What target volumes do you use for cavity SRS following surgical resection of brain metastases?
In light of the recent consensus contouring guidelines (Soliman et al, IJROBP 2017): 1) Are you routinely expanding along the dura up to 5-10 mm in cases with pre-operative tumor contacting dura and 2) Are you routinely covering the entirety of the surgical tract for deeper lesions?
Answer from: Radiation Oncologist at Academic Institution
I use Scott Solty's 2008 paper. Unfortunately the Red Journal recently published a consensus paper where experienced radoncs and neurosurgeons defined cavities. There are no outcomes-control or toxicity, nor any doses mentioned in this study. Merely contours. Its quite unsettling and I feel dangerou...
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Answer from: Radiation Oncologist at Academic Institution
This is a great question. When tumor touches dura, I have usually covered the dura with more than 3 mm (the margin I use around the cavity otherwise), probably 5 mm. As to whether the surgical tract gets covered, I think it gets covered quite routinely because it isn't so much of a "tract", ie not a...
Answer from: Radiation Oncologist at Academic Institution
1) Based on reports of pre-op, that would be the preferred approach unless symptoms/pathologic diagnosis preclude pre-op SRS
2) Post op, I would add a 2mm margin around the resection cavity (literally place a 4mm cursor and center at the rim and contour each slice and then add a cap on both ends to...