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

Radiation Oncology

Giuseppe Minniti¹  Joshua D. Palmer²  Helen A. Shih³  Paul D. Brown⁴  Scott Soltys⁵  Nicolaus Andratschke⁶  Matthias Guckenberger⁶  Claus Belka⁷  Maximilian Niyazi⁸  Simon S. Lo⁹  Ivana Russo^1,10 

[1] Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, 53100, Siena, Italy;IRCCS Neuromed, Pozzilli, IS, Italy;Department of Radiation Oncology, Arthur G. James Cancer Hospital, The Ohio State University, Columbus, OH, USA;Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA;Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA;Department of Radiation Oncology, Stanford University, Stanford, CA, USA;Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland;Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany;Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany;German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany;Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA;Radiation Oncology Unit, University of Pittsburgh Medical Center Hillman Cancer Center, San Pietro Hospital FBF, Rome, and Villa Maria Hospital, Mirabella, AV, Italy;

关键词: Stereotactic radiosurgery;    Hypofractionated stereotactic radiotherapy;    Resection cavity;    Brain metastases;    Radiation necrosis;   

DOI  :  10.1186/s13014-021-01802-9

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY