Journal article
Single-Fraction Versus Fractionated Preoperative Radiosurgery for Resected Brain Metastases: A PROPS-BM International Multicenter Cohort Study
International journal of radiation oncology, biology, physics, Vol.118(3), pp.650-661
03/01/2024
DOI: 10.1016/j.ijrobp.2023.09.012
PMID: 37717787
Abstract
Preoperative stereotactic radiosurgery (SRS) is a feasible alternative to postoperative SRS for resected brain metastases (BM). Most reported studies of preoperative SRS used single-fraction SRS (SF-SRS). The goal of this study was to compare outcomes and toxicity of preoperative SF-SRS with multifraction (3-5 fractions) SRS (MF-SRS) in a large international multicenter cohort (Preoperative Radiosurgery for Brain Metastases-PROPS-BM).
Patients with BM from solid cancers, of which at least 1 lesion was treated with preoperative SRS followed by planned resection, were included from 8 institutions. SRS to synchronous intact BM was allowed. Exclusion criteria included prior or planned whole brain radiation therapy. Intracranial outcomes were estimated using cumulative incidence with competing risk of death. Propensity score matched (PSM) analyses were performed.
The study cohort included 404 patients with 416 resected index lesions, of which SF-SRS and MF-SRS were used for 317 (78.5%) and 87 patients (21.5%), respectively. Median dose was 15 Gy in 1 fraction for SF-SRS and 24 Gy in 3 fractions for MF-SRS. Univariable analysis demonstrated that SF-SRS was associated with higher cavity local recurrence (LR) compared with MF-SRS (2-year: 16.3% vs 2.9%; P = .004), which was also demonstrated in multivariable analysis. PSM yielded 81 matched pairs (n = 162). PSM analysis also demonstrated significantly higher rate of cavity LR with SF-SRS (2-year: 19.8% vs 3.3%; P = .003). There was no difference in adverse radiation effect, meningeal disease, or overall survival between cohorts in either analysis.
Preoperative MF-SRS was associated with significantly reduced risk of cavity LR in both the unmatched and PSM analyses. There was no difference in adverse radiation effect, meningeal disease, or overall survival based on fractionation. MF-SRS may be a preferred option for neoadjuvant radiation therapy of resected BMs. Additional confirmatory studies are needed. A phase 3 randomized trial of single-fraction preoperative versus postoperative SRS (NRG-BN012) is ongoing (NCT05438212).
Details
- Title: Subtitle
- Single-Fraction Versus Fractionated Preoperative Radiosurgery for Resected Brain Metastases: A PROPS-BM International Multicenter Cohort Study
- Creators
- Roshan S Prabhu - Southeast Radiation Oncology GroupTobi Akinyelu - Levine Cancer InstituteZachary K Vaslow - Cone HealthJennifer K Matsui - The Ohio State UniversityNeda Haghighi - Peter MacCallum Cancer CentreTu Dan - The University of Texas Southwestern Medical CenterMark V Mishra - University of Maryland, BaltimoreErin S Murphy - Cleveland ClinicSusan Boyles - Cone HealthHaley K Perlow - The Ohio State UniversityJoshua D Palmer - The Ohio State UniversityCristian Udovicich - Peter MacCallum Cancer CentreToral R Patel - The University of Texas Southwestern Medical CenterZabi Wardak - The University of Texas Southwestern Medical CenterGraeme F Woodworth - University of Maryland, BaltimoreAlexander Ksendzovsky - University of Maryland, BaltimoreKailin Yang - Cleveland ClinicSamuel T Chao - Cleveland ClinicAnthony L Asher - Levine Cancer InstituteStuart H Burri - Southeast Radiation Oncology Group
- Resource Type
- Journal article
- Publication Details
- International journal of radiation oncology, biology, physics, Vol.118(3), pp.650-661
- DOI
- 10.1016/j.ijrobp.2023.09.012
- PMID
- 37717787
- ISSN
- 0360-3016
- eISSN
- 1879-355X
- Language
- English
- Date published
- 03/01/2024
- Academic Unit
- Radiation Oncology
- Record Identifier
- 9984696562102771
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