Is local radiotherapy a viable option for patients with an opening of the ventricles during surgical resection of brain metastases?
BACKGROUND
Local hypofractionated stereotactic radiotherapy (HFSRT) of the resection cavity is emerging as the standard of care in the treatment of patients with a limited number of brain metastases as it warrants less neurological impairment compared to whole brain radiotherapy. In periventricular metastases surgical resection can lead to an opening of the ventricles and subsequently carries a potential risk of cerebrospinal tumour cell dissemination. The aim of this study was to assess whether local radiotherapy of the resection cavity is viable in these cases.


METHODS
From our institutional database we analyzed the data of 125 consecutive patients with resected brain metastases treated in our institution with HFSRT between 2009 and 2017. The incidence of LMD, overall survival (OS), local recurrence (LC) and distant recurrence were evaluated depending on ventricular opening (VO) during surgery.


RESULTS
From all 125 patients, the ventricles were opened during surgery in 14 cases (11.2%). None of the patients with VO and 7 patients without VO during surgery developed LMD (p = 0.371). OS (p = 0.817), LC (p = 0.524) and distant recurrence (p = 0.488) did not differ in relation to VO during surgical resection. However, the incidence of distant intraventricular recurrence was slightly increased in patients with VO (14.3% vs. 2.7%, p < 0.01).


CONCLUSION
VO during neurosurgical resection did not affect the outcome after HFSRT of the resection cavity in patients with brain metastases. Particularly, the incidence of LMD was not increased in patients receiving local HFSRT after VO. HFSRT can therefore be offered independently of VO as a local treatment of tumor bed after resection of brain metastases.
['Scharl|Sophia|S|', 'Kessel|Kerstin A|KA|', 'Diehl|Christian|C|', 'Gempt|Jens|J|', 'Meyer|Bernhard|B|', 'Zimmer|Claus|C|', 'Straube|Christoph|C|', 'Combs|Stephanie E|SE|http://orcid.org/0000-0002-5233-1536']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D001932:Brain Neoplasms D002552:Cerebral Ventricles D006801:Humans D008577:Meningeal Neoplasms D008875:Middle Aged D009364:Neoplasm Recurrence, Local D016634:Radiosurgery D055815:Young Adult
Local radiotherapy Brain metastases Hypofractionated stereotactic radiotherapy Ventricular opening Leptomeningeal disease