Journal article
Preoperative Radiosurgery for Resected Brain Metastases: The PROPS-BM Multicenter Cohort Study
International journal of radiation oncology, biology, physics, Vol.111(3), pp.764-772
11/01/2021
DOI: 10.1016/j.ijrobp.2021.05.124
PMID: 34058254
Abstract
Preoperative radiosurgery (SRS) is a feasible alternative to postoperative SRS, with potential benefits in adverse radiation effect (ARE) and leptomeningeal disease (LMD) relapse. However, previous studies are limited by small patient numbers and single-institution designs. Our aim was to evaluate preoperative SRS outcomes and prognostic factors from a large multicenter cohort (Preoperative Radiosurgery for Brain Metastases [PROPS-BM]).
Patients with brain metastases (BM) from solid cancers who had at least 1 lesion treated with preoperative SRS and underwent a planned resection were included from 5 institutions. SRS to synchronous intact BM was allowed. Radiographic meningeal disease (MD) was categorized as either nodular or classical "sugarcoating" (cLMD).
The cohort included 242 patients with 253 index lesions. Most patients (62.4%) had a single BM, 93.7% underwent gross total resection, and 98.8% were treated with a single fraction to a median dose of 15 Gray to a median gross tumor volume of 9.9 cc. Cavity local recurrence (LR) rates at 1 and 2 years were 15% and 17.9%, respectively. Subtotal resection (STR) was a strong independent predictor of LR (hazard ratio, 9.1; P < .001). One and 2-year rates of MD were 6.1% and 7.6% and of any grade ARE were 4.7% and 6.8% , respectively. The median overall survival (OS) duration was 16.9 months and the 2-year OS rate was 38.4%. The majority of MD was cLMD (13 of 19 patients with MD; 68.4%). Of 242 patients, 10 (4.1%) experienced grade ≥3 postoperative surgical complications.
To our knowledge, this multicenter study represents the largest cohort treated with preoperative SRS. The favorable outcomes previously demonstrated in single-institution studies, particularly the low rates of MD and ARE, are confirmed in this expanded multicenter analysis, without evidence of an excessive postoperative surgical complication risk. STR, though infrequent, is associated with significantly worse cavity LR. A randomized trial between preoperative and postoperative SRS is warranted and is currently being designed.
Details
- Title: Subtitle
- Preoperative Radiosurgery for Resected Brain Metastases: The PROPS-BM Multicenter Cohort Study
- Creators
- Roshan S Prabhu - Southeast Radiation Oncology GroupReshika Dhakal - Levine Cancer InstituteZachary K Vaslow - Cone HealthTu Dan - The University of Texas Southwestern Medical CenterMark V Mishra - University of Maryland, BaltimoreErin S Murphy - Cleveland ClinicToral R Patel - The University of Texas Southwestern Medical CenterAnthony L Asher - Carolina Neurosurgery and Spine AssociatesKailin Yang - Cleveland ClinicMatthew A Manning - Cone HealthJoseph D SternAnkur R Patel - Baylor UniversityZabi Wardak - The University of Texas Southwestern Medical CenterGraeme F Woodworth - University of Maryland, BaltimoreSamuel T Chao - Cleveland ClinicAlireza Mohammadi - Cleveland ClinicStuart H Burri - Southeast Radiation Oncology Group
- Resource Type
- Journal article
- Publication Details
- International journal of radiation oncology, biology, physics, Vol.111(3), pp.764-772
- DOI
- 10.1016/j.ijrobp.2021.05.124
- PMID
- 34058254
- ISSN
- 0360-3016
- eISSN
- 1879-355X
- Language
- English
- Date published
- 11/01/2021
- Academic Unit
- Radiation Oncology
- Record Identifier
- 9984696573402771
Metrics
1 Record Views