Tuesday, September 22, 2015

A new option for brain mets...Involved-field fractionated radiotherapy - a step between SRS and WBR

Resection Followed by Involved-Field Fractionated Radiotherapy in the Management of Single Brain Metastasis.  Shim, Vatner, Tam, et al.  Frontiers of Oncology.  Sept 2015. 
We expanded upon our previous experience using involved-field fractionated radiotherapy (IFRT) as an alternative to whole brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS) for patients with surgically resected brain metastases.

All patients with single brain metastases who underwent surgical resection followed by IFRT at our institution from 2006-2013 were evaluated. Local recurrence-free survival, distant failure-free survival and overall survival were determined. Analyses were performed associating clinical variables with:  local recurrence, distant failure, salvage approaches and toxicity of treatment for each patient.

Median follow-up was 19.1 months. Fifty-six patients were treated with a median dose of 40.05 Gy/15 fractions with IFRT to the resection cavity. Local recurrence-free survival was 91.4%, distant failure-free survival was 68.4%, and overall survival was 77.7% at 12 months. No variables were associated with increased local recurrence, however melanoma histopathology and infratentorial
[below the membrane that divides the celebellum from the cerebrum...a so called eloquent area of the brain] location were associated with distant failure on multivariate analysis. Local recurrences were salvaged in 5/8 patients, and distant failures were salvaged in 24/29 patients. Two patients developed radionecrosis.

Adjuvant IFRT is feasible and safe for well-selected patients with surgically resected single brain metastases. Acceptable rates of local control and salvage of distal intracranial recurrences continue to be achieved with continued follow-up." 

Thoughts:  These numbers look pretty good, though IFRT is addressed through only in 56 patients and there is no documented comparison between results of SRS and WBR vs IFRT noted here.  There is no mention of cognition post procedure as compared to patient's ability before.  And...while brain mets here were clearly due to a variety of cancers...leave it to melanoma to be the bad boy in the room.  At any rate, perhaps it will at least come to be one more option that folks with brain mets can think about with their doc.

Best - c

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