Outcomes of Management of Progressive Radiosurgery-Treated Brain Metastasis With Resection Followed by Pathology-Informed Management: A Retrospective Study.

Neurosurgery practice Pub Date : 2024-10-10 eCollection Date: 2024-12-01 DOI:10.1227/neuprac.0000000000000117
Rohini K Bhatia, Jessica George, Catherine Siu, Emerson Lee, Kristin J Redmond, Brock Baker, Christopher M Jackson, Chetan Bettegowda, Debraj Mukherjee, Robert F Hobbs, Jon Weingart, Michael Lim, Lawrence Kleinberg
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Abstract

Background and objectives: In patients treated with stereotactic radiosurgery (SRS) for brain metastases, follow-up imaging demonstrating progression may result from treatment effect/radionecrosis (RN) or tumor progression. We report long-term outcomes for a cohort of patients who demonstrated radiological progression on serial imaging after initial radiation and who underwent resection, at which point histology informed further management.

Methods: A retrospective chart review identified 76 patients with an associated 82 brain lesions between 2009 and 2022, that were initially treated with SRS, and then demonstrated suspicious imaging developing through at least 2 scan time points with either pathologic confirmation of tumor or RN.

Results: Of the 82 lesions, 55 lesions (67.1%) were found to be tumor and were treated with repeat radiation and 27 (32.9%) were found to have pathologically confirmed RN and conservatively managed. 14/27 lesions ultimately found to be radionecrotic required steroids preoperatively due to neurological symptoms. None of these lesions required further intervention with median postsurgery follow-up of 24.4 months (range 1-104 months). There were 55 instances (in 51 patients) of confirmed recurrent/progressive tumor who we treated with repeat aggressive radiation with either Cs-131 brachytherapy (12 [21.8%]) or SRS (43 [78.2%]). Among patients treated with reirradiation, the median follow-up to local failure was 15.2 months (95% CI 7.3-26.6 months). The 2-year local control rate was 79.5% (95% CI 68.3%-92.5%).

Conclusion: These results support resection of radiosurgery-treated lesions with progression continuing through serial imaging, and this pathology-informed management results in excellent control of both RN and tumor progression after radiosurgery.

放射外科治疗的进展性脑部转移瘤切除后的病理信息管理结果:一项回顾性研究
背景和目的:在接受立体定向放射手术(SRS)治疗脑转移的患者中,随访影像显示进展可能是由于治疗效果/放射性坏死(RN)或肿瘤进展。我们报告了一组患者的长期结果,这些患者在初始放疗后连续影像学显示放射学进展,并接受了切除术,此时组织学通知了进一步的治疗。方法:回顾性分析了2009年至2022年间76例相关的82个脑病变患者,这些患者最初接受SRS治疗,然后通过至少2个扫描时间点显示可疑影像学发展,病理证实为肿瘤或RN。结果:82例病灶中55例(67.1%)为肿瘤,行重复放疗;27例(32.9%)病理证实为RN,行保守治疗。14/27的病变最终被发现为放射性坏死,由于神经系统症状,术前需要类固醇。这些病变均无需进一步干预,术后中位随访24.4个月(范围1-104个月)。有55例(51例患者)确诊复发/进展性肿瘤,我们用Cs-131近距离放射治疗(12例[21.8%])或SRS(43例[78.2%])进行重复侵袭性放射治疗。在接受再放射治疗的患者中,局部失败的中位随访时间为15.2个月(95% CI 7.3-26.6个月)。2年当地控制率为79.5% (95% CI 68.3% ~ 92.5%)。结论:这些结果支持通过连续成像切除放射手术治疗的持续进展的病变,这种病理知情的管理可以很好地控制放射手术后的RN和肿瘤进展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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