Opportunities and Alternatives of Modern Radiation Oncology and Surgery for the Management of Resectable Brain Metastases.

Autor: Diehl CD; Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, 81675 München, Germany.; Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, 85764 Neuherberg, Germany.; Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, 80336 München, Germany., Giordano FA; Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany., Grosu AL; Department of Radiation Oncology, University Medical Center, Medical Faculty, 79106 Freiburg, Germany., Ille S; Department of Neurosurgery, Faculty of Medicine, Technical University of Munich, 81675 München, Germany., Kahl KH; Department of Radiation Oncology, University Medical Center Augsburg, 86156 Augsburg, Germany., Onken J; Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany.; Berlin Institute of Health, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.; German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany., Rieken S; Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, 37075 Göttingen, Germany.; Comprehensive Cancer Center Niedersachsen (CCC-N), 37075 Göttingen, Germany., Sarria GR; Department of Radiation Oncology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany., Shiban E; Department of Neurosurgery, University Medical Center Augsburg, 86156 Augsburg, Germany., Wagner A; Department of Neurosurgery, Faculty of Medicine, Technical University of Munich, 81675 München, Germany., Beck J; Department of Neurosurgery, University Hospital Freiburg, 79106 Freiburg, Germany., Brehmer S; Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany., Ganslandt O; Neurosurgical Clinic, Klinikum Stuttgart, 70174 Stuttgart, Germany., Hamed M; Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany., Meyer B; Department of Neurosurgery, Faculty of Medicine, Technical University of Munich, 81675 München, Germany., Münter M; Department of Radiation Oncology, Klinikum Stuttgart Katharinenhospital, 70174 Stuttgart, Germany., Raabe A; Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland., Rohde V; Department of Neurosurgery, Universitätsmedizin Göttingen, 37075 Göttingen, Germany., Schaller K; Department of Neurosurgery, University of Geneva Medical Center & Faculty of Medicine, 1211 Geneva, Switzerland., Schilling D; Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, 81675 München, Germany.; Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, 85764 Neuherberg, Germany., Schneider M; Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany., Sperk E; Mannheim Cancer Center, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany., Thomé C; Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria., Vajkoczy P; Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany., Vatter H; Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany., Combs SE; Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, 81675 München, Germany.; Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, 85764 Neuherberg, Germany.; Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, 80336 München, Germany.
Jazyk: angličtina
Zdroj: Cancers [Cancers (Basel)] 2023 Jul 19; Vol. 15 (14). Date of Electronic Publication: 2023 Jul 19.
DOI: 10.3390/cancers15143670
Abstrakt: Postsurgical radiotherapy (RT) has been early proven to prevent local tumor recurrence, initially performed with whole brain RT (WBRT). Subsequent to disadvantageous cognitive sequalae for the patient and the broad distribution of modern linear accelerators, focal irradiation of the tumor has omitted WBRT in most cases. In many studies, the effectiveness of local RT of the resection cavity, either as single-fraction stereotactic radiosurgery (SRS) or hypo-fractionated stereotactic RT (hFSRT), has been demonstrated to be effective and safe. However, whereas prospective high-level incidence is still lacking on which dose and fractionation scheme is the best choice for the patient, further ablative techniques have come into play. Neoadjuvant SRS (N-SRS) prior to resection combines straightforward target delineation with an accelerated post-surgical phase, allowing an earlier start of systemic treatment or rehabilitation as indicated. In addition, low-energy intraoperative RT (IORT) on the surgical bed has been introduced as another alternative to external beam RT, offering sterilization of the cavity surface with steep dose gradients towards the healthy brain. This consensus paper summarizes current local treatment strategies for resectable brain metastases regarding available data and patient-centered decision-making.
Databáze: MEDLINE
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