Neoadjuvant And Adjuvant Radiosurgery For Treatment Of Large Metastatic Brain Tumors: The Comparative Results To Adjuvant Wbrt

Hee Jong Chang1, Won Suk Chang1, Hae Yoo Kim1, Yong Gou Park.1

1Yonsei University College of Medicine, Seoul, Korea.

Keywords: brain metastasis, radiosurgery, gamma knife, cancer, radiotherapy

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     It is well known that the surgery plus whole brain radiation therapy (WBRT) is superior to surgery only for metastatic brain tumors. However, we should defer WBRT as long as possible because we have only one chance of performing WBRT, which is only treatment option for miliary brain metastases or leptomeningeal carcinomatosis. Moreover, we should consider WBRT-related delayed neurotoxicity.
     We evaluated the treatment results of perioperative radiosurgery for large brain metastatic tumors.
     We treated 61 patients with Gamma knife radiosurgery before (n=21; Group 1) and after (n=40; Group 2) surgical resection. During same period, 65 patients with large brain metastases were treated by surgical resection followed by WBRT (Group 3). The mean patient age was 63 (35-70) years. The most common primary cancers were lung, colon, and breast.
     In Group 1, we did surgical resection within 1 week after radiosurgery, and in Group 2, we radiated the operative cavity within 1 week after operation. The mean treatment volume was 17.3 (13.5-65.2) mL, and the mean marginal dose was 17(15-20) Gy for Group 1 and 2.
     Overall, local control rate was 81% of patients. However, new intracranial metastases developed in 48 patients, and leptomeningeal carcinomatosis occurred in 19 patients. The median survival time was 18.1 months. We compared local control rate, new metastasis rate, cerebrospinal fluid (CSF) seeding rate, overall survival, and complication rate in theses 3 groups, and evaluated significant factors affecting the results.
     This is a retrospective study.
     Perioperative radiosurgery is effective in treating large metastatic brain tumors that needed surgical resection to avoid postoperative recurrence and to defer WBRT.
     However, there was higher incidence of CSF seeding in adjuvant GKS group. We should be cautious to decrease the CSF dissemination during surgical resection and include enough target volume during dose planning of radiosurgery.


Project Roles:

H. Chang (), W. Chang (), H. Kim (), Y. Park. ()