Brain metastases treated with hypofractionated stereotactic radiotherapy: 8 years experience after Cyberknife installation.
Adolescent
Adult
Aged
Aged, 80 and over
Brain Neoplasms
/ diagnostic imaging
Child
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Prognosis
Radiation Dose Hypofractionation
Radiation Injuries
/ epidemiology
Radiosurgery
/ adverse effects
Retrospective Studies
Survival Rate
Treatment Outcome
Young Adult
Brain metastases
Hypofractionated stereotactic radiotherapy
Radionecrosis
Journal
Radiation oncology (London, England)
ISSN: 1748-717X
Titre abrégé: Radiat Oncol
Pays: England
ID NLM: 101265111
Informations de publication
Date de publication:
17 Apr 2020
17 Apr 2020
Historique:
received:
12
11
2019
accepted:
19
03
2020
entrez:
19
4
2020
pubmed:
19
4
2020
medline:
20
1
2021
Statut:
epublish
Résumé
Hypofractionated stereotactic radiotherapy (HFSRT) is indicated for large brain metastases (BM) or proximity to critical organs (brainstem, chiasm, optic nerves, hippocampus). The primary aim of this study was to assess factors influencing BM local control after HFSRT. Then the effect of surgery plus HFSRT was compared with exclusive HFSRT on oncologic outcomes, including overall survival. Retrospective study conducted in Léon Bérard Cancer Center, included patients over 18 years-old with BM, secondary to a tumor proven by histology and treated by HFSRT alone or after surgery. Three different dose-fractionation schedules were compared: 27 Gy (3 × 9 Gy), 30 Gy (5 × 6 Gy) and 35 Gy (5 × 7 Gy), prescribed on isodose 80%. Primary endpoint were local control (LC). Secondary endpoints were overall survival (OS) and radionecrosis (RN) rate. A total of 389 patients and 400 BM with regular MRI follow-up were analyzed. There was no statistical difference between the different dose-fractionations. On multivariate analysis, surgery (p = 0.049) and size (< 2.5 cm) (p = 0.01) were independent factors improving LC. The 12 months LC was 87.02% in the group Surgery plus HFSRT group vs 73.53% at 12 months in the group HFSRT. OS was 61.43% at 12 months in the group Surgery plus HFSRT group vs 50.13% at 12 months in the group HFSRT (p < 0.0085). Prior surgery (OR = 1.86; p = 0.0028) and sex (OR = 1.4; p = 0.0139) control of primary tumor (OR = 0.671, p = 0.0069) and KPS < 70 (OR = 0.769, p = 0.0094) were independently predictive of OS. The RN rate was 5% and all patients concerned were symptomatic. This study suggests that HFSRT is an efficient and well-tolerated treatment. The optimal dose-fractionation remains difficult to determine. Smaller size and surgery are correlated to LC. These results evidence the importance of surgery for larger BM (> 2.5 cm) with a poorer prognosis. Multidisciplinary committees and prospective studies are necessary to validate these observations.
Sections du résumé
BACKGROUND
BACKGROUND
Hypofractionated stereotactic radiotherapy (HFSRT) is indicated for large brain metastases (BM) or proximity to critical organs (brainstem, chiasm, optic nerves, hippocampus). The primary aim of this study was to assess factors influencing BM local control after HFSRT. Then the effect of surgery plus HFSRT was compared with exclusive HFSRT on oncologic outcomes, including overall survival.
MATERIALS AND METHODS
METHODS
Retrospective study conducted in Léon Bérard Cancer Center, included patients over 18 years-old with BM, secondary to a tumor proven by histology and treated by HFSRT alone or after surgery. Three different dose-fractionation schedules were compared: 27 Gy (3 × 9 Gy), 30 Gy (5 × 6 Gy) and 35 Gy (5 × 7 Gy), prescribed on isodose 80%. Primary endpoint were local control (LC). Secondary endpoints were overall survival (OS) and radionecrosis (RN) rate.
RESULTS
RESULTS
A total of 389 patients and 400 BM with regular MRI follow-up were analyzed. There was no statistical difference between the different dose-fractionations. On multivariate analysis, surgery (p = 0.049) and size (< 2.5 cm) (p = 0.01) were independent factors improving LC. The 12 months LC was 87.02% in the group Surgery plus HFSRT group vs 73.53% at 12 months in the group HFSRT. OS was 61.43% at 12 months in the group Surgery plus HFSRT group vs 50.13% at 12 months in the group HFSRT (p < 0.0085). Prior surgery (OR = 1.86; p = 0.0028) and sex (OR = 1.4; p = 0.0139) control of primary tumor (OR = 0.671, p = 0.0069) and KPS < 70 (OR = 0.769, p = 0.0094) were independently predictive of OS. The RN rate was 5% and all patients concerned were symptomatic.
CONCLUSIONS
CONCLUSIONS
This study suggests that HFSRT is an efficient and well-tolerated treatment. The optimal dose-fractionation remains difficult to determine. Smaller size and surgery are correlated to LC. These results evidence the importance of surgery for larger BM (> 2.5 cm) with a poorer prognosis. Multidisciplinary committees and prospective studies are necessary to validate these observations.
Identifiants
pubmed: 32303236
doi: 10.1186/s13014-020-01517-3
pii: 10.1186/s13014-020-01517-3
pmc: PMC7164358
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
82Références
Int J Radiat Oncol Biol Phys. 2012 Aug 1;83(5):1399-405
pubmed: 22209155
Int J Radiat Oncol Biol Phys. 1997 Mar 1;37(4):745-51
pubmed: 9128946
Handb Clin Neurol. 2018;149:75-88
pubmed: 29307363
Neurol Sci. 2011 Jun;32(3):393-9
pubmed: 21234772
Strahlenther Onkol. 2007 Nov;183(11):625-30
pubmed: 17960338
Lancet Oncol. 2017 Aug;18(8):1040-1048
pubmed: 28687375
Neurosurg Clin N Am. 2011 Jan;22(1):1-6, v
pubmed: 21109143
Ann Oncol. 2017 Oct 1;28(10):2588-2594
pubmed: 28961826
J Clin Oncol. 2011 Jan 10;29(2):134-41
pubmed: 21041710
Int J Radiat Oncol Biol Phys. 2007 Oct 1;69(2):640-1; author reply 641
pubmed: 17869682
Neuro Oncol. 2016 Aug;18(8):1043-65
pubmed: 27382120
Am J Clin Oncol. 2016 Aug;39(4):379-83
pubmed: 24755663
J Neurosurg. 2013 Nov;119(5):1139-44
pubmed: 23971958
J Neurooncol. 2009 Jan;91(2):207-12
pubmed: 18807149
Radiat Oncol. 2011 May 15;6:48
pubmed: 21575163
J Neurooncol. 2012 Aug;109(1):91-8
pubmed: 22528795
Radiat Oncol. 2014 Oct 17;9:231
pubmed: 25322826
Lancet. 2004 May 22;363(9422):1665-72
pubmed: 15158627
Acta Oncol. 2009;48(3):457-9
pubmed: 18781455
Neuro Oncol. 2017 Feb 1;19(2):162-174
pubmed: 28391295
Front Oncol. 2018 Oct 02;8:379
pubmed: 30333955
World Neurosurg. 2014 Dec;82(6):1242-9
pubmed: 25109592
Neuro Oncol. 2017 Jan;19(1):i1-i24
pubmed: 28031389
Radiat Oncol. 2018 Jul 28;13(1):138
pubmed: 30055640
Int J Radiat Oncol Biol Phys. 2016 Jul 15;95(4):1142-8
pubmed: 27209508
J Clin Oncol. 2012 Feb 1;30(4):419-25
pubmed: 22203767
Anticancer Res. 2009 Oct;29(10):4259-63
pubmed: 19846983
Radiat Oncol. 2014 May 08;9:110
pubmed: 24886280
Expert Rev Neurother. 2016 Aug;16(8):903-14
pubmed: 27177183
Front Radiat Ther Oncol. 2011;43:382-394
pubmed: 21625164
Neuro Oncol. 2017 Apr 1;19(suppl_2):ii38-ii49
pubmed: 28380634
Cancer Radiother. 2015 Feb;19(1):66-71
pubmed: 25666314
Int J Radiat Oncol Biol Phys. 2013 Nov 15;87(4):713-8
pubmed: 24054875
Radiother Oncol. 2006 Oct;81(1):18-24
pubmed: 16978720
World Neurosurg. 2019 Feb;122:e1557-e1561
pubmed: 30471438
J Neurooncol. 2018 Sep;139(2):449-454
pubmed: 29749569
Int J Radiat Oncol Biol Phys. 2013 Apr 1;85(5):1312-8
pubmed: 23391814
Int J Radiat Oncol Biol Phys. 2019 Mar 1;103(3):618-630
pubmed: 30395902