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[Stereotactic radiotherapy in brain metastases].
F Dhermain1, N Reyns2, P Colin3
1Département de radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Réunion de concertation polydisciplinaire de neuro-oncologie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
Stereotactic radiotherapy (SRT) precisely targets brain metastases using high doses in few fractions. It offers survival benefits when combined with whole brain radiotherapy or used for recurrences, aiming to balance efficacy and toxicity.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Medical Physics
Background:
- Stereotactic radiotherapy (SRT) is increasingly utilized for brain metastases.
- Expert consensus highlights the need to define SRT's prescription, indications, and clinical value.
- Balancing treatment efficacy against toxicity is crucial for patient outcomes.
Purpose of the Study:
- To discuss the definition and prescription modalities of SRT for brain metastases.
- To outline the indications and clinical relevance of SRT.
- To evaluate the efficacy versus toxicity profile of SRT.
Main Methods:
- SRT involves high-precision irradiation (within 1mm) using various machines (e.g., photon X or gamma).
- It delivers high doses (4-25Gy) in limited fractions (1-5, max 10) with steep dose gradients.
- Dose prescription is tailored based on equipment and organ-at-risk constraints, varying with fractionation.
Main Results:
- SRT can be combined with whole brain radiotherapy to modestly improve survival in select patients (1-3 metastases, good performance status, controlled extracranial disease).
- It is indicated for recurrent brain metastases (1-3) after whole brain radiotherapy, post-resection of large/symptomatic metastases, or for 3-5 asymptomatic metastases to delay whole brain radiotherapy.
- Iterative SRT requires strict 3-month clinical and MRI follow-up to maintain survival benefits.
Conclusions:
- SRT offers precise, high-dose, fractionated radiation for brain metastases.
- Its application requires careful consideration of specific patient criteria and treatment goals.
- Careful follow-up and discussion regarding concurrent targeted therapies are essential for optimal outcomes.
