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Hypofractionated postoperative stereotactic radiotherapy for large resected brain metastases
1Service d'oncologie radiothérapie, hôpitaux universitaires Pitié-Salpêtrière - Charles-Foix, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
Summary
Hypofractionated stereotactic radiotherapy (HSRT) shows moderate local control for resected brain metastases, but distant brain control remains a challenge. Further research is needed to optimize HSRT dose and timing for better patient outcomes.
Area of Science:
- Neuro-oncology
- Radiation Oncology
- Neurosurgery
Background:
- Brain metastases (BM) represent a significant challenge in cancer care, often requiring multimodal treatment strategies.
- Stereotactic radiotherapy (SRT) is a key modality for treating BM, with hypofractionated schedules gaining traction.
- Evaluating outcomes after hypofractionated stereotactic radiotherapy (HSRT) for resected brain metastases is crucial for refining treatment protocols.
Approach:
- This retrospective study analyzed data from patients with resected BM treated with postoperative HSRT (3×7.7Gy) between May 2013 and June 2020.
- Key outcomes assessed included local control (LC), distant brain control (DBC), overall survival (OS), leptomeningeal disease relapse (LMDR), and radiation necrosis (RN).
- Statistical analysis identified factors associated with OS and RN occurrence.
Key Points:
- One and two-year local control rates were 60.9% and 52.2%, respectively.
- One and two-year distant brain control rates were 45.5% and 40.9%.
- Radiation necrosis occurred in 27.2% of patients, with factors like PTV volume and irradiated normal brain volumes influencing its occurrence.
Conclusions:
- HSRT is a common treatment for larger resected brain cavities, but optimal dose and timing require further definition.
- Factors such as ECOG-PS, KPS, and metastasis characteristics impact overall survival.
- Dose escalation may be beneficial, particularly in cases of subtotal resection.
