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Purpose <p>Management of brain metastases (BM) that recur after stereotactic radiosurgery (SRS) (rBM) is challenging. We reviewed our experience with resection with Cs-131 collagen tile brachytherapy for rBM.</p> Methods <p>Patients with rBM after SRS salvaged with resection and Cs-131 brachytherapy were reviewed. Analyses included descriptive statistics, Kaplan-Meier for overall survival (OS), Fine and Gray modeling for subgroup comparisons, and cumulative incidence of LF (CILF).</p> Results <p>Thirty-one patients (38 surgical cavities) were reviewed; primaries were most commonly breast (37%) or non-small cell lung cancer (26%). All BMs had received prior SRS to a median 20&#xa0;Gy in 1 fraction at a median 12.3 months before tile implantation; disease in 32 cavities (84%) was gross totally resected. At a median patient follow-up time of 11.8 months, LF developed in 6 of 38 cavities (16%); with CILF 7.9% at 6 months and 13% at 1 year. Risk factors for LF included &gt; 1 prior radiation courses (HR 2.44; <i>p</i> = 0.001), subtotal resection (HR 6.99; <i>p</i> = 0.015), tumor volume (HR 1.04; <i>p</i> = 0.006), and degree of dural contact (<i>p</i> &lt; 0.001). One-year OS rate was 65.8%. Three cavities (8%) among two patients (6%) developed grade 2 + radionecrosis. Two patients developed classical leptomeningeal disease (LMD) and two patients had nodular dural seeding for an overall incidence of LMD of 12.9%.</p> Conclusions <p>Salvage resection with Cs-131 collagen tile brachytherapy for rBM after SRS provides favorable local control with minimal toxicity. Lesion characteristics may help to identify patients at increased risk for LF.</p>

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Cesium-131 collagen tile brachytherapy for salvage of recurrent intracranial metastases

  • 期刊论文

  • 发表日期：

    2025年6月23日

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  • Thomas H. Beckham,
  • Elaine E. Cha,
  • Michael K. Rooney,
  • Martin C. Tom,
  • Subha Perni,
  • Mary Frances McAleer,
  • Jing Li,
  • Rajat J. Kudchadker,
  • Surendra Prajapati,
  • Yana Zlateva,
  • Diana Kaya,
  • Chibawanye I. Ene,
  • Sherise D. Ferguson,
  • Jason T. Huse,
  • Sujit S. Prabhu,
  • Jeffrey S. Weinberg

摘要

Purpose

Management of brain metastases (BM) that recur after stereotactic radiosurgery (SRS) (rBM) is challenging. We reviewed our experience with resection with Cs-131 collagen tile brachytherapy for rBM.

Methods

Patients with rBM after SRS salvaged with resection and Cs-131 brachytherapy were reviewed. Analyses included descriptive statistics, Kaplan-Meier for overall survival (OS), Fine and Gray modeling for subgroup comparisons, and cumulative incidence of LF (CILF).

Results

Thirty-one patients (38 surgical cavities) were reviewed; primaries were most commonly breast (37%) or non-small cell lung cancer (26%). All BMs had received prior SRS to a median 20 Gy in 1 fraction at a median 12.3 months before tile implantation; disease in 32 cavities (84%) was gross totally resected. At a median patient follow-up time of 11.8 months, LF developed in 6 of 38 cavities (16%); with CILF 7.9% at 6 months and 13% at 1 year. Risk factors for LF included > 1 prior radiation courses (HR 2.44; p = 0.001), subtotal resection (HR 6.99; p = 0.015), tumor volume (HR 1.04; p = 0.006), and degree of dural contact (p < 0.001). One-year OS rate was 65.8%. Three cavities (8%) among two patients (6%) developed grade 2 + radionecrosis. Two patients developed classical leptomeningeal disease (LMD) and two patients had nodular dural seeding for an overall incidence of LMD of 12.9%.

Conclusions

Salvage resection with Cs-131 collagen tile brachytherapy for rBM after SRS provides favorable local control with minimal toxicity. Lesion characteristics may help to identify patients at increased risk for LF.