Postoperative Cavity Stereotactic Radiosurgery for Brain Metastases
During the past decade, tumor bed stereotactic radiosurgery (SRS) after surgical resection has been increasingly utilized in the management of brain metastases. SRS has risen as an alternative to adjuvant whole brain radiation therapy (WBRT), which has been shown in several studies to be associated...
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doaj-2eb166fc22ee4a389a85ae24a1acec4a2020-11-25T00:21:07ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2018-08-01810.3389/fonc.2018.00342408662Postoperative Cavity Stereotactic Radiosurgery for Brain MetastasesEduardo M. Marchan0Jennifer Peterson1Terence T. Sio2Kaisorn L. Chaichana3Anna C. Harrell4Henry Ruiz-Garcia5Anita Mahajan6Paul D. Brown7Daniel M. Trifiletti8Daniel M. Trifiletti9Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United StatesDepartment of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United StatesDepartment of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United StatesDepartment of Neurological Surgery, Mayo Clinic, Jacksonville, FL, United StatesDepartment of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United StatesDepartment of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United StatesDepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, United StatesDepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, United StatesDepartment of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United StatesDepartment of Neurological Surgery, Mayo Clinic, Jacksonville, FL, United StatesDuring the past decade, tumor bed stereotactic radiosurgery (SRS) after surgical resection has been increasingly utilized in the management of brain metastases. SRS has risen as an alternative to adjuvant whole brain radiation therapy (WBRT), which has been shown in several studies to be associated with increased neurotoxicity. Multiple recent articles have shown favorable local control rates compared to those of WBRT. Specifically, improvements in local control can be achieved by adding a 2 mm margin around the resection cavity. Risk factors that have been established as increasing the risk of local recurrence after resection include: subtotal resection, larger treatment volume, lower margin dose, and a long delay between surgery and SRS (>3 weeks). Moreover, consensus among experts in the field have established the importance of (a) fusion of the pre-operative magnetic resonance imaging scan to aid in volume delineation (b) contouring the entire surgical tract and (c) expanding the target to include possible microscopic disease that may extend to meningeal or venous sinus territory. These strategies can minimize the risks of symptomatic radiation-induced injury and leptomeningeal dissemination after postoperative SRS. Emerging data has arisen suggesting that multifraction postoperative SRS, or alternatively, preoperative SRS could provide decreased rates of radiation necrosis and leptomeningeal disease. Future prospective randomized clinical trials comparing outcomes between these techniques are necessary in order to improve outcomes in these patients.https://www.frontiersin.org/article/10.3389/fonc.2018.00342/fullpostoperativeradiosurgerymetastasisresectionradiation |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Eduardo M. Marchan Jennifer Peterson Terence T. Sio Kaisorn L. Chaichana Anna C. Harrell Henry Ruiz-Garcia Anita Mahajan Paul D. Brown Daniel M. Trifiletti Daniel M. Trifiletti |
spellingShingle |
Eduardo M. Marchan Jennifer Peterson Terence T. Sio Kaisorn L. Chaichana Anna C. Harrell Henry Ruiz-Garcia Anita Mahajan Paul D. Brown Daniel M. Trifiletti Daniel M. Trifiletti Postoperative Cavity Stereotactic Radiosurgery for Brain Metastases Frontiers in Oncology postoperative radiosurgery metastasis resection radiation |
author_facet |
Eduardo M. Marchan Jennifer Peterson Terence T. Sio Kaisorn L. Chaichana Anna C. Harrell Henry Ruiz-Garcia Anita Mahajan Paul D. Brown Daniel M. Trifiletti Daniel M. Trifiletti |
author_sort |
Eduardo M. Marchan |
title |
Postoperative Cavity Stereotactic Radiosurgery for Brain Metastases |
title_short |
Postoperative Cavity Stereotactic Radiosurgery for Brain Metastases |
title_full |
Postoperative Cavity Stereotactic Radiosurgery for Brain Metastases |
title_fullStr |
Postoperative Cavity Stereotactic Radiosurgery for Brain Metastases |
title_full_unstemmed |
Postoperative Cavity Stereotactic Radiosurgery for Brain Metastases |
title_sort |
postoperative cavity stereotactic radiosurgery for brain metastases |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Oncology |
issn |
2234-943X |
publishDate |
2018-08-01 |
description |
During the past decade, tumor bed stereotactic radiosurgery (SRS) after surgical resection has been increasingly utilized in the management of brain metastases. SRS has risen as an alternative to adjuvant whole brain radiation therapy (WBRT), which has been shown in several studies to be associated with increased neurotoxicity. Multiple recent articles have shown favorable local control rates compared to those of WBRT. Specifically, improvements in local control can be achieved by adding a 2 mm margin around the resection cavity. Risk factors that have been established as increasing the risk of local recurrence after resection include: subtotal resection, larger treatment volume, lower margin dose, and a long delay between surgery and SRS (>3 weeks). Moreover, consensus among experts in the field have established the importance of (a) fusion of the pre-operative magnetic resonance imaging scan to aid in volume delineation (b) contouring the entire surgical tract and (c) expanding the target to include possible microscopic disease that may extend to meningeal or venous sinus territory. These strategies can minimize the risks of symptomatic radiation-induced injury and leptomeningeal dissemination after postoperative SRS. Emerging data has arisen suggesting that multifraction postoperative SRS, or alternatively, preoperative SRS could provide decreased rates of radiation necrosis and leptomeningeal disease. Future prospective randomized clinical trials comparing outcomes between these techniques are necessary in order to improve outcomes in these patients. |
topic |
postoperative radiosurgery metastasis resection radiation |
url |
https://www.frontiersin.org/article/10.3389/fonc.2018.00342/full |
work_keys_str_mv |
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