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Repeated Stereotactic Radiotherapy for Local Brain Metastases Failure or Distant Brain Recurrent: A Retrospective
Laure Kuntz1, Clara Le Fèvre1, Delphine Jarnet2
1Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 17 Rue Albert Calmette, 67200 Strasbourg, France.
Cancers
|October 28, 2023
Summary
Stereotactic radiotherapy (SRT) can delay whole-brain radiotherapy (WBRT) and treat brain metastases (BM). This study found that factors like KPS and BMV grade influence survival outcomes in patients receiving multiple SRT courses.
Area of Science:
- Neuro-oncology
- Radiation Oncology
- Clinical Outcomes Research
Background:
- Stereotactic radiotherapy (SRT) offers advantages in delaying whole-brain radiotherapy (WBRT) and delivering ablative doses for brain metastases (BM).
- Despite SRT's efficacy, significant rates of distant BM recurrence (26-77%) and need for salvage treatment (20-40%) highlight the challenge of long-term control.
- The impact of reirradiation on survival and the identification of prognostic factors remain critical areas of investigation.
Purpose of the Study:
- To evaluate overall survival (OS) and neurological death-free survival (NDFS) in patients undergoing repeat SRT for BM.
- To identify prognostic factors associated with long-term survival after multiple SRT courses.
- To clarify the role and consequences of reirradiation in the management of brain metastases.
Main Methods:
- Retrospective review of 184 patients treated with at least two courses of SRT between 2010 and 2020, excluding those with prior WBRT.
- Analysis of treatment data, including number of SRT sessions, time between sessions, and salvage WBRT use.
- Statistical analysis to determine factors influencing OS and NDFS, including recursive partitioning analysis (RPA) and brain metastasis velocity (BMV).
Main Results:
- 184 patients received 915 BM treatments across two-to-six SRT sessions, primarily for distant recurrence (94.4%).
- The 6-, 12-, and 24-month NDFS rates were 97%, 82%, and 52%, respectively. The 6-, 12-, and 24-month OS rates were 91%, 70%, and 38%, respectively.
- OS was significantly associated with the number of SRT sessions, RPA, salvage WBRT, and BMV grade. High KPS and low BMV grade were linked to better OS.
Conclusions:
- Lung cancer and melanoma prognoses were poorer for NDFS compared to breast cancer.
- Factors such as low KPS, fewer SRT sessions, synchronous metastases, synchronous BMs, extracerebral progression, high BMV grade, no WBRT, and local recurrence were associated with lower NDFS.
- High KPS and low BMV grade emerged as key prognostic indicators for improved OS, irrespective of BM recurrence events.
