Efficacy and Tolerance of Post-operative Hypo-Fractionated Stereotactic Radiotherapy in a Large Series of Patients With Brain Metastases

Geoffrey Martinage (1) , Julien Geffrelot (2) , Dinu Stefan (2, 3) , Emilie Bogart (1) , Erwan Rault (1) , Nicolas Reyns (4) , Evelyne Emery (5) , Samira Makhloufi-Martinage (1) , Raphaelle Mouttet-Audouard (1) , Laurent Basson (1) , Xavier Mirabel (1) , Eric Lartigau (1) , David Pasquier (1, 6)

1 UNICANCER/Lille - Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille]
2 UNICANCER/CRLC - Centre Régional de Lutte contre le Cancer François Baclesse [Caen]
3 ABTE - Aliments Bioprocédés Toxicologie Environnements
4 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
5 Service de Neurochirurgie [CHU Caen]
6 CRIStAL - Centre de Recherche en Informatique, Signal et Automatique de Lille - UMR 9189

Purpose: The aim of this study was to assess, in a large series, the efficacy and tolerance of post-operative adjuvant hypofractionated stereotactic radiation therapy (HFSRT) for brain metastases (BMs). Materials and Methods: Between July 2012 and January 2017, 160 patients from 2 centers were operated for BM and treated by HFSRT. Patients had between 1 and 3 BMs, no brainstem lesions or carcinomatous meningitis. The primary endpoint was local control. Secondary endpoints were distant brain control, overall survival (OS) and tolerance to HFSRT. Results: 73 patients (46%) presented with non-small cell lung cancer (NSCLC), 23 (14%) had melanoma and 21 (13%) breast cancer. Median age was 58 years (range, 22–83 years). BMs were synchronous in 50% of the cases. The most frequent prescription regimens were 24 Gy in 3 fractions (n = 52, 33%) and 30 Gy in 5 fractions (n = 37, 23%). Local control rates at 1 and 2 years were 88% [95%CI, 81–93%] and 81% [95%CI, 70–88%], respectively. Distant control rate at 1 year was 48% [95%CI, 81–93%]. In multivariate analysis, primary NSCLC was associated with a significant reduction in the risk of death compared to other primary sites (HR = 0.57, p = 0.007), the number of extra-cerebral metastatic sites (HR = 1.26, p = 0.003) and planning target volumes (HR = 1.15, p = 0.012) were associated with a lower OS. There was no prognostic factor of time to local progression. Median OS was 15.2 months [95%CI, 12.0–17.9 months] and the OS rate at 1 year was 58% [95% CI, 50–65%]. Salvage radiotherapy was administered to 72 patients (45%), of which 49 received new HFSRT. Ten (7%) patients presented late grade 2 and 4 (3%) patients late grade 3 toxicities. Thirteen (8.9%) patients developed radiation necrosis. Conclusions: This large multicenter retrospective study shows that HFSRT allows for good local control of metastasectomy tumor beds and that this technique is well-tolerated by patients.

Mots clés: radiotherapy; hypofractionated stereotactic radiation therapy; brain metastasis; surgery; Cyberknife

Domaines: Sciences du Vivant [q-bio]; Cancer

Geoffrey Martinage, Julien Geffrelot, Dinu Stefan, Emilie Bogart, Erwan Rault, et al.. Efficacy and Tolerance of Post-operative Hypo-Fractionated Stereotactic Radiotherapy in a Large Series of Patients With Brain Metastases. Frontiers in Oncology, 2019, 9, pp.Article 184. ⟨10.3389/fonc.2019.00184⟩. ⟨hal-02478999⟩