Ayas, Ahmad Walid, Grau, Stefan, Jablonska, Karolina, Ruess, Daniel, Ruge, Maximilian, Marnitz, Simone, Goldbrunner, Roland and Kocher, Martin (2018). Postoperative local fractionated radiotherapy for resected single brain metastases. Strahlenther. Onkol., 194 (12). S. 1163 - 1171. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1439-099X
Full text not available from this repository.Abstract
PurposeEvaluation of postoperative fractionated local 3D-conformal radiotherapy (3DRT) of the resection cavity in brain metastases.Patients and methodsBetween 2011 and 2016, 57patients underwent resection of asingle, previously untreated (37/57, 65%) or recurrent (20/57, 35%) brain metastasis (median maximal diameter 3.5cm [1.1-6.5cm]) followed by 3DRT. For definition of the gross tumor volume (GTV), the resection cavity was used and for the clinical target volume (CTV), margins of 1.0-1.5cm were added. Median dose was 48.0Gy (30.0-50.4Gy) in 25 (10-28) fractions; most patients had 36.0-42.0Gy in 3.0Gy fractions (n=16, EQD2(10Gy) 39.0-45.5Gy) or 40.0-50.4Gy in 1.8-2.0Gy fractions (n=37, EQD2(10Gy) 39.3-50.0Gy).ResultsMedian follow-up was 18months. Local control rates were 83% at 1year and 78% at 2years and were significantly influenced by histology (breast cancer 100%, non-small lung cancer 87%, melanoma 80%, colorectal cancer 26% at 2years, p=0.006) and resection status (p<0.0001), but not by EQD2(10Gy) or size of the planning target volume (median 96.7ml [16.7-282.8ml]). At 1 and 2years, 74% and 52% of the patients were free from distant brain metastases. Salvage procedures were applied in 25/27 (93%) of recurrent patients. Survival was 68% at 1year and 41% at 2years and was significantly improved in younger patients (p=0.006) with higher Karnofsky performance score (p<0.0001) and without prior radiotherapy (54% vs. 9% at 2years, p=0.006). No cases of radiographic or symptomatic radionecrosis were observed.ConclusionAdjuvant fractionated local 3DRT is highly effective in radiosensitive, completely resected metastases and should be considered for treating large resection cavities as an alternative to postoperative stereotactic single dose or hypofractionated radiosurgery. ZusammenfassungZielUntersuchung der Wirksamkeit einer postoperativen fraktionierten, lokalen 3-D-konformalen Strahlentherapie (3DRT) der Resektionshohle bei Hirnmetastasen.Patienten und MethodenVon 2011-2016 wurde bei 57Patienten eine unbehandelte (37/57, 65%) oder rezidivierte (20/57, 35%) Hirnmetastase (medianer maximaler Durchmesser 3,5cm [1,1-6,5cm]) reseziert und postoperativ lokal bestrahlt. Fur das klinische Zielvolumen (CTV) wurden Saume von 1,0-1,5cm um die Resektionshohle verwendet. Die mediane Dosis betrug 48,0Gy (30,0-50,4Gy) in 25 (10-28) Fraktionen (meistens36,0-42,0Gy/3,0Gy [n=16, EQD2(10Gy) 39,0-45,5Gy] oder 40,0-50,4Gy/1,8-2,0Gy [n=37, EQD2(10Gy) 39,3-50,0Gy]).ErgebnisseDie lokalen Kontrollraten von 83% nach 1Jahr und 78% nach 2Jahren wurden signifikant durch den Primartumor (Mammakarzinom 100%, nichtkleinzelliges Lungenkarzinom 87%, Melanom 80%, kolorektale Tumoren 26% nach 2Jahren, p=0,006) und den Resektionsstatus (p<0,0001), nicht aber durch die EQD2(10Gy) oder die Gro ss e des Planungszielvolumens (Median 96,7ml [16,7-282,8ml]) beeinflusst. Nach 1(2) Jahren waren 74% (52%) frei von neuen Hirnmetastasen. Salvage-Verfahren wurden bei 25/27 (93%) angewendet. Das uberleben lag nach 1(2) Jahren bei 68% (41%) und war bei jungeren Patienten (p=0,006), bei hoherem Karnofsky-Score (p<0,0001) und ohne Vorbestrahlung (54% vs. 9% nach 2Jahren, p=0,006) signifikant verbessert. Es wurden keine radiologischen oder symptomatischen Radionekrosen beobachtet. SchlussfolgerungDie adjuvante fraktionierte, lokale 3DRT ist bei strahlensensiblen, vollstandig resezierten Metastasen hoch wirksam und sollte zur Behandlung gro ss er Resektionshohlen als Alternative zur postoperativen stereotaktischen Einzeldosis- oder hypofraktionierten Radiochirurgie in Betracht gezogen werden.
| Item Type: | Journal Article | ||||||||||||||||||||||||||||||||||||
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| URN: | urn:nbn:de:hbz:38-164394 | ||||||||||||||||||||||||||||||||||||
| DOI: | 10.1007/s00066-018-1368-1 | ||||||||||||||||||||||||||||||||||||
| Journal or Publication Title: | Strahlenther. Onkol. | ||||||||||||||||||||||||||||||||||||
| Volume: | 194 | ||||||||||||||||||||||||||||||||||||
| Number: | 12 | ||||||||||||||||||||||||||||||||||||
| Page Range: | S. 1163 - 1171 | ||||||||||||||||||||||||||||||||||||
| Date: | 2018 | ||||||||||||||||||||||||||||||||||||
| Publisher: | SPRINGER HEIDELBERG | ||||||||||||||||||||||||||||||||||||
| Place of Publication: | HEIDELBERG | ||||||||||||||||||||||||||||||||||||
| ISSN: | 1439-099X | ||||||||||||||||||||||||||||||||||||
| Language: | English | ||||||||||||||||||||||||||||||||||||
| Faculty: | Unspecified | ||||||||||||||||||||||||||||||||||||
| Divisions: | Unspecified | ||||||||||||||||||||||||||||||||||||
| Subjects: | no entry | ||||||||||||||||||||||||||||||||||||
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| Refereed: | Yes | ||||||||||||||||||||||||||||||||||||
| URI: | http://kups.ub.uni-koeln.de/id/eprint/16439 |
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