Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug;169(1):187-193.
doi: 10.1007/s11060-024-04691-6. Epub 2024 Jul 4.

Intraoperative radiotherapy after neurosurgical resection of brain metastases as institutional standard treatment- update of the oncological outcome form a single center cohort after 117 procedures

Klaus-Henning Kahl  1 , Philipp E Krauss  2 , Maria Neu  3 , Christoph J Maurer  4 , Sabine Schill-Reiner  5 , Zoha Roushan  5 , Eva Laukmanis  5 , Christian Dobner  5 , Tilman Janzen  5 , Nikolaos Balagiannis  3 , Björn Sommer  2 , Georg Stüben  3 , Ehab Shiban  2
Affiliations

Intraoperative radiotherapy after neurosurgical resection of brain metastases as institutional standard treatment- update of the oncological outcome form a single center cohort after 117 procedures

Klaus-Henning Kahl et al. J Neurooncol. 2024 Aug.

Abstract

Purpose: Stereotactic radiotherapy (SRT) is the predominant method for the irradiation of resection cavities after resection of brain metastases (BM). Intraoperative radiotherapy (IORT) with 50 kV x-rays is an alternative way to irradiate the resection cavity focally. We have already reported the outcome of our first 40 IORT patients treated until 2020. Since then, IORT has become the predominant cavity treatment in our center due to patients´ choice.

Methods: We retrospectively analyzed the outcomes of all patients who underwent resection of BM and IORT between 2013 and August 2023 at Augsburg University Medical Center (UKA).

Results: We identified 105 patients with 117 resected BM treated with 50 kV x-ray IORT. Median diameter of the resected metastases was 3.1 cm (range 1.3 - 7.0 cm). Median applied dose was 20 Gy. All patients received standardized follow-up (FU) including three-monthly MRI of the brain. Mean FU was 14 months, with a median MRI FU for patients alive of nine months. Median overall survival (OS) of all treated patients was 18.2 months (estimated 1-year OS 57.7%). The observed local control (LC) rate of the resection cavity was 90.5% (estimated 1-year LC 84.2%). Distant brain control (DC) was 61.9% (estimated 1-year DC 47.9%). Only 16.2% of all patients needed WBI in the further course of disease. The observed radio necrosis rate was 2.6%.

Conclusion: After 117 procedures IORT still appears to be a safe and appealing way to perform cavity RT after neurosurgical resection of BM with low toxicity and excellent LC.

Keywords: Brachytherapy; Brain metastasis; Cavity RT; Focal radiotherapy; IORT.

PubMed Disclaimer

Conflict of interest statement

KHK has received travel grants and speakers honoria from Varian, Elekta, Zeiss Meditec, AstraZeneca, BMS, MSD, Sanofi-Aventis, Merck and Icotec. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Probability of local control after resection of BM and IORT (the dotted lines represent the 95% confidence intervals)
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Vogelbaum MA, Brown PD, Messersmith H, Brastianos PK, Burri S, Cahill D, Dunn IF, Gaspar LE, Gatson NTN, Gondi V, Jordan JT, Lassman AB, Maues J, Mohile N, Redjal N, Stevens G, Sulman E, Van Den Bent M, Wallace HJ, Weinberg JS, Zadeh G, Schiff D (2022) Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline. JCO 40:492–516. 10.1200/JCO.21.0231410.1200/JCO.21.02314 - DOI - PubMed
    1. Le Rhun E, Guckenberger M, Smits M, Dummer R, Bachelot T, Sahm F, Galldiks N, De Azambuja E, Berghoff AS, Metellus P, Peters S, Hong Y-K, Winkler F, Schadendorf D, Van Den Bent M, Seoane J, Stahel R, Minniti G, Wesseling P, Weller M, Preusser M (2021) EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours. Ann Oncol 32:1332–1347. 10.1016/j.annonc.2021.07.016 10.1016/j.annonc.2021.07.016 - DOI - PubMed
    1. Gutschenritter T, Venur VA, Combs SE, Vellayappan B, Patel AP, Foote M, Redmond KJ, Wang TJC, Sahgal A, Chao ST, Suh JH, Chang EL, Ellenbogen RG, Lo SS (2020) The Judicious Use of Stereotactic Radiosurgery and Hypofractionated Stereotactic Radiotherapy in the Management of Large Brain Metastases. Cancers 13:70. 10.3390/cancers13010070 10.3390/cancers13010070 - DOI - PMC - PubMed
    1. Kocher M, Soffietti R, Abacioglu U, Villà S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann R-D, Carrie C, Hassel MB, Kouri M, Valeinis E, van den Berge D, Collette S, Collette L, Mueller R-P (2011) Adjuvant Whole-Brain Radiotherapy Versus Observation After Radiosurgery or Surgical Resection of One to Three Cerebral Metastases: Results of the EORTC 22952–26001 Study. JCO 29:134–141. 10.1200/JCO.2010.30.165510.1200/JCO.2010.30.1655 - DOI - PMC - PubMed
    1. Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, Greenspoon J, Parney IF, Laack NNI, Ashman JB, Bahary J-P, Hadjipanayis CG, Urbanic JJ, Barker FG, Farace E, Khuntia D, Giannini C, Buckner JC, Galanis E, Roberge D (2017) Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 18:1049–1060. 10.1016/S1470-2045(17)30441-2 10.1016/S1470-2045(17)30441-2 - DOI - PMC - PubMed

LinkOut - more resources