Hypo-fractionated radiotherapy to the cavity for resected brain metastases: a UK series
Barker, C. L. Shane, T. Hodgson, C. Jameson, M. King, J. Sanghera, P. Meade, S. Colaco, R. J. Benghiat, H.
Barker, C. L.
Shane, T.
Hodgson, C.
Jameson, M.
King, J.
Sanghera, P.
Meade, S.
Colaco, R. J.
Benghiat, H.
Abstract
AIMS: With improved systemic disease control, the incidence of brain metastases in patients with cancer is increasing. Neurosurgical resection is recommended in selected cases, although local control following surgery remains an ongoing concern. Both fractionated radiotherapy and stereotactic radiosurgery (SRS) improve local control after surgical resection. Although postoperative SRS can avoid whole brain radiotherapy-associated toxicity, due to lack of survival and quality of life data, the optimum strategy remains debated. Furthermore, some cavities may be too large for SRS. MATERIALS AND METHODS: In this multicentre study, patients following surgery for brain metastases were treated with a hypo-fractionated radiotherapy regimen (25Gy given in 5 fractions/30Gy in 6 fractions) to the surgical cavity. RESULTS: Sixty-five patients were identified from electronic patient notes with a median follow-up of 23.6 months (95% CI: 20.1-28.6). The 6-, 12-, 24- and 36-month freedom from local failure rates were 92.7% (95% CI: 81.7-97.2%), 77.3% (95% CI: 61.0-87.4%) and 70.6% (both 24- and 36-months, 95% CI: 52.9-82.5%), respectively. The 6-, 12- and 24-month overall survival rates were 80.0% (95% CI: 68.0-87.9%), 53.7% (95% CI: 40.6-65.2%) and 27.7% (95% CI: 16.0-40.7%), respectively. During follow-up, 10.8% (7/65 patients) developed leptomeningeal disease (LMD) and 3% (2/65 patients) developed radiation necrosis (RN). Treatment with hypo-fractionated radiotherapy to the surgical cavity was well tolerated; there was one episode of grade 3 toxicity (vomiting) in this patient cohort. CONCLUSION: In this multicentre series of postoperative hypo-fractionated radiotherapy to the surgical cavity following resection of a brain metastasis, we demonstrated good rates of local control, with low risk of LMD and RN. Therefore, this radiotherapy regimen is a reasonable alternative to cavity SRS in patients with large cavity volumes or complete gross total resection within the UK. This should be investigated further within a prospective trial.
Description
Date
2025
Publisher
Collections
Keywords
Type
Article
Citation
Barker CL, Shane T, Hodgson C, Jameson M, King J, Sanghera P, et al. Hypo-Fractionated Radiotherapy to the Cavity for Resected Brain Metastases: A UK Series. Clinical oncology (Royal College of Radiologists (Great Britain)). 2025 Jul;43:103847. PubMed PMID: 40460535. Epub 2025/06/04. eng.