of California, San Diego, La Jolla, CA. Purpose/Objective(s): Frameless stereotactic radiosurgery for intracranial brain metastases can provide more comfortable ...
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Volume 93 Number 3S Supplement 2015 (range, 35-82 years). There were 12 males and 9 females. At recurrence, 50% of patients achieved GTR and 50% achieved a STR. Twenty of 21 patients received bevacizumab (10mg/kg) prior to Cs-131 implantation, after Cs-131 implantation, or both prior to and after implant. Patients underwent MRI scans to monitor for recurrence/progression and RN with follow-up exams about every 2 months. Results: Median follow-up time from resection and Cs-131 brachytherapy was 10 months (range, 5-26 months). The median number of Cs-131 seeds placed was 40 (range, 20-74), with a median total activity of 87.2 U (range, 41.08-201.3 U). The median tumor size was 4.65cm (range 1.2-9 cm). Twenty-five percent of patients were alive at last follow-up. Median time to local recurrence was 5.0 months. Median time to distant recurrence was 5.1 months. Fifteen of 21 (71%) sustained local progression. There was a 0% incidence of RN. Conclusion: Our pilot study demonstrates that treatment with intraoperative Cs-131 brachytherapy isotope in the tumor bed is a good treatment approach for recurrent GBM with no incidence of RN. From the literature, we know that bevacizumab reduces the risk of RN. The fact that no RN occurred in any of our re-irradiated patients suggests that high conformality of brachytherapy and addition of bevacizumab is an appropriate combination to avoid this potentially serious complication. Further prospective studies are ongoing to evaluate the efficacy of Cs-131 for GBM in the recurrent setting. Author Disclosure: A. Herskovic: None. S. Taube: None. M. Yondorf: None. T. Schwartz: None. R. Ramakrishna: None. P. Stieg: None. B. Parashar: None. D. Nori: None. S. Trichter: None. L. Nedialkova: None. A.M. Sabbas: None. A. Wernicke: None.
2267 Frameless, Real Time, Surface Imaging Guided Radiosurgery: Clinical Outcomes for Brain Metastases N.L. Pham,1 P.V. Reddy,2 J.D. Murphy,1 P. Sanghvi,3 J.A. Hattangadi,1 G.Y. Kim,3 L.I. Cervino,3 T. Pawlicki,1 and K.T. Murphy3; 1University of California, San Diego, La Jolla, CA, 2UCSD, San Diego, CA, 3University of California, San Diego, La Jolla, CA Purpose/Objective(s): Frameless stereotactic radiosurgery for intracranial brain metastases can provide more comfortable treatment setup than rigid frame-based immobilization with equivalent accuracy. The aim of this study is to report the Stereotactic Radiosurgery experience and update the clinical outcomes using a novel real-time, frameless, surface imaging-guided (SIGRS) technique in the treatment of brain metastases at our institute. Materials/Methods: Medical records for 163 patients with a minimum age of 16 were retrieved for this study, with approval from the local institutional review board. A total of 490 lesions were reported between December 2008 and April 2014 among the 163 patients. Results: Data were retrospectively examined for 163 patients totaling 490 lesions and 45 post-operative cavities treated with SIG-RS in a median delivery of 1 fraction (range, 1-5) and to a median dose of 22 Gy (range, 12-30 Gy). Local control and overall survival were estimated by the Kaplan-Meier method. Median follow-up for all patients was 6.7 months (range, 0.5-45.1 months), with 119 of 163 (73%) deceased at the time of analysis. The 134 patients (82%) with follow-up imaging studies totaling 378 lesions and 39 post-operative cavities were evaluated for local control. The actuarial 6- and 12-month local control was 90% (95% confidence interval, 84-94) and 79% (95% confidence interval, 71-86), respectively. The actuarial 6- and 12-month overall survival was 80% (95% confidence interval, 74-85) and 56% (95% confidence interval, 49-63), respectively. There is no significant difference in local control between treatment to post-operative cavities or intact lesions. Conclusion: Consistent with reported literature, SIG-RS for treatment of intracranial metastases can produce outcomes comparable to those with conventional frame-based and frameless stereotactic radiosurgery techniques while providing greater patient comfort with an open-faced mask and fast treatment time. Author Disclosure: N. Pham: None. P.V. Reddy: None. J.D. Murphy: None. P. Sanghvi: None. J.A. Hattangadi: None. G. Kim: None.
L.I. Cervino: None. T. Pawlicki: Honoraria; Varian. K.T. Murphy: Honoraria; Varian.
2268 Patients With Long-term Control of Systemic Disease Are a Favorable Prognostic Group for Treatment of Brain Metastases With SRS Alone D.K. Ebner,1 D. Gorovets,2,3 P.S. Rava,4 D. Cielo,5 T.J. Kinsella,2,3 T.A. DiPetrillo,3,6 and J.T. Hepel6,7; 1Alpert Medical School of Brown University, Providence, RI, 2Department of Radiation Oncology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, 3Department of Radiation Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, 4Department of Radiation Oncology, University of Massachusetts Memorial Medical Center, Worcester, MA, 5Department of Neurosurgery, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, 6Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, 7 Tufts Medical Center, Tufts University School of Medicine, Boston, MA Purpose/Objective(s): Stereotactic radiosurgery (SRS) alone is an attractive option for treatment of brain metastases that avoids the morbidity associated with whole brain irradiation. The use of SRS alone is limited by regional CNS failures and short survival in some patients. We evaluated a subgroup of patients with controlled primary and systemic disease that may represent a particularly favorable patient population for SRS alone. Materials/Methods: All patients with brain metastases treated with SRS without whole brain irradiation at our institution between 2004 and 2014 were reviewed. Systemic disease status was evaluated and patients were grouped into two cohorts, those who had controlled systemic disease for 1yr (CSD) prior to presentation with brain metastases and those who did not (USD). Patient, disease, and treatment variables were evaluated. Following SRS treatment, patients were followed clinically and with brain MRIs at 3-month intervals for 2 years and at 6-month intervals thereafter. Rates of local failure, regional CNS failure, and overall survival were assessed from time of SRS. Variables and outcomes were analyzed using Chi-squared and Student’s T tests. Results: A total of 295 patients underwent SRS to 697 lesions of which 65 patients had CSD. The median follow-up was 9.7 mos. Comparison of demographics between patients with CSD and USD revealed that mean age was similar (61.0 vs. 61.1, p Z 0.9). Patients who had CSD were more likely to be female (75% vs. 49%, p < 0.001), have breast primary (28% vs 8%, p Z 0.001), present with CNS symptoms (82% vs 69%, p Z 0.047), and have a larger metastasis (mean 2.4 cm vs 2.0 cm, p Z 0.03). Patients with USD were more likely to have NSCLC (64% vs 45%, p Z 0.001). There was no difference in local control between the two cohorts with 1-year rates of 70% and 73%, respectively (p Z 0.795). However, regional CNS control was significantly better for patients with CSD, 68.2% vs. 48.0% (p Z 0.001). Overall survival was also improved for patients with CSD (p < 0.001). Overall survival at 1 and 5 years was 64.6% vs. 40.2% and 13.1% vs. 6.6% for patients with CSD vs. USD, respectively. Conclusion: Patients who present with brain metastases after having their primary and systemic disease controlled for 1 year represent a particularly very favorable cohort of patients, with a lower propensity for regional CNS failure and prolonged survival, making this population ideally suited for an approach of SRS alone. Author Disclosure: D.K. Ebner: None. D. Gorovets: None. P.S. Rava: None. D. Cielo: None. T.J. Kinsella: None. T.A. DiPetrillo: None. J.T. Hepel: None.
2269 Prospective Assessment of Neurocognitive Outcomes Following Partial-Brain Radiation Therapy to Low Grade Tumors C.H. Chapman, H. Buchtel, T.S. Lawrence, C.I. Tsien, and Y. Cao; University of Michigan, Ann Arbor, MI Purpose/Objective(s): While there has been substantial research on radiation induced neurocognitive decline in pediatric patients, adults are also
