SURG-02 - Clark Chen.mp4

Stereotactic Laser Ablation (SLA) followed by consolidation stereotactic radiosurgery (SRS) as a treatment strategy for brain metastasis that recurred locally after initial radiosurgery (BMRS): a collaborative institutional experience

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Isabela Pena-Pino1, Jun Ma1, Yusuki Hori2, Elena Fomchenko3, Kathryn Dusenbery1, Margaret Reynolds1, Christopher Wilke1, Jianling Yuan1, Gene Barnett2, Veronica Chiang3, Alireza Mohammadi2, Clark Chen1

1University of Minnesota, MN, USA. 2Cleveland Clinic, Ohio, USA. 3Yale Medical Center, CT, USA

Introduction: In independent clinical trials, ~30% of brain metastases recur locally after radiosurgery (BMRS). For these lesions, treatment with stereotactic laser ablation (SLA, also known as laser interstitial thermal therapy (LITT)) alone achieves a 12-month local control (LC12) of 54-85% while repeat SRS achieved LC12 of 54-79%. Here, we report favorable outcomes for BMRS treated with SLA followed by consolidation radiosurgery (SLA/cSRS).

Methods: Clinical outcome of 18 patients with 19 histologically confirmed BMRS treated with SLA followed by consolidation SRS and >3 months follow-up were collected retrospectively across three institutions. Local control was defined as stability or decrease in contrast-enhancing (CE) and FLAIR volume.

Results: SLA achieved ablation of 73-100% of the BMRS CE volumes. Consolidation hypo-fractionated radiosurgery (5 Gy x 5 or 6 Gy x 5) was carried out 16-40 days post-SLA (median of 26 days). With a median follow-up of 185 days (range: 93-1367 days) and median overall survival (OS) of 185 days (range: 99-1367 days), 100% LC12 was achieved. 13/18 (72%) patients that required steroid therapy prior to SLA/cSRS were successfully weaned off steroid by three months post-SLA/cSRS. Post-SLA, KPS declined for 3/19 (16%) patients and improved for 1/19 (5%) patients. No KPS changes occurred subsequent to consolidation SRS. There were no 30-day mortalities or wound complications. Two patients required re-admission within 30 days of SRS (severe headache that resolved with steroid therapy (n=1) and new-onset seizure (n=1)). Except for two patients who suffered histologically confirmed, local failure at 649 and 899 days, all other patients are either alive (n=5) or died from systemic disease progression (n=11). None of the treated patients developed symptomatic radiation necrosis.

Duration: 05:13

Posted: Monday, August 16, 2021

Video tags: 3rd Annual Conference on Brain Metastases - Pre-Records