PMID- 26528673
OWN - NLM
STAT- MEDLINE
DCOM- 20171106
LR  - 20220409
IS  - 1524-4040 (Electronic)
IS  - 0148-396X (Linking)
VI  - 79
IP  - 2
DP  - 2016 Aug
TI  - Comparing Preoperative With Postoperative Stereotactic Radiosurgery for 
      Resectable Brain Metastases: A Multi-institutional Analysis.
PG  - 279-85
LID - 10.1227/NEU.0000000000001096 [doi]
AB  - BACKGROUND: Stereotactic radiosurgery (SRS) is an increasingly common modality 
      used with surgery for resectable brain metastases (BM). OBJECTIVE: To present a 
      multi-institutional retrospective comparison of outcomes and toxicities of 
      preoperative SRS (Pre-SRS) and postoperative SRS (Post-SRS). METHODS: We reviewed 
      the records of patients who underwent resection of BM and either Pre-SRS or 
      Post-SRS alone between 2005 and 2013 at 2 institutions. Pre-SRS used a 
      dose-reduction strategy based on tumor size, with planned resection within 48 
      hours. Cumulative incidence with competing risks was used to determine estimated 
      rates. RESULTS: A total of 180 patients underwent surgical resection for 189 BM: 
      66 (36.7%) underwent Pre-SRS and 114 (63.3%) underwent Post-SRS. Baseline patient 
      characteristics were balanced except for higher rates of performance status 0 
      (62.1% vs 28.9%, P < .001) and primary breast cancer (27.2% vs 10.5%, P = .010) 
      for Pre-SRS. Pre-SRS had lower median planning target volume margin (0 mm vs 2 
      mm) and peripheral dose (14.5 Gy vs 18 Gy), but similar gross tumor volume (8.3 
      mL vs 9.2 mL, P = .85). The median imaging follow-up period was 24.6 months for 
      alive patients. Multivariable analyses revealed no difference between groups for 
      overall survival (P = .1), local recurrence (P = .24), and distant brain 
      recurrence (P = .75). Post-SRS was associated with significantly higher rates of 
      leptomeningeal disease (2 years: 16.6% vs 3.2%, P = .010) and symptomatic 
      radiation necrosis (2 years: 16.4% vs 4.9%, P = .010). CONCLUSION: Pre-SRS and 
      Post-SRS for resected BM provide similarly favorable rates of local recurrence, 
      distant brain recurrence, and overall survival, but with significantly lower 
      rates of symptomatic radiation necrosis and leptomeningeal disease in the Pre-SRS 
      cohort. A prospective clinical trial comparing these treatment approaches is 
      warranted. ABBREVIATIONS: BM, brain metastasesCI, confidence intervalCTV, 
      clinical target volumeDBR, distant brain recurrenceGTV, gross tumor volumeLC, 
      local controlLMD, leptomeningeal diseaseLR, local recurrenceMVA, multivariable 
      analysisOS, overall survivalPost-SRS, postoperative stereotactic 
      radiosurgeryPre-SRS, preoperative stereotactic radiosurgeryPTV, planning target 
      volumeRN, radiation necrosisSRN, symptomatic radiation necrosisSRS, stereotactic 
      radiosurgeryWBRT, whole-brain radiation therapy.
FAU - Patel, Kirtesh R
AU  - Patel KR
AD  - *Department of Radiation Oncology and Winship Cancer Institute, Emory University, 
      Atlanta, Georgia; double daggerSoutheast Radiation Oncology Group, Levine Cancer Institute, 
      Carolinas Healthcare System, Charlotte, North Carolina;  section signCarolina Neurosurgery 
      and Spine Associates, Levine Cancer Institute, Charlotte, North Carolina; 
       paragraph signBiostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, 
      Emory University, Atlanta, Georgia;  ||Department of Neurological Surgery, Emory 
      University, Atlanta, Georgia.
FAU - Burri, Stuart H
AU  - Burri SH
FAU - Asher, Anthony L
AU  - Asher AL
FAU - Crocker, Ian R
AU  - Crocker IR
FAU - Fraser, Robert W
AU  - Fraser RW
FAU - Zhang, Chao
AU  - Zhang C
FAU - Chen, Zhengjia
AU  - Chen Z
FAU - Kandula, Shravan
AU  - Kandula S
FAU - Zhong, Jim
AU  - Zhong J
FAU - Press, Robert H
AU  - Press RH
FAU - Olson, Jeffery J
AU  - Olson JJ
FAU - Oyesiku, Nelson M
AU  - Oyesiku NM
FAU - Wait, Scott D
AU  - Wait SD
FAU - Curran, Walter J
AU  - Curran WJ
FAU - Shu, Hui-Kuo G
AU  - Shu HK
FAU - Prabhu, Roshan S
AU  - Prabhu RS
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
SB  - IM
CIN - Int J Radiat Oncol Biol Phys. 2018 Mar 1;100(3):535-538. PMID: 29413262
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Brain Neoplasms/*radiotherapy/secondary/*surgery
MH  - Breast Neoplasms/pathology
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Recurrence, Local/epidemiology
MH  - *Postoperative Care
MH  - *Preoperative Care
MH  - *Radiosurgery
MH  - Retrospective Studies
EDAT- 2015/11/04 06:00
MHDA- 2017/11/07 06:00
CRDT- 2015/11/04 06:00
PHST- 2015/11/04 06:00 [entrez]
PHST- 2015/11/04 06:00 [pubmed]
PHST- 2017/11/07 06:00 [medline]
AID - 10.1227/NEU.0000000000001096 [doi]
PST - ppublish
SO  - Neurosurgery. 2016 Aug;79(2):279-85. doi: 10.1227/NEU.0000000000001096.