Central Nervous System

PV QA 2 - Poster Viewing Q&A 2

MO_1_2483 - Post-operative cavity radiation therapy with standard fractionation for brain metastases

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Post-operative cavity radiation therapy with standard fractionation for brain metastases
J. Byrne1, H. A. Shih2, J. S. Loeffler3, and K. S. Oh4; 1Harvard Radiation Oncology Program, Boston, MA, 2Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 3Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, 4Massachusetts General Hospital, Boston, MA

Purpose/Objective(s): Postoperative radiation therapy to the surgical cavity is emerging as a common alternative to whole brain radiation therapy (WBRT) as a means to reduce the risk of local failure. Single-fraction and hypofractionated approaches to cavity radiation have been associated with failure rates as high as 20-30% in randomized trials. We propose an alternative strategy of standard fractionation (3 Gy/fraction) to the surgical cavity with the goal of allowing generous volumes, maximizing local control, and minimizing risk of late radionecrosis.

Materials/Methods: Patients with brain metastases who underwent radiation treatment to 30-39 Gy in 3 Gy/fraction regimens to surgical cavity were retrospectively identified. Data collected included time to local recurrence, distant brain recurrence, late radionecrosis, and overall survival.

Results: Between April 2012 and September 2017, 45 patients were identified for analysis. Median follow-up was 6 months. Three patients were lost to follow-up within 6 months. The 6-month actuarial risks of local failure and distant failure were 7% and 30%, respectively. Three patients experienced a local failure at 4, 6, and 22 months. Of these, the histologies were colorectal adenocarcinoma (N = 1) and breast adenocarcinoma (N = 2). The 6-month overall survival was 76%. The median overall survival was 32 months. There were no events of radionecrosis.

Conclusion: Post-operative cavity radiation therapy with standard fractionation results in very low risks of local recurrence and late radionecrosis. This may represent a safe and straightforward alternative to postoperative stereotactic radiosurgery and WBRT.

Author Disclosure: J. Byrne: Employee; Tufts Medical Center. Independent Contractor; Advanced Chemotherapy Technologies. Stock; Advanced Chemotherapy Technologies. H.A. Shih: Employee; Dartmouth Hitchcock. Honoraria; UpToDate. Chief, CNS & Eye Radiat Oncol Services; Massachusetts General Hospital. Associate Medical Director; MGH Proton Therapy Center. Associate Director; Harvard Radiation Oncology Program. J.S. Loeffler: Employee; Massachusetts General Hospital. K.S. Oh: Research Grant; Elekta, Merck & Co., Inc. CME editor; IJROBP.

James Byrne, MD, PhD

Presentation(s):

Send Email for James Byrne


Assets

MO_1_2483 - Post-operative cavity radiation therapy with standard fractionation for brain metastases



Attendees who have favorited this

Please enter your access key

The asset you are trying to access is locked. Please enter your access key to unlock.

Send Email for Post-operative cavity radiation therapy with standard fractionation for brain metastases