Re-Irradiation by Stereotactic Radiotherapy of Brain Metastases in the Case of Local Recurrence

SIMPLE SUMMARY: This is the first study to evaluate the outcomes of repeated salvage stereotactic radiotherapy (SRT) for the local recurrence of brain metastases after initial stereotactic radiotherapy at our center using the Hypofractionated Treatment Effects in the Clinic (HyTEC) reporting standards of the WGSBRT and the European Society for Radiotherapy and Oncology guidelines. The performance of surgery was predictive of a significantly better local control and survival. The volume of a normal brain receiving 5 Gy during re-irradiation, a dose delivered to the PTV in the first irradiation, and concomitant systemic therapy were associated with an increased risk of radionecrosis. ABSTRACT: Purpose: To evaluate the efficacy and safety of a second course of stereotactic radiotherapy (SRT2) treatment for a local recurrence of brain metastases previously treated with SRT (SRT1), using the Hypofractionated Treatment Effects in the Clinic (HyTEC) reporting standards and the European Society for Radiotherapy and Oncology guidelines. Methods: From December 2014 to May 2021, 32 patients with 34 brain metastases received salvage SRT2 after failed SRT1. A total dose of 21 to 27 Gy in 3 fractions or 30 Gy in 5 fractions was prescribed to the periphery of the PTV (99% of the prescribed dose covering 99% of the PTV). After SRT2, multiparametric MRI, sometimes combined with 18F-DOPA PET-CT, was performed every 3 months to determine local control (LC) and radionecrosis (RN). Results: After a median follow-up of 12 months (range: 1–37 months), the crude LC and RN rates were 68% and 12%, respectively, and the median overall survival was 25 months. In a multivariate analysis, the performance of surgery was predictive of a significantly better LC (p = 0.002) and survival benefit (p = 0.04). The volume of a normal brain receiving 5 Gy during SRT2 (p = 0.04), a dose delivered to the PTV in SRT1 (p = 0.003), and concomitant systemic therapy (p = 0.04) were associated with an increased risk of RN. Conclusion: SRT2 is an effective approach for the local recurrence of BM after initial SRT treatment and is a potential salvage therapy option for well-selected people with a good performance status. Surgery was associated with a higher LC.