Timing of Adjuvant Fractionated Stereotactic Radiosurgery Affects Local Control of Resected Brain Metastases |
| |
| Authors: | Diana A. Roth O’Brien Phillip Poppas Sydney M. Kaye Sean S. Mahase Anjile An Paul J. Christos Benjamin Liechty David Pisapia Rohan Ramakrishna A. Gabriella Wernicke Jonathan P.S. Knisely Susan Pannullo Theodore H. Schwartz |
| |
| Affiliation: | 1. Stich Radiation Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York;2. Department of Neurosurgery, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York;3. Division of Biostatistics and Epidemiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York;4. Department of Neuropathology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York;5. Savera Liberty Medical, New York, New York;6. Department of Otolaryngology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York;7. Department of Neuroscience, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York;1. Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Milan, Italy;2. Risk Management Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy;3. Department of Biomedical Sciences, Humanitas University, Milan, Italy;1. Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California;2. Harvard Business School, Cambridge, Massachusetts;1. IROC Houston Quality Assurance Center, The University of Texas MD Anderson Cancer Center, Houston, Texas;2. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas;1. New York Medical College, New York, New York;2. The Ottawa Hospital Cancer Centre, Ottawa, Canada;3. Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ontario, Canada;4. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan |
| |
| Abstract: | PurposeFor resected brain metastases (BMs), stereotactic radiosurgery (SRS) is often offered to minimize local recurrence (LR). Although the aim is to deliver SRS within a few weeks of surgery, a variety of socioeconomic, medical, and procedural issues can cause delays. We evaluated the relationship between timing of postoperative SRS and LR.Methods and MaterialsWe retrospectively identified a consecutive series of patients with BM managed with resection and SRS or fractionated SRS at our institution from 2012 to 2018. We assessed the correlation of time to SRS and other demographic, disease, and treatment variables with LR, local recurrence-free survival, distant recurrence, distant recurrence-free survival, and overall survival.ResultsA total of 133 patients met inclusion criteria. The median age was 64.5 years. Approximately half of patients had a single BM, and median BM size was 2.9 cm. Gross total resection was achieved in 111 patients (83.5%), and more than 90% of patients received fractionated SRS. The median time to SRS was 37.0 days, and the LR rate was 16.4%. Time to SRS was predictive of LR. The median time from surgery to SRS was 34.0 days for patients without LR versus 61.0 days for those with LR (P < .01). The LR rate was 2.3% with SRS administered ≤4 weeks postoperatively, compared with 23.6% if SRS was administered >4 weeks postoperatively (P < .01). Local recurrence-free survival was also improved for patients who underwent SRS at ≤4 weeks (P = .02). Delayed SRS was also predictive of distant recurrence (P = .02) but not overall survival.ConclusionsIn this retrospective study, the strongest predictor of LR after postoperative SRS for BM was time to SRS, and a cutoff of 4 weeks was a reliable predictor of recurrence. These findings merit investigation in a prospective, randomized trial. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
