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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 standar...

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Autores principales: Touati, Ruben, Bourbonne, Vincent, Dissaux, Gurvan, Goasduff, Gaëlle, Pradier, Olivier, Peltier, Charles, Seizeur, Romuald, Schick, Ulrike, Lucia, François
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9913463/
https://www.ncbi.nlm.nih.gov/pubmed/36765953
http://dx.doi.org/10.3390/cancers15030996
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author Touati, Ruben
Bourbonne, Vincent
Dissaux, Gurvan
Goasduff, Gaëlle
Pradier, Olivier
Peltier, Charles
Seizeur, Romuald
Schick, Ulrike
Lucia, François
author_facet Touati, Ruben
Bourbonne, Vincent
Dissaux, Gurvan
Goasduff, Gaëlle
Pradier, Olivier
Peltier, Charles
Seizeur, Romuald
Schick, Ulrike
Lucia, François
author_sort Touati, Ruben
collection PubMed
description 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.
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spelling pubmed-99134632023-02-11 Re-Irradiation by Stereotactic Radiotherapy of Brain Metastases in the Case of Local Recurrence Touati, Ruben Bourbonne, Vincent Dissaux, Gurvan Goasduff, Gaëlle Pradier, Olivier Peltier, Charles Seizeur, Romuald Schick, Ulrike Lucia, François Cancers (Basel) Article 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. MDPI 2023-02-03 /pmc/articles/PMC9913463/ /pubmed/36765953 http://dx.doi.org/10.3390/cancers15030996 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Touati, Ruben
Bourbonne, Vincent
Dissaux, Gurvan
Goasduff, Gaëlle
Pradier, Olivier
Peltier, Charles
Seizeur, Romuald
Schick, Ulrike
Lucia, François
Re-Irradiation by Stereotactic Radiotherapy of Brain Metastases in the Case of Local Recurrence
title Re-Irradiation by Stereotactic Radiotherapy of Brain Metastases in the Case of Local Recurrence
title_full Re-Irradiation by Stereotactic Radiotherapy of Brain Metastases in the Case of Local Recurrence
title_fullStr Re-Irradiation by Stereotactic Radiotherapy of Brain Metastases in the Case of Local Recurrence
title_full_unstemmed Re-Irradiation by Stereotactic Radiotherapy of Brain Metastases in the Case of Local Recurrence
title_short Re-Irradiation by Stereotactic Radiotherapy of Brain Metastases in the Case of Local Recurrence
title_sort re-irradiation by stereotactic radiotherapy of brain metastases in the case of local recurrence
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9913463/
https://www.ncbi.nlm.nih.gov/pubmed/36765953
http://dx.doi.org/10.3390/cancers15030996
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