ArticleJournal of neuro-oncology2021
Salvage resection of recurrent previously irradiated brain metastases: tumor control and radiation necrosis dependency on adjuvant re-irradiation.
Article in Journal of neuro-oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Outcomes and adverse events of postoperative stereotactic interventional radiotherapy/brachytherapy for brain metastases: a systematic review.La Radiologia medica · 2026Pooled it
- Treatment modalities in recurrent brain metastases: a combined institutional and individual patient data meta-analysis of post-recurrence survival and local progression-free survival.Journal of neuro-oncology · 2025Pooled it
- Reirradiation of recurrent brain tumors: a review by the ESTRO CNS Focus Group.Clinical and translational radiation oncology · 2027Review
- Review
- The evolving landscape of brain metastasis: volume II.Trends in cancer · 2026Review
- Article
- Cesium-131 collagen tile brachytherapy for salvage of recurrent intracranial metastases.Journal of neuro-oncology · 2025Article
- Prognostic factors after salvage resection for local progression of brain metastases after radiotherapy.Acta neurochirurgica · 2025Article
- Multidisciplinary management strategies for recurrent brain metastasis after prior radiotherapy: An overview.Neuro-oncology · 2025Review
- A Novel Multimodal Approach to Refractory Brain Metastases: A Case Report.Advances in radiation oncology · 2024Article
- The role of GammaTile in the treatment of brain tumors: a technical and clinical overview.Journal of neuro-oncology · 2024Review
- Review
- Opportunities and Alternatives of Modern Radiation Oncology and Surgery for the Management of Resectable Brain Metastases.Cancers · 2023Review
- Review
- Postradiosurgery cystic degeneration in brain metastases causing delayed and potentially severe sequelae: systematic review and illustrative cases.Journal of neurosurgery. Case lessons · 2023Article
- Does early adjuvant brain metastasis SRS increase mortality?Neuro-oncology practice · 2022Article
- Surgically targeted radiation therapy (STaRT) trials for brain neoplasms: A comprehensive review.Neuro-oncology · 2022Review
- Review
- Patient-specific radiological protection precautions following Cs collagen embedded Cs-131 implantation in the brain.Journal of applied clinical medical physics · 2022Article
- Salvage resection plus cesium-131 brachytherapy durably controls post-SRS recurrent brain metastases.Journal of neuro-oncology · 2022Article
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Authors and funding
13 authors at 2 institutions in 1 country.
Funding
Abstract
purposeThe efficacy of salvage resection (SR) of recurrent brain metastases (rBrM) following stereotactic radiosurgery (SRS) is undefined. We sought to describe local recurrence (LR) and radiation necrosis (RN) rates in patients undergoing SR, with or without adjuvant post-salvage radiation therapy (PSRT).
methodsA retrospective cohort study evaluated patients undergoing SR of post-SRS rBrM between 3/2003-2/2020 at an NCI-designated cancer center. Cases with histologically-viable malignancy were stratified by receipt of adjuvant PSRT within 60 days of SR. Clinical outcomes were described using cumulative incidences in the clustered competing-risks setting, competing risks regression, and Kaplan-Meier methodology.
resultsOne-hundred fifty-five rBrM in 135 patients were evaluated. The overall rate of LR was 40.2% (95% CI 34.3-47.2%) at 12 months. Thirty-nine (25.2%) rBrM treated with SR + PSRT trended towards lower 12-month LR versus SR alone [28.8% (95% CI 17.0-48.8%) versus 43.9% (95% CI 36.2-53.4%), p = .07 by multivariate analysis]. SR as re-operation (p = .03) and subtotal resection (p = .01) were independently associated with higher rates of LR. On univariate analysis, tumor size (p = .48), primary malignancy (p = .35), and PSRT technique (p = .43) bore no influence on LR. SR + PSRT was associated with an increased risk of radiographic RN at 12 months versus SR alone [13.4% (95% CI 5.5-32.7%) versus 3.5% (95% CI 1.5-8.0%), p = .02], though the percentage with symptomatic RN remained low (5.1% versus 0.9%, respectively). Median overall survival from SR was 13.4 months (95% CI 10.5-17.7).
conclusionIn this largest-known series evaluating SR outcomes in histopathologically-confirmed rBrM, we identify a significant LR risk that may be reduced with adjuvant PSRT and with minimal symptomatic RN. Prospective analysis is warranted.
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