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

• Verfasst von: El-Shafie, Rami [VerfasserIn]
• Verfasst von: Tonndorf-Martini, Eric [VerfasserIn]
• Verfasst von: Schmitt, Daniela [VerfasserIn]
• Verfasst von: Kronsteiner, Dorothea [VerfasserIn]
• Verfasst von: Celik, Aylin [VerfasserIn]
• Verfasst von: Dresel, Thorsten [VerfasserIn]
• Verfasst von: Bernhardt, Denise [VerfasserIn]
• Verfasst von: Uzun-Lang, Kristin [VerfasserIn]
• Verfasst von: Hoegen-Saßmannshausen, Philipp [VerfasserIn]
• Verfasst von: Adeberg, Sebastian [VerfasserIn]
• Verfasst von: Paul, Angela [VerfasserIn]
• Verfasst von: Debus, Jürgen [VerfasserIn]
• Verfasst von: Rieken, Stefan [VerfasserIn]
• Titel: Pre-operative versus post-operative radiosurgery of brain metastases - volumetric and dosimetric impact of treatment sequence and margin concept
• Verf.angabe: 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
• E-Jahr: 2019
• Jahr: 1 March 2019
• Umfang: 18 S.
• Fussnoten: Gesehen am 16.10.2019
• Titel Quelle: Enthalten in: Cancers
• Ort Quelle: Basel : MDPI, 2009
• Jahr Quelle: 2019
• Band/Heft Quelle: 11(2019,3) Artikel-Nummer 294, 18 Seiten
• ISSN Quelle: 2072-6694
• DOI: doi:10.3390/cancers11030294
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: metastases
• Sach-SW: neurosurgery
• Sach-SW: radiation therapy
• Sach-SW: radiosurgery
• Sach-SW: radiotherapy
• Sach-SW: stereotactic
• Sach-SW: tumor
• K10plus-PPN: 1679012967
• K10plus-PPN:
  Universitätsbibliothek
• Lokale URL UB: Zum Volltext

Abstract

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.