Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, 53100, Siena, Italy.
IRCCS Neuromed, Pozzilli, IS, Italy.
Radiat Oncol. 2021 Apr 15;16(1):73. doi: 10.1186/s13014-021-01802-9.
Despite complete surgical resection brain metastases are at significant risk of local recurrence without additional radiation therapy. Traditionally, the addition of postoperative whole brain radiotherapy (WBRT) has been considered the standard of care on the basis of randomized studies demonstrating its efficacy in reducing the risk of recurrence in the surgical bed as well as the incidence of new distant metastases. More recently, postoperative stereotactic radiosurgery (SRS) to the surgical bed has emerged as an effective and safe treatment option for resected brain metastases. Published randomized trials have demonstrated that postoperative SRS to the resection cavity provides superior local control compared to surgery alone, and significantly decreases the risk of neurocognitive decline compared to WBRT, without detrimental effects on survival. While studies support the use of postoperative SRS to the resection cavity as the standard of care after surgery, there are several issues that need to be investigated further with the aim of improving local control and reducing the risk of leptomeningeal disease and radiation necrosis, including the optimal dose prescription/fractionation, the timing of postoperative SRS treatment, and surgical cavity target delineation. We provide a clinical overview on current status and recent advances in resection cavity irradiation of brain metastases, focusing on relevant strategies that can improve local control and minimize the risk of radiation-induced toxicity.
尽管进行了完全的手术切除，但如果不进行额外的放射治疗，脑转移瘤仍有很高的局部复发风险。传统上，基于随机研究显示术后全脑放疗 (WBRT) 可降低手术床复发风险和新发远处转移发生率的疗效，术后 WBRT 被认为是标准治疗方法。最近，术后立体定向放射外科 (SRS) 治疗手术床已成为治疗切除脑转移瘤的有效且安全的治疗选择。已发表的随机试验表明，与单独手术相比，术后 SRS 治疗切除腔可提供更好的局部控制，与 WBRT 相比，显著降低神经认知下降的风险，而对生存无不利影响。虽然研究支持术后 SRS 治疗切除腔作为手术治疗后的标准护理方法，但仍有几个问题需要进一步研究，以提高局部控制率，降低软脑膜疾病和放射性坏死的风险，包括最佳剂量处方/分割、术后 SRS 治疗时机和手术腔靶区勾画。我们提供了脑转移瘤切除腔照射的现状和最新进展的临床概述，重点介绍了可以提高局部控制率并最大限度降低放射性毒性风险的相关策略。
