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Journal of Neurosurgical Sciences 2020 Feb 04

DOI: 10.23736/S0390-5616.20.04830-4

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Postoperative stereotactic radiosurgery and hypofractionated radiotherapy for brain metastases using Gamma Knife and CyberKnife: a dual-center analysis

Jens KÜBLER 1, Michael WESTER-EBBINGHAUS 1, Frederik WENZ 2, Florian STIELER 1, Bastian BATHEN 3, 4, Sabine K. MAI 1, Robert WOLFF 3, 5, Daniel HÄNGGI 6, Oliver BLANCK 3, 7, Frank GIORDANO 1

1 Department of Radiation Oncology, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 2 University Hospital Freiburg, Freiburg, Germany; 3 Saphir Radiosurgery Center Frankfurt, Frankfurt am Main, Germany; 4 Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany; 5 Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany; 6 Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 7 Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany



BACKGROUND: Postoperative stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (hFSRT) to tumor cavities is emerging as a new standard of care after resection of brain metastases. Both Gamma Knife (GK) and CyberKnife (CK) are modalities commonly used for stereotactic radiotherapy, but fractional schemes are not consistent. The objective of this study was to evaluate outcomes in patients receiving postoperative stereotactic radiotherapy of resected brain metastases (BM) using different fractionation schedules and modalities in two large centers.
METHODS: Patients with newly diagnosed BM who underwent postoperative SRS or hFSRT with either GK or CK at two large cancer centers were retrospectively evaluated. We analyzed local control (LC), regional control (RC) and overall survival (OS).
RESULTS: From 04/14 to 05/18 79 patients with 81 resection cavities were treated. Forty-seven patients (59.5%) received GK and 32 patients (40.5%) received CK treatment. Fifty-four cavities (66.7%) were treated with hFSRT and 27 (33.3%) with SRS. The most common hFSRT and SRS scheme was 3x10 Gy and 1x16 Gy, respectively. Median OS was 11.7 months with survival rates of 44.7% at 1 year and 18.5% at 2 years. LC was 83.3% after 1 year. Median time to regional progression was 12.0 months with RC rates of 61.1% at 6 months and 41.0% at 12 months. There was no difference in OS, LC or RC between GK and CK treatments or SRS and hFSRT.
CONCLUSIONs: Both SRS and hFSRT provide high local control rates in resected BM regardless of the applied modality.


KEY WORDS: Stereotactic radiotherapy; Brain metastases; Postoperative radiotherapy; Radiosurgery; Gamma Knife; CyberKnife

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