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Preoperative stereotactic radiosurgery of brain metastases
EANS Academy. Golanov A. Sep 26, 2019; 276039; EP03081
Abstract
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Preoperative stereotactic radiosurgery (pre-SRS) is a new advancement in a strategy for treating brain metastases (BM). The purpose of the analysis is to assess local control, overall survival and toxicity for 48 patients with brain metastases who had preoperative SRS, followed by surgical resection. 39 of them are available for analysis. 3 patients, who died in early postoperative period, 3 patients who had non-metastatic morphology, and 3 who also had lesions of other localization — were excluded. 21 patients had only one lesion, and 18 patients had multiple metastases to the brain (the number of metastases ranged from 2 to 7). 9 patients had NSCLC, 10 - breast cancer, 7 melanoma, 6 - kidney cancer, and 7 had others.
The average target volume for combined treatment was 12 cc (4 - 57 cc). Median target dose was 19 Gy (12-24 Gy)
All patients underwent radiosurgery without any neurological deterioration and with subsequent surgical resection, which was performed within 48 hours (Me = 24 hours). The mean follow-up was 11.3 months. During the observation period, the postoperative cavity in 27 of 39 patients had no signs of post-radiation changes in perifocal tissues. Local relapses were detected in 3 cases: 6, 12 and 17 months after treatment. Cumulative incidence after 6 months and 1 year was as follows: local control of the cavity was 95.7% and 89.3%, respectively. The median overall survival (OS) and 6/12 months of OS were 17.1 months and 77.8%/62.5%, respectively. Radionecrosis was present in 3 observations at the time of observation.
Conclusion: Preliminary SRS provides excellent local cavity control with a low risk of adverse radiation exposure. Pre-SRS in patients with relatively large brain metastases has several potential advantages compared with postoperative SRS, including higher efficacy, patient comfort, cost effectiveness, and reduced risk of necrosis and leptomenengial dissemination.
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