Object Optimal case management after surgical @entity75 remains controversial. Although postoperative whole-brain radiation therapy (WBRT) has been shown to prevent local recurrence and decrease deaths, this modality can substantially decrease neurocognitive function and quality of life. Stereotactic radiosurgery (SRS) can theoretically achieve the same level of local control with fewer side effects, although studies conclusively demonstrating such outcomes are lacking. To assess the effectiveness and safety profile of @entity5 bed SRS after resection of brain @entity3 , the authors performed a retrospective analysis of 110 @entity1 who had received such treatment at the Centre Hospitalier Universitaire de Sherbrooke. They designed the study to identify risk factors for local recurrence and placed special emphasis on factors that could potentially be addressed. Methods @entity1 who had received treatment from 2004 through 2013 were included if they had undergone surgical removal of 1 or more brain metastases and if the @entity5 bed was treated by SRS regardless of the extent of resection or prior WBRT. All cases were retrospectively analyzed for @entity1 and @entity5 -specific factors, treatment protocol, adverse outcomes, cavity outcomes, and survival for as long as follow-up was available. Univariate and multivariate Cox regression analyses were performed to identify risk factors for local recurrence and predictors of increased survival times. Results Median @entity1 age at first SRS treatment was 58 years (range 37-84 years). The most frequently diagnosed @entity5 was @entity1149 . The rate of gross-total resection was 81%. The median Karnofsky Performance Scale score was 90%. Tumor bed SRS was performed at a median of 3 weeks after surgery. Median follow-up and survival times were 10 and 11 months, respectively. Actuarial local control of the cavity at 12 months was 73%; median time to recurrence was 6 months. According to multivariate analysis, risk factors for recurrence were a longer surgery-to-SRS delay (HR 1.625, p = 0.003) and a lower maximum radiation dose delivered to the cavity (HR 0.817, p = 0.006). Factors not associated with increased recurrence were subtotal or piecemeal resections, prior WBRT, histology of the @entity5 , and larger cavity volume. No factors predictive of survival were identified. Symptomatic radiation-induced enhancement occurred in 6% of @entity1 and leptomeningeal dissemination in 11%. Pathologically confirmed radiation-induced @entity39 occurred in 1 (0.9%) @entity1 . Conclusions @entity5 bed SRS after the resection of brain @entity3 is a valuable alternative to adjuvant WBRT. Risk factors for local recurrence are lower maximum radiation dose and a surgery-to-SRS delay longer than 3 weeks. Outcomes were not worse for @entity1 who had undergone prior WBRT and subtotal or piecemeal resections. Pending the results of prospective randomized controlled trials, the authors' study supports the safety and efficacy of adjuvant SRS after resection of brain @entity3 . SRS should be performed as early as possible, ideally within 3 weeks of the surgery.

Early Gamma Knife stereotactic radiosurgery to the @entity5 bed of resected brain XXXX for improved local control.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity39 :: ('MESH:D009336', 'Disease') :: ['necrosis'] @entity75 :: ('MESH:D001927', 'Disease') :: ['removal of brain metastasis'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'primary tumor', 'Adjuvant tumor'] @entity1149 :: ('MESH:D002289', 'Disease') :: ['non-small cell lung cancer'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastasis']
@entity3 :: (MESH:D009362,Disease) :: ['metastasis']
