Local control of brain metastasis with post-surgical cavity-directed adjuvant radiation utilizing stereotactic radiosurgery: a scoping literature review and institutional retrospective study

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Alarifi, Norah
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Objective: To investigate potential factors influencing local control in metastatic brain disease patients undergoing adjuvant stereotactic radiosurgery (SRS) to surgical cavities. Methods: A scoping review of the literature and retrospective analysis were conducted. The scoping review encompassed multiple databases, to determine relevant studies that identified factors impacting local control in metastatic tumor surgical cavities. The retrospective analysis involved a 17-year cohort of patients who underwent adjuvant SRS for metastatic surgical cavities. Data regarding factors influencing control rates were collected and analyzed. Results: The scoping review yielded 10,633 articles, with 22 included in the final analysis. Factors such as histology, radiation dose, tumor size, extent of resection, treatment timing, tumor depth, and dural or pial attachment demonstrated impacts on local control. However, primary disease status, surgical corridor coverage, and tumor location did not significantly affect control. In the retrospective study of 63 patients with 63 surgical cavities, the 12-month local control rate was 66.7%, and the 24-month rate was 57.1%. Distant progression occurred in 58.7% of cases. Overall development of leptomeningeal disease, and treated cavity adverse radiation effects were observed in 15.9% and 20.6% of cases, respectively. None of the examined factors significantly influenced local control. Local progression within the first year of treatment was associated with a 5.0-fold increased risk of death at 24 months, while distant intracranial progression showed a 6.0-fold increased risk at 12 months and an 8.2-fold increased risk at 24 months. Conclusion: Prospective studies are necessary to identify predictive factors for achieving local control following cavity-directed SRS. These findings have implications for developing future treatment guidelines and optimizing outcomes in the management of metastatic brain disease.
Brain Metastasis, Stereotatcic Radiosurgery, Gamma Knife