Abstract
BackgroundThe treatment paradigm from postoperative whole brain radiation therapy (WBRT) to post-operative stereotactic radiosurgery (SRS) to the tumor bed has shifted with little data to evaluate whether each treatment modality confers equivalent tumor control and survival outcomes.MethodsPatients with surgical resection of single brain metastases from January 2010 to December 2014 were treated postoperatively with either WBRT or SRS. Retrospective patient data was compared for local control, distant brain recurrence, overall survival, and radiation complications.ResultsForty-six received WBRT, and 37 received tumor bed SRS. Twelve of 35 (34%) SRS patients experienced local recurrence compared to 17 of 31 (55%) WBRT patients (p = 0.09). The median survival was 440 days (14.7 months) for SRS and 202 days (6.7 months) for WBRT (p = 0.062, log-rank). SRS demonstrated improved survival benefit in the first six months (p = 0.0034; Wilcoxon). Radiation-related adverse changes after SRS (22%) were not statistically different from WBRT (8.7%) (p = 0.152). Age (p = 0.08), systemic cancer status (p = 0.30), Graded Prognostic Assessment (p = 0.28), number of brain metastases at diagnosis (p = 0.65), tumor volume at diagnosis (p = 0.13), new brain lesions (p = 0.74) and neurologic versus systemic cause of death (p = 0.11) did not differ between the groups.ConclusionsFollowing surgical resection, tumor bed SRS can be used effectively in lieu of WBRT to treat brain metastases with comparable local control and distant control and without significantly more adverse events.
Highlights
Brain metastases have been treated with surgical resection followed by whole brain radiation therapy (WBRT) to decrease the rates of local recurrence, distant brain recurrence and neurologic cause of death [1,2]
WBRT has become increasingly implicated with global cognitive impairment that persists after cessation of treatment [3,4], thereby expanding concerns regarding quality of life despite reducing tumor burden
All patients who received either surgical resection followed by WBRT or stereotactic radiosurgery (SRS) for a presumed metastatic brain tumor from January 1, 2010 to December 31, 2014 at the University Hospital were retrospectively identified from patient treatment databases of the senior author [National Science Library (NSL)]
Summary
Brain metastases have been treated with surgical resection followed by whole brain radiation therapy (WBRT) to decrease the rates of local recurrence, distant brain recurrence and neurologic cause of death [1,2]. A number of studies have examined the ability of SRS to the post-resection tumor bed to control metastatic brain disease after tumor resection [12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27] All of these studies, look only at populations of patients treated with SRS and do not compare outcomes between postoperative WBRT and SRS. The treatment paradigm from postoperative whole brain radiation therapy (WBRT) to postoperative stereotactic radiosurgery (SRS) to the tumor bed has shifted with little data to evaluate whether each treatment modality confers equivalent tumor control and survival outcomes
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