MLTI-05- Jessica Wilcox.mp4

Adjuvant re-irradiation improves local control of surgically resected recurrent brain metastases

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Jessica Wilcox1, Samantha Brown1, Anne Reiner1, Robert Young1, Justin Chen2, Tejus Bale1, Marc Rosenblum1, William Newman3, Cameron Brennan1, Viviane Tabar1, Kathryn Beal1, Katherine Panageas1, Nelson Moss1

1Memorial Sloan Kettering Cancer Center, New York, NY, USA. 2Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA. 3Louisiana State University Health Shreveport, Shreveport, LA, USA

BACKGROUND: The efficacy of salvage resection (SR) of recurrent brain metastases (BrM) post-stereotactic radiosurgery (SRS) is not well described. We sought to characterize the impact of adjuvant post-salvage radiation therapy (PSRT) in this setting and identify tumor-specific variables that influence local control.

METHODS: Retrospective analysis of post-SRS recurrent BrM that underwent SR between 2003-2020 at Memorial Sloan Kettering Cancer Center was performed. Cases with histologically-viable malignancy were included and stratified by receipt of adjuvant PSRT within 60 days of SR (PSRT cohort) vs. observation (observation cohort). Resection-site outcomes were described using cumulative incidences and univariate and multivariate competing risks regression accounting for clustering.

RESULTS: One-hundred fifty-five recurrent BrM in 135 patients were included. Thirty-nine (25.2%) of the post-operative cavities were treated with adjuvant PSRT, and the remaining 116 (74.8%) cavities were initially observed. Gross- or near-total resection was associated with significantly improved local control compared to subtotal resection (p=0.007). Adjuvant PSRT was associated with a reduced rate of LR at 6 months [18.0% (95%CI: 9.8-33.1%) vs. 35.9% (95%CI: 27.9-46.2%) with initial observation] and 12 months [28.8% (95%CI: 17.0-48.8%) vs. 43.9% (95%CI: 36.2-53.4%)]. On multivariate analysis, adjuvant PSRT (p=0.095), low tumor-viability within the resected BrM (p=0.17), and first-time resection (p=0.035) all independently trended towards improved local control. BrM size at SR (≥3cm vs. <3cm, p=0.48), primary malignancy (p=0.35), and specific PSRT modality (whole or partial brain radiation vs. SRS, p=0.43) were not associated with differences in LR rate. Radiation necrosis (RN) was significantly increased in the PSRT cohort (HR 4.55, 95%CI: 1.26-16.39, p=0.02), though the total percentage with symptomatic RN remained low (PSRT cohort 5.1% vs observation cohort 0.9%).

CONCLUSIONS: Local control after SR of a recurrent BrM may be optimized with gross- or near-total resection and adjuvant post-operative re-irradiation, with low symptomatic RN.

Duration: 04:59

Posted: Monday, August 16, 2021

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