Hypofractionated stereotactic radiotherapy of limited brain metastases: a single-centre individualized treatment approach
Menée sur 75 patients atteints d'un cancer avec métastases cérébrales traitées entre 2006 et 2010, cette étude rétrospective évalue, du point de vue de la survie globale et en fonction du volume tumoral, l'efficacité et la toxicité de différentes doses de rayonnements ionisants dans le cadre d'une radiothérapie stéréotaxique hypofractionnée
BACKGROUND:We retrospectively report treatment results of our single-centre experience with hypofractionated stereotactic radiotherapy (hfSRT) of limited brain metastases in primary and recurrence disease situations. Our aim was to find the most effective and safe dose concept.METHODS:From 04/2006 to 12/2010, 75 patients, with 108 intracranial metastases, were treated with hfSRT. 52 newly diagnosed metastases (48%), without up-front whole brain radiotherapy (WBRT), received hfSRT as a primary treatment. 56 metastases (52%) received a prior WBRT and were treated in this study in a recurrence situation. Main fractionation concepts used for primary hfSRT were 6-7x5Gy (61.5%) and 5x6Gy (19.2%), for recurrent hfSRT 7 to 10x4Gy (33.9%) and 5-6x5Gy (33.9%).RESULTS:Median overall survival (OS) of all patients summed up to 9.1 months, actuarial 6-and 12-month-OS was 59% and 35%, respectively. Median local brain control (LC) was 11.9 months, median distant brain control (DC) 3.9 months and intracranial control (IC) 3.4 months, respectively. Variables with significant influence on OS were Gross Tumour Volume (GTV) (p = 0.019), the biological eqivalent dose (calculated on a 2 Gy single dose, EQD2, alpha/beta = 10) < and >= median of 39 Gy (p = 0.012), extracerebral activity of the primary tumour (p < 0.001) and the steroid uptake during hfSRT (p = 0.03). LC was significantly influenced by the EQD2, <= and > 35 Gy (p = 0.004) in both uni- and multivariate Cox regression analysis. Median LC was 14.7 months for EQD2 >=35 Gy and 3.4 months for doses <35 Gy, respectively. Early treatment related side effects were usually mild. Nevertheless, patients with a EQD2 >35 Gy had higher rates of toxicity (31%) than <=35Gy (8.3%, p=0.026).CONCLUSION:Comparing different dose concepts in hfSRT, a cumulative EQD2 of >=35 Gy seems to be the most effective concept in patients with primary or recurrent limited brain metastases. Despite higher rates of only mild toxicity, this concept represents a safe treatment option.
BMC Cancer 2012