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Background/Aim <p>At our institution, large resection cavities (LRC) of brain metastases (BRM) are typically treated with reduced dose (RD), single-fraction (SF) frame-based (FB) postoperative stereotactic radiosurgery (PSR). We aimed to determine the impact of this management practice on efficacy and safety outcomes.</p> Methods <p>This retrospective analysis examined 50 consecutive patients whose BRM-associated LRCs (&gt; 10 cm<sup>3</sup>) were treated with SF FB PSR between October 2000 and October 2021. The prescription dose of &lt; 18&#xa0;Gy for the large tumor beds was applied in 41 patients, and 18&#xa0;Gy was administered in nine. The frequencies of local tumor control and radionecrosis were the primary endpoints of the study, and survival was the secondary measure of treatment.</p> Results <p>The median follow-up was 12 months. Comparative analysis of the applied lower versus higher dose revealed: local tumor control rates of 88% (95% CI 83%-93%) and 100% (95% CI 96%–104%) respectively, <i>p</i> &gt; 0.64; corresponding incidences of radionecrosis were 0% and 11% (95% CI 0%-22%), <i>p</i> &gt; 0.38, and the median periods of survival were 8 months and 19 months (<i>p</i><i> &gt; 0.05</i>). In the 25 individuals with at least 12 months of follow-up, the local tumor control and radionecrosis rates were 84% (n-21) and 4% (<i>n</i> = 1), respectively. In the proven case of radionecrosis without observed tumor cells, the V12 Gy normal brain volume was 21.7 cm<sup>3</sup>.</p> Conclusion <p>We believe that SF RD PSR can be considered a rational treatment strategy for patients with LRC-BRM due to the observed favorable tumor control and minimal toxicity.</p>

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Reduced dose single-fraction frame-based postoperative radiosurgery for large (> 10 cm3) brain metastases cavities: real world outcomes

  • 期刊论文

  • 发表日期：

    2026年3月11日

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  • Federico Ampil,
  • Olivia Moncrief,
  • Anthony Sin,
  • Jamie Toms,
  • Kristee O’Glee

摘要

Background/Aim

At our institution, large resection cavities (LRC) of brain metastases (BRM) are typically treated with reduced dose (RD), single-fraction (SF) frame-based (FB) postoperative stereotactic radiosurgery (PSR). We aimed to determine the impact of this management practice on efficacy and safety outcomes.

Methods

This retrospective analysis examined 50 consecutive patients whose BRM-associated LRCs (> 10 cm3) were treated with SF FB PSR between October 2000 and October 2021. The prescription dose of < 18 Gy for the large tumor beds was applied in 41 patients, and 18 Gy was administered in nine. The frequencies of local tumor control and radionecrosis were the primary endpoints of the study, and survival was the secondary measure of treatment.

Results

The median follow-up was 12 months. Comparative analysis of the applied lower versus higher dose revealed: local tumor control rates of 88% (95% CI 83%-93%) and 100% (95% CI 96%–104%) respectively, p > 0.64; corresponding incidences of radionecrosis were 0% and 11% (95% CI 0%-22%), p > 0.38, and the median periods of survival were 8 months and 19 months (p > 0.05). In the 25 individuals with at least 12 months of follow-up, the local tumor control and radionecrosis rates were 84% (n-21) and 4% (n = 1), respectively. In the proven case of radionecrosis without observed tumor cells, the V12 Gy normal brain volume was 21.7 cm3.

Conclusion

We believe that SF RD PSR can be considered a rational treatment strategy for patients with LRC-BRM due to the observed favorable tumor control and minimal toxicity.