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: | , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
1 March 2019
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| 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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| 245 | 1 | 0 | |a Pre-operative versus post-operative radiosurgery of brain metastases - volumetric and dosimetric impact of treatment sequence and margin concept |c 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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| 520 | |a 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. | ||
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