Stereotactic radiosurgery: Treatment of brain metastasis without interruption of systemic therapy
Menée à partir de données portant sur 193 patients présentant des métastases cérébrales traitées entre 2009 et 2014 (âge médian : 61 ans), cette étude évalue, du point de vue de la toxicité et de la survie, l'intérêt d'un traitement systémique en combinaison avec une radiochirurgie stéréotaxique concomitante
Purpose/Objective : Systemic therapy is typically not given concurrently with whole brain radiation therapy (WBRT) for treatment of metastatic disease due to increased risk of myelosuppression and neurotoxicity. The goal of this study was to evaluate the prevalence, outcomes, and toxicities of concurrent delivery of systemic therapy with stereotactic radiosurgery (SRS) for treatment of brain metastases. Materials/Methods : We conducted a retrospective review of 193 patients treated at our institution with SRS without prior WBRT for brain metastases between 2009 and 2014. Outcome metrics included administration of concurrent systemic therapy, myelosuppression, neurotoxicity, and survival. Results : One hundred ninety-three patients with a median age of 61 years underwent a total of 291 SRS treatments. Thirty-seven percent of SRS treatments were delivered concurrently with systemic therapy, of which 46% were with conventional myelosuppressive chemotherapy, and 54% with targeted and immune therapy agents. Myelosuppression was minimal following treatment with both systemic therapy and SRS, with 14% grade 3-4 toxicity for lymphopenia and 4-9% for leukopenia, neutropenia, anemia, and thrombocytopenia. Neurotoxicity was also minimal following combined therapy, with no grade 4 and <5% grade 3 toxicity, 33% dexamethasone requirement, and 4% radiation necrosis, all similar to treatments with SRS alone. Median overall survival was similar following SRS alone (14.4 months) versus SRS with systemic therapy (12.9 months). In patients with a new diagnosis of primary cancer with brain metastasis, early treatment with concurrent systemic therapy and SRS correlated with improved survival versus SRS alone (41.6 vs 21.5 months, p<0.05). Conclusion : Systemic therapy can be safely given concurrently with SRS for brain metastases, as our results suggest minimal myelosuppression and neurotoxicity. Concurrent therapy is an attractive option for patients who have both intracranial and extracranial metastatic disease and may be particularly beneficial in patients with a new diagnosis of primary cancer with brain metastasis.