Intracranial control after Cyberknife radiosurgery to the resection bed for large brain metastases
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RESEARCH
Open Access
Intracranial control after Cyberknife radiosurgery to the resection bed for large brain metastases Jennifer Vogel1, Eric Ojerholm1, Andrew Hollander1, Cynthia Briola2, Rob Mooij2, Michael Bieda2, James Kolker2, Suneel Nagda2, Geoffrey Geiger2, Jay Dorsey1, Robert Lustig1, Donald M. O’Rourke3, Steven Brem3, John Lee3 and Michelle Alonso-Basanta1*
Abstract Background: Stereotactic radiosurgery (SRS) is an alternative to post-operative whole brain radiation therapy (WBRT) following resection of brain metastases. At our institution, CyberKnife (CK) is considered for local treatment of large cavities ≥2 cm. In this study, we aimed to evaluate patterns of failure and characterize patients best suited to treatment with this approach. Methods: We retrospectively reviewed 30 patients treated with CK to 33 resection cavities ≥2 cm between 2011 and 2014. Patterns of intracranial failure were analyzed in 26 patients with post-treatment imaging. Survival was estimated by the Kaplan-Meier method and prognostic factors examined with log-rank test and Cox proportional hazards model. Results: The most frequent histologies were lung (43 %) and breast (20 %). Median treatment volume was 25.1 cm3 (range 4.7–90.9 cm3) and median maximal postoperative cavity diameter was 3.8 cm (range 2.8–6.7). The most common treatment was 30 Gy in 5 fractions prescribed to the 75 % isodose line. Median follow up for the entire cohort was 9.5 months (range 1.0–34.3). Local failure developed in 7 treated cavities (24 %). Neither cavity volume nor CK treatment volume was associated with local failure. Distant brain failure occurred in 20 cases (62 %) at a median of 4.2 months. There were increased rates of distant failure in patients who initially presented with synchronous metastases (p = 0.02). Leptomeningeal carcinomatosis (LMC) developed in 9 cases, (34 %). Salvage WBRT was performed in 5 cases (17 %) at a median of 5.2 months from CK. Median overall survival was 10.1 months from treatment. Conclusions: This study suggests that adjuvant CK is a reasonable strategy to achieve local control in large resection cavities. Patients with synchronous metastases at the time of CK may be at higher risk for distant brain failure. The majority of cases were spared or delayed WBRT with the use of local CK therapy. Keywords: Brain metastases, Radiosurgery, CyberKnife
Background Approximately 20–40 % of patients with cancer will develop intracranial metastases [1]. Treatment options for these patients include surgery, whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS). For patients with large intracranial metastases, local control with single modality treatment is poor. Studies have shown 0.2). Of the 26 patients with available follow-up imaging, distant brain failure occurred in 16 (62 %) at a median of 4.2 months from CK. Actuarial 6-month and 1-year distant brain failure were 55.3 and 73.9 % [Fig. 2]. On univariable analysis, presence of synchronous metastases at the time of diagnosis (p = 0.04), dose per fraction 0
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