
==== Front
Neurooncol Adv
Neurooncol Adv
noa
Neuro-Oncology Advances
2632-2498
Oxford University Press US

10.1093/noajnl/vdae090.086
vdae090.086
Final Category: Ongoing Clinical Trials
AcademicSubjects/MED00300
AcademicSubjects/MED00310
OCTS-01 DOSE ESCALATION FOR PREOPERATIVE STEREOTACTIC RADIOSURGERY FOR PATIENTS WITH LARGE BRAIN METASTASES
Murphy Erin S Cleveland Clinic, Cleveland, OH, USA

Yang Kailin Cleveland Clinic, Cleveland, OH, USA

Suh John Cleveland Clinic, Cleveland, OH, USA

Yu Jennifer Cleveland Clinic, Cleveland, OH, USA

Stevens Glen Cleveland Clinic, Cleveland, OH, USA

Angelov Lilyana Cleveland Clinic, Cleveland, OH, USA

Vogelbaum Michael Moffitt Cancer Center, Tampa, FL, USA

Barnett Gene Cleveland Clinic, Cleveland, OH, USA

Ahluwalia Manmeet Baptist Health, Miami, FL, USA

Neyman Gennady Cleveland Clinic, Cleveland, OH, USA

Mohammadi Alireza Cleveland Clinic, Cleveland, OH, USA

Chao Samuel Cleveland Clinic, Cleveland, OH, USA

8 2024
02 8 2024
02 8 2024
6 Suppl 1 2024 SNO/ASCO CNS Metastases Conference i26i26
© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Abstract

PURPOSE/OBJECTIVE(S)

We conducted a prospective phase I preoperative radiosurgery dose escalation trial for brain metastases greater than 2 cm. We report updated results with known prognostic variables.

MATERIALS/METHODS

Radiosurgery dose was escalated at 3 Gy increments for 3 cohorts based on maximum tumor diameter. Dose limiting toxicity (DLT) was defined as grade 3 or greater acute toxicity. Patients underwent surgical resection within 2 weeks and were followed with imaging and neurological evaluations every 3 months.

RESULTS

A total of 35 patients were enrolled. The most common histology was NSCLC (57.1%), followed by breast cancer (14.3%). Only 12 out of 35 patients had actionable mutations and received targeted therapy and/or immunotherapy. 13 (37%) underwent piecemeal resection. 7 (20%) were infratentorial. There were 3 DLTs: 2 in the >3-4 cm cohort and 1 in the >4-6 cm cohort. For >3-4 cm, the maximum tolerable dose (MTD) was 18 Gy (2nd dose level), and for >4-6 cm, 18 Gy (3rd dose level). Time to DLT occurred within 2 days to 2 months of surgery. With a median follow-up of 64.0 months, the 6- and 12-month local control rates were 85.9% and 76.6%, respectively. The 6- and 12-month distant brain control was 63.1% and 55.3%, respectively. Overall survival at 6 and 12 months was 82.9% and 59.0%. The rate of leptomeningeal disease (LMD) at 2 years was 0%.

CONCLUSION

Preoperative SRS with dose escalation followed by surgical resection for brain metastases greater than 2 cm in size demonstrates acceptable acute toxicity. The Phase II portion of the trial is accruing patients with tumor size >3-6 cm at 18Gy.
==== Body
pmc
