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Review
. 2021 Apr 15;16(1):73.
doi: 10.1186/s13014-021-01802-9.

Current status and recent advances in resection cavity irradiation of brain metastases

Giuseppe Minniti  1   2 , Maximilian Niyazi  3   4 , Nicolaus Andratschke  5 , Matthias Guckenberger  5 , Joshua D Palmer  6 , Helen A Shih  7 , Simon S Lo  8 , Scott Soltys  9 , Ivana Russo  10 , Paul D Brown  11 , Claus Belka  3
Affiliations
Review

Current status and recent advances in resection cavity irradiation of brain metastases

Giuseppe Minniti et al. Radiat Oncol. .

Abstract

Despite complete surgical resection brain metastases are at significant risk of local recurrence without additional radiation therapy. Traditionally, the addition of postoperative whole brain radiotherapy (WBRT) has been considered the standard of care on the basis of randomized studies demonstrating its efficacy in reducing the risk of recurrence in the surgical bed as well as the incidence of new distant metastases. More recently, postoperative stereotactic radiosurgery (SRS) to the surgical bed has emerged as an effective and safe treatment option for resected brain metastases. Published randomized trials have demonstrated that postoperative SRS to the resection cavity provides superior local control compared to surgery alone, and significantly decreases the risk of neurocognitive decline compared to WBRT, without detrimental effects on survival. While studies support the use of postoperative SRS to the resection cavity as the standard of care after surgery, there are several issues that need to be investigated further with the aim of improving local control and reducing the risk of leptomeningeal disease and radiation necrosis, including the optimal dose prescription/fractionation, the timing of postoperative SRS treatment, and surgical cavity target delineation. We provide a clinical overview on current status and recent advances in resection cavity irradiation of brain metastases, focusing on relevant strategies that can improve local control and minimize the risk of radiation-induced toxicity.

Keywords: Brain metastases; Hypofractionated stereotactic radiotherapy; Radiation necrosis; Resection cavity; Stereotactic radiosurgery.

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Conflict of interest statement

GM received speaker honoraria from Brainlab. SSL is a member of the Elekta ICON Gamma Knife Expert Group. PDB reports personal fees from UpToDate (contributor), outside the submitted work. JDP reports grant and personal fees from Varian Medical Systems, Consultant for Novocure and Huron, outside of submitted work. CB received speaker honoraria and research grants from ELEKTA AB (Stockholm, Sweden) outside the submitted work. The other authors declare that they have no competing interests with the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
An overview of target volumes for postoperative resection cavity is presented on post-contrast T1-weighted MRI sequences and CT scans. The gross tumor volume (GTV) is presented in red, the clinical target volume (CTV) in blue and the planning tumor volume (PTV) in pink. For this case, CTV was created by 1-mm expansion of the GTV, extended by 5 mm along the bone flap beyond the initial region of preoperative tumor contact. Note that an extension by 10 mm along the meningeal margin for brain metastases with preoperative dural contact [59] or the inclusion of the entirety of the craniotomy site [71] has been suggested by some authors
See this image and copyright information in PMC

Comment in

References

    1. Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, Markesbery WR, Foon KA, Young B. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA. 1998;280:1485–1489. doi: 10.1001/jama.280.17.1485. - DOI - PubMed
    1. Kocher M, Soffietti R, Abacioglu U, Villà S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Ben Hassel M, Kouri M, Valeinis E, van den Berge D, Collette S, Collette L, Mueller RP. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952–26001 study. J Clin Oncol. 2011;29:134–141. doi: 10.1200/JCO.2010.30.1655. - DOI - PMC - PubMed
    1. Brown PD, Jaeckle K, Ballman KV, Farace E, Cerhan JH, Anderson SK, Carrero XW, Barker FG, 2nd, Deming R, Burri SH, Ménard C, Chung C, Stieber VW, Pollock BE, Galanis E, Buckner JC, Asher AL. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA. 2016;316:401–409. doi: 10.1001/jama.2016.9839. - DOI - PMC - PubMed
    1. Lamba N, Muskens IS, DiRisio AC, Meijer L, Briceno V, Edrees H, Aslam B, Minhas S, Verhoeff JJC, Kleynen CE, Smith TR, Mekary RA, Broekman ML. Stereotactic radiosurgery versus whole-brain radiotherapy after intracranial metastasis resection: a systematic review and meta-analysis. Radiat Oncol. 2017;12(1):106. doi: 10.1186/s13014-017-0840-x. - DOI - PMC - PubMed
    1. Akanda ZZ, Hong W, Nahavandi S, Haghighi N, Phillips C, Kok DL. Post-operative stereotactic radiosurgery following excision of brain metastases: A systematic review and meta-analysis. Radiother Oncol. 2020;142:27–35. doi: 10.1016/j.radonc.2019.08.024. - DOI - PubMed