BACKGROUND:: Postoperative stereotactic radiosurgery for brain @entity3 potentially offers similar local control rates and fewer long-term neurocognitive sequelae compared to whole brain radiation therapy, although @entity1 remain at risk for distant brain failure (DBF). OBJECTIVE:: To describe clinical outcomes of adjuvant stereotactic radiosurgery for large brain @entity3 and identify predictors of @entity177 and their implications on optimal @entity1 selection criteria. METHODS:: We performed a retrospective review on 100 large (>3 cm) brain @entity3 in 99 @entity1 managed by resection followed by postoperative stereotactic radiosurgery to a median dose of 22 Gy (range, 10-28) in 1 to 5 fractions (median, 3). Primary histology was nonsmall cell lung in 40%, @entity0 in 18%, and @entity320 in 17%. Forty (40%) @entity1 had uncontrolled @entity262 . RESULTS:: With a median follow-up of 12.2 months (range, 0.6-87.4), the 1-year Kaplan-Meier local control was 72%, DBF 64%, and overall survival 55%. Nine @entity1 (9%) developed evidence of @entity1161 , and 6 (6%) developed @entity66 . Uncontrolled @entity262 (P = .03), @entity320 histology (P = .04), and increasing number of brain @entity3 (P < .001) were significant predictors of DBF on Cox multivariate analysis. @entity1 with <4 @entity3 , controlled @entity262 , and nonmelanoma primary (n = 47) had a 1-year DBF of 48.6% vs 80.1% for all others (P = .01). CONCLUSION:: Postoperative stereotactic radiosurgery to the resection cavity safely and effectively augments local control of large brain @entity3 . @entity1 with <4 @entity3 and controlled @entity262 have significantly lower rates of DBF and are ideal treatment candidates. ABBREVIATIONS:: CTV, clinical target volumeDBF, distant brain failureGTR, gross total resectionKPS, Karnofsky Performance StatusLC, local controlOS, overall survivalPTV, planning target volumeRPA, recursive partitioning analysisSRS, sterotactic radiosurgerySTR, subtotal resectionWBRT, whole brain radiotherapy.

Postoperative Stereotactic Radiosurgery to the Resection Cavity for Large Brain Metastases: Clinical Outcomes, Predictors of Intracranial Failure, and Implications for Optimal XXXX Selection.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity0 :: ('MESH:D001943', 'Disease') :: ['breast cancer'] @entity66 :: ('MESH:D004194', 'Disease') :: ['leptomeningeal disease'] @entity1161 :: ('MESH:D011832', 'Disease') :: ['radiation injury'] @entity262 :: ('MESH:D034721', 'Disease') :: ['systemic disease'] @entity177 :: ('MESH:D051437', 'Disease') :: ['intracranial failure'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastases'] @entity320 :: ('MESH:D008545', 'Disease') :: ['melanoma']
@entity1 :: (9606,Species) :: ['Patient']
