Surgical Resection with Intraoperative Radiotherapy versus Adjuvant Radiotherapy for the Treatment of Eloquent Brain Metastases: An Assessment of Feasibility and Safety.
Philipp Krauss (Augsburg), Micol Colosimo (Augsburg), Christina Wolfert (Augsburg), Bastian Stemmer (Augsburg), Björn Sommer (Augsburg), Dorothee Mielke (Augsburg), Georg Stüben (Augsburg), Klaus Henning Kahl (Augsburg), Ehab Shiban (Cottbus; Augsburg)
The management of motor eloquent brain metastases (BMs) presents the risk of neurological deficits due to potential damage to the motor cortex and tracts. Maintaining optimal functional and neurological status is essential for enabling comprehensive oncological treatment. Emerging evidence suggests that intraoperative radiotherapy (IORT) utilizing low-voltage X-rays may serve as an alternative to adjuvant external beam radiotherapy (EBRT). The aim of this study was to assess the safety and feasibility of combining surgery with IORT in motor eloquent regions, as compared to adjuvant radiotherapy (RT).
We conducted a retrospective chart review of patients who underwent surgery for motor eloquent BMs at our institution, receiving either IORT or adjuvant RT. All surgeries were performed under intraoperative neuromonitoring (IONM). We compared patient demographics, rates of neurological deficits, IONM parameters, functional status (Karnofsky Performance Status, KPS), and adverse events (AEs) between the two groups.
A total of 33 patients were included in the analysis, with 25 undergoing IORT and 8 receiving adjuvant EBRT for motor eloquent BMs. New motor deficits developed in 7 of 33 patients, with no significant difference between the two groups at 30 days post-surgery (IORT: 4/25 vs. adjuvant RT: 3/8; Chi-square test: p = 0.19). The KPS following surgery did not differ significantly between the groups (IORT: 90% [72.5–90] vs. adjuvant RT: 80% [70–90]; Mann-Whitney U-test: p = 0.31). No patient experienced local tumor recurrence or radionecrosis. Nine patients (9/33) experienced postoperative AEs within the 30-day follow-up, with no significant differences between the two groups (IORT: 5/25 vs. adjuvant RT: 4/8; Chi-square test: p = 0.09).
50 kV photon IORT is a safe treatment option for motor eloquent BMs and does not appear to provoke symptomatic brain irritation.
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