Surgically targeted radiation therapy (STaRT) for recurrent brain metastases: Initial clinical experience.

Autor: Kutuk T; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL., Tolakanahalli R; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL., Chaswal V; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL., Yarlagadda S; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL., Herrera R; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL., Appel H; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL., La Rosa A; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL., Mishra V; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL., Wieczorek DJJ; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL., McDermott MW; Department of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL., Siomin V; Department of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL., Mehta MP; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL., Odia Y; Department of Neuro-oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL., Gutierrez AN; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL., Kotecha R; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL. Electronic address: rupeshk@baptisthealth.net.
Jazyk: angličtina
Zdroj: Brachytherapy [Brachytherapy] 2023 Nov-Dec; Vol. 22 (6), pp. 872-881. Date of Electronic Publication: 2023 Sep 16.
DOI: 10.1016/j.brachy.2023.08.002
Abstrakt: Purpose: This study evaluates the outcomes of recurrent brain metastasis treated with resection and brachytherapy using a novel Cesium-131 carrier, termed surgically targeted radiation therapy (STaRT), and compares them to the first course of external beam radiotherapy (EBRT).
Methods: Consecutive patients who underwent STaRT between August 2020 and June 2022 were included. All patients underwent maximal safe resection with pathologic confirmation of viable disease prior to STaRT to 60 Gy to a 5-mm depth from the surface of the resection cavity. Complications were assessed using CTCAE version 5.0.
Results: Ten patients with 12 recurrent brain metastases after EBRT (median 15.5 months, range: 4.9-44.7) met the inclusion criteria. The median BED 10Gy 90% and 95% were 132.2 Gy (113.9-265.1 Gy) and 116.0 Gy (96.8-250.6 Gy), respectively. The median maximum point dose BED 10Gy for the target was 1076.0 Gy (range: 120.7-1478.3 Gy). The 6-month and 1-year local control rates were 66.7% and 33.3% for the prior EBRT course; these rates were 100% and 100% for STaRT, respectively (p < 0.001). At a median follow-up of 14.5 months, there was one instance of grade two radiation necrosis. Surgery-attributed complications were observed in two patients including pseudomeningocele and minor headache.
Conclusions: STaRT with Cs-131 presents an alternative approach for operable recurrent brain metastases and was associated with superior local control than the first course of EBRT in this series. Our initial clinical experience shows that STaRT is associated with a high local control rate, modest surgical complication rate, and low radiation necrosis risk in the reirradiation setting.
(Copyright © 2023 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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