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Bernhardt D, Peeken JC, Kehl V, Eitz K, Guckenberger M, Andratschke N, Mayinger MC, Lindel K, Dieckmann K, El Shafie R, Debus J, Riesterer O, Rogers S, Blanck O, Wolff R, Grosu A, Bilger A, Henkenberens C, Schulze K, Gani C, Müller AC, Radlanski K, Janssen S, Ferentinos K, Combs SE. Post-Operative Stereotactic Radiotherapy for Resected Brain Metastases: Results of the Multicenter Analysis (AURORA) of the German Working Group "Stereotactic Radiotherapy". Int J Radiat Oncol Biol Phys 2023; 117:e87-e88. [PMID: 37786203 DOI: 10.1016/j.ijrobp.2023.06.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) While the results of prospective studies support the use of postoperative stereotactic radiotherapy (RT) to the resection cavity (RC) as the standard of care after surgery, there are several issues that need to be investigated such as factors for improving local control, risk of leptomeningeal disease and radiation necrosis. Further, the optimal dose and fractionation is still under debate. MATERIALS/METHODS The working group "Stereotactic Radiotherapy" of the German Society of Radiation Oncology (DEGRO) analyzed its multi-institutional database with 661 patients who received postoperative stereotactic RT to the RC. Treatment was performed at 13 centers between 2008 and 2021. Patient characteristics, treatment details, and follow-up data including overall survival (OS), local control (LC) were evaluated. Cox Regression and Kaplan-Meier curves with Log-rank Tests were calculated for selected variables. RESULTS In this retrospective study, overall survival was 61.5% at 1 year, 47.6% at 2 years, and 35.5% at 3 years, and local control was 84.6% at 1 year, 74.8% at 2 years, and 72.8% at 3 years. 96% of patients were treated with hypofractionated stereotactic radiotherapy (HSRT), only 26 patients received single fraction radiosurgery (4%). Prognostic factors associated with overall survival were Karnofsky Performance Status, RPA and GPA class, controlled primary tumor and absence of extracranial metastases, whereas prognostic factor associated with local control was planning target volume (23 mL or less). CONCLUSION HSRT is the most common fractionation form in the treatment of RCs in this multicenter analysis. This approach results in excellent OS and LC outcomes. OS in patients with resected brain metastases is mainly influenced by performance status. In regard to local control, RT of large cavities remain a challenge with significantly worse outcome.
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Affiliation(s)
- D Bernhardt
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Germany, Munich, Germany
| | - J C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Center Munich, Munich, Germany
| | - V Kehl
- Institute for AI and Informatics in Medicine, Munich, NA, Germany
| | - K Eitz
- Department of Radiation Oncology - Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - N Andratschke
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - M C Mayinger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - K Lindel
- Municipal Hospital, Department for Radiation Oncology, Karlsruhe, Germany
| | - K Dieckmann
- Department of Radiation Oncology, Vienna, Austria
| | - R El Shafie
- 8Department of Radiation Oncology, University Hospital Göttingen, Göttingen, Germany
| | - J Debus
- CCU Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Radiation Oncology University Hospital Heidelberg, Heidelberg, Germany
| | - O Riesterer
- Center for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
| | - S Rogers
- Radiation Oncology Center KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - O Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - R Wolff
- University Hospital Frankfurt, Department of Neurosurgery, Frankfurt, Germany
| | - A Grosu
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Bilger
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Henkenberens
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Hannover, Germany
| | - K Schulze
- Klinikum Fulda, 36251 Bad Hersfeld, Germany
| | - C Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - A C Müller
- Department of Radiotherapy, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - K Radlanski
- Radiation Oncology and Radiotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - S Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - K Ferentinos
- Radiation Oncology Department, German Oncology Center, Limassol, Cyprus
| | - S E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany
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Diehl C, Rosenkranz E, Mißlbeck M, Schwendner M, Sollmann N, Eitz K, Bernhardt D, Ille S, Meyer B, Combs S, Krieg S. RADT-06. SPARING OF MOTOR STRUCTURES IN ADJUVANT RADIATION THERAPY AFTER RESECTION OF BRAIN METASTASES: APPLICATION OF NTMS-DERIVED DTI-BASED MOTOR FIBER TRACKING IN ADJUVANT STEREOTACTIC RT TREATMENT PLANNING. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Resection of brain metastases (BM) close to the motor cortex and the corticospinal tract (CST) bears a significant risk for treatment-related morbidity. Navigated transcranial mapping (nTMS) combined with diffusion-tensor-imaging (DTI) based fiber tracking (DTI-FTTMS) is a valuable tool to guide the neurosurgeon along the CST to preserve motor function. This study aims to proof the practicability of DTI-FTTMS in local adjuvant stereotactic RT planning in the management of BM. Method: Pre-surgical generated DTI-FTTMS-based CST reconstructions of 24 patients with 25 resected BM were incorporated into the RT planning system and elastic fused with planning imaging. The CST was delineated as the planning risk volume (PRV-FTTMS). Fractionated stereotactic intensity-modulated RT (IMRT) plans (7 x 5 Gy) were retrospectively calculated and then optimized to preserve PRV-FTTMS. Areas covered by the planning target volume (PTV) were not spared (overlap).
RESULTS
In regular plans mean dose (Dmean) of complete PRV-FTTMS was 5.4 ± 2.5 Gy. Regarding PRV-FTTMS portions within the 8.75 Gy (25% of prescription dose) isodose level Dmean was 18.2 ± 4.3 Gy and after plan optimization 13.1 ± 3.8Gy (-28.0%, p < 0.001). Within the 17.5 Gy (50%) isodose line PRV-FTTMS Dmean was reduced by 31.7% from 24.3 ± 3 Gy to 16.6 ± 4.8 Gy (p< 0.001). There was no decline of the effective treatment dose, PTV Dmean in regular plans was 36.9 ± 0.7 Gy vs. 37.7 ± 1.4Gy (p=0.013) after adaption. PTV coverage (V35Gy(%)*100) did not change with plan optimization: 0.99 vs. 0.99 (p=0.43). Dose constraints of organs at risk were all met both in regular and optimized plans.
CONCLUSION
DTI-FTTMS based motor tracts could be implemented in the adjuvant stereotactic RT planning of cavities after resection of BM. A significant dose reduction of motor structures within critical dose levels seems possible without reducing PTV treatment dose. However, the functional benefit needs to be investigated prospectively within clinical trials.
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Affiliation(s)
- Christian Diehl
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM) , 81675 Munich , Germany
| | | | - Martin Mißlbeck
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM) , 81675 Munich , Germany
| | - Maximilian Schwendner
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM) , 81675 Munich , Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM) , 81675 Munich , Germany
| | - Kerstin Eitz
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM) , 81675 Munich , Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM) , 81675 Munich , Germany
| | - Sebastian Ille
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM) , 81675 Munich , Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM) , 81675 Munich , Germany
| | - Stephanie Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM) , Munich , Germany
| | - Sandro Krieg
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM) , 81675 Munich , Germany
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