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Pre-operative versus post-operative radiosurgery of brain metastases - volumetric and dosimetric impact of treatment sequence and margin concept

Background: Pre-operative radiosurgery (SRS) preceding the resection of brain metastases promises to circumvent limitations of post-operative cavity SRS. It minimizes uncertainties regarding delineation and safety margins and could reduce dose exposure of the healthy brain (HB). Methods: We performe...

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Main Authors: El-Shafie, Rami (Author) , Tonndorf-Martini, Eric (Author) , Schmitt, Daniela (Author) , Kronsteiner, Dorothea (Author) , Celik, Aylin (Author) , Dresel, Thorsten (Author) , Bernhardt, Denise (Author) , Uzun-Lang, Kristin (Author) , Hoegen-Saßmannshausen, Philipp (Author) , Adeberg, Sebastian (Author) , Paul, Angela (Author) , Debus, Jürgen (Author) , Rieken, Stefan (Author)
Format: Article (Journal)
Language:English
Published: 1 March 2019
In: Cancers
Year: 2019, Volume: 11, Issue: 3
ISSN:2072-6694
DOI:10.3390/cancers11030294
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.3390/cancers11030294
Verlag, kostenfrei, Volltext: https://www.mdpi.com/2072-6694/11/3/294
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Author Notes:Rami A. El Shafie, Eric Tonndorf-Martini, Daniela Schmitt, Dorothea Weber, Aylin Celik, Thorsten Dresel, Denise Bernhardt, Kristin Lang, Philipp Hoegen, Sebastian Adeberg, Angela Paul, Jürgen Debus and Stefan Rieken
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Summary:Background: Pre-operative radiosurgery (SRS) preceding the resection of brain metastases promises to circumvent limitations of post-operative cavity SRS. It minimizes uncertainties regarding delineation and safety margins and could reduce dose exposure of the healthy brain (HB). Methods: We performed a systematic treatment plan comparison on 24 patients who received post-operative radiosurgery of the resection cavity at our institution. Comparative treatment plans were calculated for hypofractionated stereotactic radiotherapy (7 x 5 Gray (Gy)) in a hypothetical pre-operative (pre-op) and two post-operative scenarios, either with (extended field, post-op-E) or without the surgical tract (involved field, post-op-I). Detailed volumetric comparison of the resulting target volumes was performed, as well as dosimetric comparison focusing on targets and the HB. Results: The resection cavity was significantly smaller and different in morphology from the pre-operative lesion, yielding a low Dice Similarity Coefficient (DSC) of 53% (p = 0.019). Post-op-I and post-op-E targets showed high similarity (DSC = 93%), and including the surgical tract moderately enlarged resulting median target size (18.58 ccm vs. 22.89 ccm, p < 0.001). Dosimetric analysis favored the pre-operative treatment setting since it significantly decreased relevant dose exposure of the HB (Median volume receiving 28 Gy: 6.79 vs. 10.79 for pre-op vs. post-op-E, p < 0.001). Dosimetrically, pre-operative SRS is a promising alternative to post-operative cavity irradiation that could furthermore offer practical benefits regarding delineation and treatment planning. Comparative trials are required to evaluate potential clinical advantages of this approach.
Item Description:Gesehen am 16.10.2019
Physical Description:Online Resource
ISSN:2072-6694
DOI:10.3390/cancers11030294

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