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Author Notes:

Jim Zhong, Department of Radiation Oncology, Emory University, 1365 Clifton Rd NE, Room AT225, Atlanta, GA 30322. Email: jim.zhong@emory.edu.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflicts of interest: None.


Research Funding:

Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and the National Institutes of Health/National Cancer Institute under award number P30CA138292.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • Radiology, Nuclear Medicine & Medical Imaging

Postoperative stereotactic radiosurgery for resected brain metastases: A comparison of outcomes for large resection cavities

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Journal Title:

International Journal of Radiation Oncology - Biology - Physics


Volume 99, Number 2


, Pages E120-E120

Type of Work:

Article | Final Publisher PDF


Although historical trials have established the role of surgical resection followed by whole brain irradiation (WBRT) for brain metastases, WBRT has recently been shown to cause significant neurocognitive decline. Many practitioners have employed postoperative stereotactic radiosurgery (SRS) to tumor resection cavities to increase local control without causing significant neurocognitive sequelae. However, studies analyzing outcomes of large brain metastases treated with resection and postoperative SRS are lacking. Here we compare outcomes in patients with large brain metastases > 4 cm to those with smaller metastases ≤4 cm treated with surgical resection followed by SRS to the resection cavity. Methods and materials Consecutive patients with brain metastases treated at our institution with surgical resection and postoperative SRS were retrospectively reviewed. Patients were stratified into ≤4 cm and > 4 cm cohorts based on preoperative maximal tumor dimension. Cumulative incidence of local failure, radiation necrosis, and death were analyzed for the 2 cohorts using a competing-risk model, defined as the time from SRS treatment date to the measured event, death, or last follow-up. Results A total of 117 consecutive cases were identified. Of these patients, 90 (77%) had preoperative tumors ≤4 cm, and 27 (23%) > 4 cm in greatest dimension. The only significant baseline difference between the 2 groups was a higher proportion of patients who underwent gross total resection in the ≤4 cm compared with the > 4 cm cohort, 76% versus 48%, respectively (P < .01). The 1-year rates of local failure, radiation necrosis, and overall survival for the ≤4 cm and > 4 cm cohorts were 12.3% and 16.0%, 26.9% and 28.4%, and 80.6% and 67.6%, respectively (all P > .05). The rates of local failure and radiation necrosis were not statistically different on multivariable analysis based on tumor size. Conclusions Brain metastases > 4 cm in largest dimension managed by resection and radiosurgery to the tumor cavity have promising local control rates without a significant increase in radiation necrosis on our retrospective review.

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© 2017 American Society for Radiation Oncology

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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