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Purpose: Optimal timing of SRS after surgical resection of brain metastases (BMs) remains debated but is generally advocated to occur within 4 weeks of surgery to account for cavity remodeling. Our study assesses this recommendation by examining cavity dynamics and any downstream effects on outcome. Methods: Post-operative MRIs were used to compare target lesion volumes to target volume at time of SRS. Spearman's analysis identified a relationship between the time to SRS (ttSRS) and target remodeling. The Mann-Whitney-U test compared median remodeling between groups receiving standard (=4 weeks) and late (>4 weeks) adjuvant SRS. Kaplan Meier functions estimated probabilities of local recurrence (LR) and survival (OS). A Cox proportional hazards model (CPH) identified predictors of OS, LR, and leptomeningeal disease (LMD). Results: Median ttSRS was 32 days (3-72). A positive correlation exists when comparing ttSRS to reduction in cavity volume (0-10 weeks; p = 0.01) with no difference in median cavity remodeling between standard and late SRS groups. OS and LR rates were respectively 53.3% and 70.2% at 12 months with no difference in OS (p = 0.16) or LR (p = 0.54) between standard and late SRS groups. Subtotal resection predicted LMD (HR: 6.37; p = 0.03). No grade 3 or higher toxicity was seen in follow-up. Conclusions: Resection cavities may continue to shrink well after resection. There is no significant difference in OS or LR based on ttSRS, however, treatment factors such as the extent of resection may account for outcomes such as LMD. [ABSTRACT FROM AUTHOR]

Objectives: Brain metastases are a rare finding in patients with primary gynecologic malignancies having a poor outcome despite treatment. We sought to use the National Cancer Database (NCDB) to characterize the incidence of brain metastases and types of treatment administered. Methods: We queried the NCDB from 2010-16 for patients with endometrial, cervical, and ovarian primaries with brain metastases at diagnosis treated with radiation--whole brain radiation (WBRT) or stereotactic radiosurgery (SRS). We tabulated baseline characteristics and performed a multivariable logistic regression to identify predictors of SRS. Multivariable Cox regression was used to identify predictors of death. Propensity matching was done to account for indication bias. Results: We identified 765 patients meeting above criteria, representing <1% of patients. Of patients with brain metastases, 287 received radiation to the brain. The median age was 60 (40-90). The majority of patients (80%) received WBRT. On multivariable logistic regression the only predictor of SRS was receipt of chemotherapy. Median follow up was 4.9 months. The overall survival for the entire cohort was 5.2 months. On Cox regression predictors of improved survival were receipt of chemotherapy, no extracranial disease, and SRS. After propensity matching, median survival was 8.3 months compared to 6.3 months in favor of SRS. Conclusions: This study represents the largest series to date of patients with brain metastases from gynecologic malignancies, confirming an incidence of <1% and overall poor prognosis. Radiation remains a viable treatment option. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 pandemic necessitated drastic and rapid changes throughout the field of radiation oncology, some of which were unique to the discipline of radiosurgery. Guidelines called for reduced frame use and reducing the number of fractions. Our institution implemented these guidelines, and herein we show the resultant effect on patient treatments on our Gamma Knife Icon program. Methods: In early March 2020 we rapidly implemented suggested changes according to ASTRO and other consensus guidelines as they relate to stereotactic radiosurgery in the COVID-19 era. We reviewed the GK Icon schedule at our institution between January 01 and April 30, 2020. We documented age, condition treated, technique (frame vs. mask), and number of fractions. We then tabulated and graphed the number of patients, framed cases, and fractions delivered. Results: Seventy-seven patients were treated on the GK Icon over that period, for a total of 231 fractions. The number of unique patients varied from 18 (April) to 22 (January). Of the 77 patients only 5 were treated using a frame. The number of fractions per month decreased significantly over time, from 70 in January to 36 in April. Likewise, the percentage of single fraction cases increased from 4.5% per month in January to 67% in April. Conclusions: The results presented here show that it is possible to quickly and efficiently change work flows to allow for reduced fractionation and frame use in the time of a global pandemic. Multidisciplinary cooperation and ongoing communication are integral to the success of such programs. [ABSTRACT FROM AUTHOR]