Hypofractionated stereotactic radiotherapy to the resection bed for intracranial metastases

Publication date: Available online 19 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Audrey Keller, Mélanie Doré, Hélène Cebula, François Thillays, François Proust, Ioana Darié, Stéphane-André Martin, Gregory Delpon, François Lefebvre, Georges Noël, Delphine Antoni
PurposeWe retrospectively report the outcomes of a large multicenter cohort of patients treated with surgery and hypofractionated stereotactic radiotherapy (HFSRT) to the resection cavities of brain metastases (BMs).Methods and materialsBetween March 2008 and February 2015, 181 patients with no prior whole-brain radiation therapy (WBRT) were treated by HFSRT to the surgical bed of BM at the dose of 33 Gy (3×11 Gy). The primary end-point was local control (LC). Secondary endpoints were distant brain control (DBC), overall survival (OS), risk of radionecrosis (RN) and leptomeningeal disease (LMD).ResultsOf the 189 resected lesions, 44% were metastatic from a non-small cell lung cancer (NSCLC) primary tumor, and 76% of patients had a single BM at the time of treatment. With a median follow up of 15 months, the 6-and 12-month LC rates were 93% and 88%, respectively. On multivariate analysis, PTV (p=0.005), GPA score (p=0.021) and meningeal contact of BM (p=0.032), were predictive of local failure. The 6-and 12-month DBC rates were 70% and 61%. Twenty-six patients (14%) developed signs of LMD at a median time of 3.8 months. The preoperative tumor volume was predictive of LMD (p=0.029). The median OS was 17months. The 6-,12-and 24-month OS rates were 79%, 62% and 39%, respectively. RPA Class 3 (p=0.02), piecemeal resection (p=0.017) and an increasing number of BMs (p<0.01) were independent unfavorable prognostic factors for OS. Fifty-four patients (30%) were subsequently treated with salvage WBRT at a median time of 6.5 months, and 41% were re-irradiated with SRT. RN occurred in 19% of cases at a median time of 15 months and was associated with the infratentorial location of the BM (p=0.0025).ConclusionThis study demonstrated the safety and efficacy of a 3×11 Gy HFSRT regimen for the irradiation of BMs resection cavities. It was an alternative to adjuvant WBRT.

Teaser

We retrospectively report the outcomes of a large multicenter cohort of patients treated with surgery and hypofractionated stereotactic radiotherapy (HFSRT) to the resection cavities of brain metastases (BMs). We analyzed the local control, distant brain control, overall survival, risk of radionecrosis and leptomeningeal disease. This study demonstrated the safety and efficacy of a 3×11Gy HFSRT regimen for the irradiation of BMs resection cavities. It was an alternative to adjuvant whole-brain radiotherapy (WBRT).


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