Miriam Knoll MD, Presenter: Nothing to Disclose

Seth Blacksburg MD, MBA, Abstract Co-Author: Speakers Bureau, Bayer AG

Isabelle Germano MD, Abstract Co-Author: Nothing to Disclose

Blagoja Todorov, Abstract Co-Author: Nothing to Disclose

Kathleen Maloney-Lutz RN, Abstract Co-Author: Nothing to Disclose

Yeh-Chi Lo PhD, Abstract Co-Author: Nothing to Disclose

Sheryl Green MD, Abstract Co-Author: Advisory Board, Toshiba Corporation

Tumor histology plays an important role in the local control of lesions treated with surgery or radiation. The aim of this retrospective study was to evaluate local control of brain metastases arising from tumors of relatively radioresistant histologies, treated with surgical resection followed by a SRS boost. 

We reviewed all patients (pts) with brain metastases arising from primary tumors considered to be relatively radioresistent, i.e. RCC and melanoma, who were treated with surgical resection followed by SRS boost to the surgical cavity. We recorded the radiographic local tumor control of the treated lesion and regional progression in the brain outside the treated lesion. IRB approval was obtained.

Thirteen lesions in 11 pts received SRS boost after surgical resection at a median lapsed time between surgery and SRS of 1.4 months (mos). Eight lesions received one fraction with a median dose of 17 Gy. 5 lesions received 25 Gy in 5 fractions. Median radiographic follow up was 18.5 mos after SRS (range 1.6-34.6), and utilized MRI/CT in 11/2 lesions, respectively. Two lesions demonstrated local failure occurring at 14.0 and 18.2 mos after SRS; both recurrent lesions were melanoma metastases treated with 25 Gy in 5 fractions. Seven pts experienced progression elsewhere in the brain and were treated with SRS (3 pts) and 3 additional pts (27%) were treated with whole brain radiation therapy. In patients with a minimum follow up of 12 mos (64%) or 18 mos (55%), local control was 100% at 12 mos and 85% at 18 mos. Two pts (15%) with melanoma developed hemorrhage in the treated surgical bed at 6 and 28 days after SRS; 1 of these patients required surgical intervention.

Our results demonstrate that local control can be achieved in the treatment of brain metastases arising from RCC or melanoma utilizing SRS boost following surgical resection. A randomized clinical trial is needed to confirm these findings and to establish a standard of care.

SRS boost after surgical resection can achieve local control of radioresistent tumor metastases, i.e. RCC and melanoma.

Knoll, M, Blacksburg, S, Germano, I, Todorov, B, Maloney-Lutz, K, Lo, Y, Green, S, Stereotactic Radiosurgery Boost to the Surgical Cavity after Surgical Resection of Renal Cell Carcinoma (RCC) or Melanoma Brain Metastases: Radiographic Review of Tumor Loco-regional Control.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014002.html