Vol.:(0123456789) 1 3 Journal of Neuro-Oncology https://doi.org/10.1007/s11060-017-2651-1 CLINICAL STUDY Local control and overall survival for adjuvant stereotactic radiosurgery in patients with residual or recurrent disease Tavish Nanda 1,2  · Andrew Yaeh 1  · Cheng‑Chia Wu 2  · Ashish Jani 2  · Shumaila Saad 2  · Yasir H. Qureshi 3  · Keith A. Cauley 4  · Jeraldine Lesser 2  · Simon K. Cheng 2  · Steven R. Isaacson 2,5  · Michael B. Sisti 5,6  · Jefrey N. Bruce 5,6  · Guy M. McKhann 5,6  · Sameer A. Sheth 5,6  · Andrew B. Lassman 5,7  · Tony J. C. Wang 2,5 Received: 23 June 2017 / Accepted: 22 October 2017 © Springer Science+Business Media, LLC 2017 Abstract Prior studies of post-operative stereotactic radiosurgery (SRS) have not distinguished between Adjuvant SRS (ARS) versus Adjuvant SRS to residual/recurrent disease (ARD). In this study, we defned ARS and ARD and investigated local control (LC), overall survival (OS), distant development of brain metastases (DBF), and leptomeningeal disease (LMD). We retro- spectively identifed BM patients who received surgical resection and SRS for BM from an IRB approved database between Jan 2009–Aug 2015. Patients were stratifed into two groups: ARS and ARD. LC was determined by follow-up MRI stud- ies and OS was measured from the date of surgery. LC and OS were assessed using the Kaplan–Meier method. 70 cavities underwent surgical resection of BM and received SRS to the post-operative bed. 41 cavities were classifed as ARS and 29 as ARD. There was no signifcant diference in 12-month LC between the ARS and ARD group (71.4 vs. 80.8%, respectively; p = 0.135) from the time point of SRS. The overall 1-year survival for ARS and ARD was 79.9 and 86.1%, respectively (p = 0.339). Mean time to progression was 6.45 and 8.0 months and median follow-up was 10 and 15 months for ARS and ARD, respectively. 11.8% of ARS patients and 15.4% of ARD patients developed LMD, p = 0.72. 29.4% of ARS and 48.0% of ARD patients developed DBF, p = 0.145. Our fndings suggest that observation after surgical resection, with subsequent treatment with SRS after the development of local failure, may not compromise treatment efcacy. If validated, this would spare patients who do not recur post-surgically from additional treatment. Keywords Brain metastases · Adjuvant · Stereotactic radiosurgery · Local control · Gamma knife Abbreviations BM Brain metastases WBRT Whole brain radiotherapy SRS Stereotactic radiosurgery GKRS Gamma knife radiosurgery LC Local control LF Local failure OS Overall survival STR Subtotal resection KPS Karnofsky performance status RPA Recursive partitioning analysis This article was presented in part at the 18th Leksell Gamma Knife Society Meeting, Amsterdam, Netherlands, May 15, 2016 (plenary) and at the American Society for Radiation Oncology Annual Meeting, San Antonio, TX, October 18–21, 2015 (poster). * Tavish Nanda tavishnanda2290@gmail.com 1 Columbia University College of Physicians and Surgeons, New York, NY, USA 2 Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B-11, New York, NY 10032, USA 3 The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA 4 Department of Radiology, Division of Neuroradiology, Columbia University Medical Center, New York, NY, USA 5 Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA 6 Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA 7 Department of Neurology, Columbia University Medical Center, New York, NY, USA