Journal of neuro-oncology · 2025
Cesium-131 collagen tile brachytherapy for salvage of recurrent intracranial metastases.
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Beckham Thomas H, Cha Elaine E, Rooney Michael K, Tom Martin C, Perni Subha, McAleer Mary Frances, Li Jing, Kudchadker Rajat J, Prajapati Surendra, Zlateva Yana, Kaya Diana, Ene Chibawanye I, Ferguson Sherise D, Huse Jason T, Prabhu Sujit S, Weinberg Jeffrey S
Аннотация
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.
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.