scholarly journals Impact of clinical and pathological factors on local recurrence after breast-conserving treatment: CT-based localization for a tumor bed boost yielded better local control when compared with a surgical scar

2019 ◽  
Vol 10 (3) ◽  
pp. 708-715 ◽  
Author(s):  
Lize Wang ◽  
Jinfeng Li ◽  
Tianfeng Wang ◽  
Yuntao Xie ◽  
Zhaoqing Fan ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Local Control ◽  
Breast Conserving Treatment ◽  
Surgical Scar ◽  
Tumor Bed ◽  
Tumor Bed Boost

scholarly journals Early Gamma Knife stereotactic radiosurgery to the tumor bed of resected brain metastasis for improved local control

2014 ◽  
Vol 121 (Suppl_2) ◽  
pp. 69-74 ◽  
Author(s):  
Christian Iorio-Morin ◽  
Laurence Masson-Côté ◽  
Youssef Ezahr ◽  
Jocelyn Blanchard ◽  
Annie Ebacher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Local Recurrence ◽  
Brain Metastasis ◽  
Local Control ◽  
Surgical Removal ◽  
Survival Times ◽  
Tumor Bed ◽  
Radiation Induced ◽  
Lower Maximum

ObjectOptimal case management after surgical removal of brain metastasis remains controversial. Although postoperative whole-brain radiation therapy (WBRT) has been shown to prevent local recurrence and decrease deaths, this modality can substantially decrease neurocognitive function and quality of life. Stereotactic radiosurgery (SRS) can theoretically achieve the same level of local control with fewer side effects, although studies conclusively demonstrating such outcomes are lacking. To assess the effectiveness and safety profile of tumor bed SRS after resection of brain metastasis, the authors performed a retrospective analysis of 110 patients who had received such treatment at the Centre Hospitalier Universitaire de Sherbrooke. They designed the study to identify risk factors for local recurrence and placed special emphasis on factors that could potentially be addressed.MethodsPatients who had received treatment from 2004 through 2013 were included if they had undergone surgical removal of 1 or more brain metastases and if the tumor bed was treated by SRS regardless of the extent of resection or prior WBRT. All cases were retrospectively analyzed for patient and tumor-specific factors, treatment protocol, adverse outcomes, cavity outcomes, and survival for as long as follow-up was available. Univariate and multivariate Cox regression analyses were performed to identify risk factors for local recurrence and predictors of increased survival times.ResultsMedian patient age at first SRS treatment was 58 years (range 37–84 years). The most frequently diagnosed primary tumor was non–small cell lung cancer. The rate of gross-total resection was 81%. The median Karnofsky Performance Scale score was 90%. Tumor bed SRS was performed at a median of 3 weeks after surgery. Median follow-up and survival times were 10 and 11 months, respectively. Actuarial local control of the cavity at 12 months was 73%; median time to recurrence was 6 months. According to multivariate analysis, risk factors for recurrence were a longer surgery-to-SRS delay (HR 1.625, p = 0.003) and a lower maximum radiation dose delivered to the cavity (HR 0.817, p = 0.006). Factors not associated with increased recurrence were subtotal or piecemeal resections, prior WBRT, histology of the primary tumor, and larger cavity volume. No factors predictive of survival were identified. Symptomatic radiation-induced enhancement occurred in 6% of patients and leptomeningeal dissemination in 11%. Pathologically confirmed radiation-induced necrosis occurred in 1 (0.9%) patient.ConclusionsAdjuvant tumor bed SRS after the resection of brain metastasis is a valuable alternative to adjuvant WBRT. Risk factors for local recurrence are lower maximum radiation dose and a surgery-to-SRS delay longer than 3 weeks. Outcomes were not worse for patients who had undergone prior WBRT and subtotal or piecemeal resections. Pending the results of prospective randomized controlled trials, the authors' study supports the safety and efficacy of adjuvant SRS after resection of brain metastasis. SRS should be performed as early as possible, ideally within 3 weeks of the surgery.

TUMOR BED RADIOSURGERY AFTER RESECTION OF CEREBRAL METASTASES

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. 817-824 ◽  
Author(s):  
David Mathieu ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
David Fortin ◽  
Brendan Kenny ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Recurrence ◽  
Brain Metastases ◽  
Local Control ◽  
Systemic Disease ◽  
Tumor Resection ◽  
Karnofsky Performance Scale ◽  
Tumor Bed ◽  
Whole Brain Radiation ◽  
Academic Medical

Abstract OBJECTVE Adjuvant irradiation after resection of brain metastases reduces the risk of local recurrence. Whole-brain radiation therapy can be associated with significant neurotoxicity in long-term survivors of brain metastases. This retrospective study evaluates the role of tumor bed stereotactic radiosurgery as an alternative method of irradiation after initial resection of brain metastases to prevent local recurrence. METHODS Forty patients underwent tumor bed radiosurgery after resection of brain metastases at two separate academic medical centers. The median age was 59.5 years. Twenty patients (67.5%) had single metastases. Resection was complete in 80% and partial in 20% of the patients. At the time of radiosurgery, systemic disease was active in 57.5%, inactive in 32.5%, and in remission in 10% of the patients. The median Karnofsky Performance Scale score was 80% (range, 60–100%). Radiosurgery was performed a median of 4 weeks after tumor resection. The median cavity radiosurgery volume was 9.1 ml (range, 0.6–39.9 ml). The median margin and maximum radiation dose were 16 and 32 Gy, respectively. RESULTS Local control at the resection site was achieved in 73% of patients at a median follow-up period of 13 months. No variable significantly affected local control. New remote brain metastases occurred in 54% of the patients. Symptomatic radiation effect was seen in 5.4% of the patients. The median survival was 13 months after radiosurgery (range, 2–56 mo). CONCLUSION Tumor bed radiosurgery provides effective local control of the tumor after resection in most patients. These preliminary data support radiosurgery after resection rather than traditional radiation therapy.

Reduced‐volume tumor‐bed boost is not associated with inferior local control and survival outcomes in high‐risk medulloblastoma

2019 ◽  
Vol 67 (1) ◽  
Author(s):  
Sibo Tian ◽  
Lisa J. Sudmeier ◽  
Chao Zhang ◽  
Nicholas A. Madden ◽  
Zachary S. Buchwald ◽  
...  
Keyword(s):  
High Risk ◽  
Local Control ◽  
Survival Outcomes ◽  
Tumor Bed ◽  
Reduced Volume ◽  
Tumor Bed Boost
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