brain irradiation to the surgical cavity of resected brain metastases results in low rates of local failure. This strategy represents an alternative to SRS and WBRT.
Highlights
The paradigm for post-operative cavity radiation therapy has shifted to more targeted, less morbid approaches
Surgical resection of brain metastases is an important modality for management and has been shown to improve survival when compared to whole brain radiation therapy (WBRT) alone
Multiple randomized trials have demonstrated that the addition of post-operative whole brain radiation therapy is associated with improving both local and distant intracranial control[4,5,6,7]
Summary
The paradigm for post-operative cavity radiation therapy has shifted to more targeted, less morbid approaches. Single-fraction or hypofractionated radiation therapy is a common approach to treating the postoperative cavity but is associated with a local failure rate 20–40%. Fractionated partial brain irradiation to the surgical cavity of resected brain metastases results in low rates of local failure. This strategy represents an alternative to SRS and WBRT. Multiple randomized trials have demonstrated that the addition of post-operative whole brain radiation therapy is associated with improving both local and distant intracranial control[4,5,6,7]. We evaluate the use of post-operative cavity radiation therapy with standard fractionation with respect to local control, distant intracranial control, and late radionecrosis
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