Stereotactic radiosurgery or hypofractionated radiotherapy of the resection cavity after metastasectomy in cancer patients with brain metastases

Patients with limited number of brain metastases from solid tumors are at high risk of local recurrence after surgical removal of the tumor mass. The standard Whole-brain radiotherapy (WBRT) demonstrated to reduce the risk of recurrence without improving survival. At the same time WBRT have substantial acute and late toxicity. Preliminary experiences with Stereotactic radiosurgery or hypofractionated radiotherapy of the resection cavity indicate promising local control and good tolerance. This attitude was only partially explored in prospective trials. In this research patients with limited number of brain metastases and controlled systemic disease will be treated, with such a stereotactic irradiation, at the same time with evaluation of the local control (Primary endpoint) by repeated MRI and of quality of life, neurologic functionning (with a battery of thsts, e.g. MMSE, QLQ-C30, EORTC BN-20) as well as overall survival as secondary endpoints.

Inclusion criteria:

• Patient underwent surgery for single brain metastasis arising from solid neoplasia (lung, breast, melanoma, kidney, colorectal), with initial histological diagnosis, or selected cases with a resected lesion and a further non-resected lesion (from 1 to 2 lesions), treatable with SRS / IGRT of the surgical cavity
• Patient ≥ 18 years
• Willngness to participate in the study, written informed consent
• Performance Status according to WHO 0-I
• Good general conditions and organ function
• Newly diagnosed chemotherapy-naïve disease or controlled systemic disease
• Good bone marrow, renal and hepatic function
• Stable steroid dose or reduced for at least 5 days

Exclusion Criteria:

• History of previous brain irradiation
• Pregnancy or breastfeeding
• Histological diagnosis other than lung, breast, melanoma, kidney and colorectal malignancy