RADI-22 - Rohini Bhatia.mp4

Toxicity and local control outcomes for brain metastases managed with resection and aggressive reirradiation after initial radiosurgery failure

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Rohini Bhatia1, Catherine Siu1, Brock Baker1, Kristin Redmond1, Christopher Jackson2, Chetan Bettegowda2, Michael Lim3, Lawrence Kleinberg1

1Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore/MD, USA. 2Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore/MD, USA. 3Department of Neurosurgery, Stanford University, Stanford/CA, USA

Objectives: To describe toxicity and tumor outcome after resection and aggressive re-irradiation (stereotactic radiosurgery(SRS) or brachytherapy) of brain metastasis that have pathologically confirmed recurrence after prior radiosurgery.

Methods: A retrospective chart review identified 40 lesions in 35 patients that were initially treated with SRS, then demonstrated evidence of recurrence with pathologic confirmation and underwent re-irradiation either with radiosurgery (n=28, 70%) or intracavitary brachytherapy with Cesium-131 seeds (n=12, 30%). Toxicity was measured by: steroids initiated or increased within 3 months, imaging evidence of treatment effect vs disease progression at any time point, further intervention for local recurrence or necrosis, and any grade 3/4 neurologic events. Local control (with failure defined by sustained progression on imaging or pathologic confirmation of tumor) was measured from time of retreatment.

Results: Median follow-up from time of re-irradiation was 11.8 months (range 1 – 89.7 months). Dose for repeat radiosurgery was 18-25 Gy in 1-5 fractions, and brachytherapy dose was 55-65 Gy at 5 mm depth. Twelve lesions subsequently had imaging evidence of radionecrosis vs. progression. Of these, eight underwent repeat resection with pathology demonstrating radiation necrosis in five patients (n=4 with SRS, n=1 with brachy) and tumor recurrence in 3 (n=2 with brachy, and n=1 with SRS). Toxicities included: Steroids, 14(35%); imaging progression/necrosis 12(30%); grade 3/4 event, 3(20%); and surgically confirmed radionecrosis 5(12.5%). Local control of retreated lesions at 6 months is 85.5%, and at 12 months is 79.3%, OS at 1 year is 52.5% and at 2 years 46.6%. Local control at one year for repeat stereotactic treatment was 82.9% and for Cs131 brachytherapy was 80.8%

Conclusions: Aggressive re-irradiation after resection for pathologic confirmation appears to be appropriately safe and effective for the majority of patients after local failure of initial radiosurgery.

Duration: 05:26

Posted: Monday, August 9, 2021

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