Repeated Stereotactic Radiotherapy for Local Brain Metastases Failure or Distant Brain Recurrent: A Retrospective Study of 184 Patients
Background: The main advantages of stereotactic radiotherapy (SRT) are to delay whole-brain radiotherapy (WBRT) and to deliver ablative doses. Despite this efficacy, the risk of distant brain metastases (BM) one year after SRT ranges from 26% to 77% and 20 to 40% of patients required salvage treatme...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-10-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/20/4948 |
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| author | Laure Kuntz Clara Le Fèvre Delphine Jarnet Audrey Keller Philippe Meyer Christophe Mazzara Hélène Cebula Georges Noel Delphine Antoni |
| author_facet | Laure Kuntz Clara Le Fèvre Delphine Jarnet Audrey Keller Philippe Meyer Christophe Mazzara Hélène Cebula Georges Noel Delphine Antoni |
| author_sort | Laure Kuntz |
| collection | DOAJ |
| description | Background: The main advantages of stereotactic radiotherapy (SRT) are to delay whole-brain radiotherapy (WBRT) and to deliver ablative doses. Despite this efficacy, the risk of distant brain metastases (BM) one year after SRT ranges from 26% to 77% and 20 to 40% of patients required salvage treatment. The role and consequences of reirradiation remain unclear, particularly in terms of survival. The objective was to study overall survival (OS) and neurological death-free survival (NDFS) and to specify the prognostic factors of long-term survival. Methods: we retrospectively reviewed the data of patients treated between 2010 and 2020 with at least two courses of SRT without previous WBRT. Results: In total, 184 patients were treated for 915 BMs with two-to-six SRT sessions. Additional SRT sessions were provided for local (5.6%) or distant (94.4%) BM recurrence. The median number of BMs treated per SRT was one with a median of four BMs in total. The mean time between the two SRT sessions was 8.9 months (95%CI 7.7–10.1) and there was no significant difference in the delay between the two sessions. The 6-, 12- and 24-month NDFS rates were 97%, 82% and 52%, respectively. The 6-, 12- and 24-month OS rates were 91%, 70% and 38%, respectively. OS was statistically related to the number of SRT sessions (HR = 0.48; <i>p</i> < 0.01), recursive partitioning analysis (HR = 1.84; <i>p</i> = 0.01), salvage WBRT (HR = 0.48; <i>p</i> = 0.01) and brain metastasis velocity (high: HR = 13.83; <i>p</i> < 0.01; intermediate: HR = 4.93; <i>p</i> < 0.01). Conclusions: Lung cancer and melanoma were associated with a lower NDFS compared to breast cancer. A low KPS, a low number of SRT sessions, synchronous extracerebral metastases, synchronous BMs, extracerebral progression at SRT1, a high BMV grade, no WBRT and local recurrence were also associated with a lower NDFS. A high KPS at SRT1 and low BMV grade are prognostic factors for better OS, regardless of the number of BM recurrence events. |
| first_indexed | 2024-03-10T21:22:15Z |
| format | Article |
| id | doaj.art-146c2c3422604fb5a59be5a439496dfd |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T21:22:15Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-146c2c3422604fb5a59be5a439496dfd2023-11-19T15:58:23ZengMDPI AGCancers2072-66942023-10-011520494810.3390/cancers15204948Repeated Stereotactic Radiotherapy for Local Brain Metastases Failure or Distant Brain Recurrent: A Retrospective Study of 184 PatientsLaure Kuntz0Clara Le Fèvre1Delphine Jarnet2Audrey Keller3Philippe Meyer4Christophe Mazzara5Hélène Cebula6Georges Noel7Delphine Antoni8Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 17 Rue Albert Calmette, 67200 Strasbourg, FranceDepartment of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 17 Rue Albert Calmette, 67200 Strasbourg, FranceDepartment of Medical Physics, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 17 Rue Albert Calmette, 67200 Strasbourg, FranceDepartment of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 17 Rue Albert Calmette, 67200 Strasbourg, FranceDepartment of Medical Physics, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 17 Rue Albert Calmette, 67200 Strasbourg, FranceDepartment of Medical Physics, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 17 Rue Albert Calmette, 67200 Strasbourg, FranceNeurosurgery Department, Hôpitaux Universitaires de Strasbourg, 1, Avenue Molière, 67098 Strasbourg, FranceDepartment of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 17 Rue Albert Calmette, 67200 Strasbourg, FranceDepartment of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 17 Rue Albert Calmette, 67200 Strasbourg, FranceBackground: The main advantages of stereotactic radiotherapy (SRT) are to delay whole-brain radiotherapy (WBRT) and to deliver ablative doses. Despite this efficacy, the risk of distant brain metastases (BM) one year after SRT ranges from 26% to 77% and 20 to 40% of patients required salvage treatment. The role and consequences of reirradiation remain unclear, particularly in terms of survival. The objective was to study overall survival (OS) and neurological death-free survival (NDFS) and to specify the prognostic factors of long-term survival. Methods: we retrospectively reviewed the data of patients treated between 2010 and 2020 with at least two courses of SRT without previous WBRT. Results: In total, 184 patients were treated for 915 BMs with two-to-six SRT sessions. Additional SRT sessions were provided for local (5.6%) or distant (94.4%) BM recurrence. The median number of BMs treated per SRT was one with a median of four BMs in total. The mean time between the two SRT sessions was 8.9 months (95%CI 7.7–10.1) and there was no significant difference in the delay between the two sessions. The 6-, 12- and 24-month NDFS rates were 97%, 82% and 52%, respectively. The 6-, 12- and 24-month OS rates were 91%, 70% and 38%, respectively. OS was statistically related to the number of SRT sessions (HR = 0.48; <i>p</i> < 0.01), recursive partitioning analysis (HR = 1.84; <i>p</i> = 0.01), salvage WBRT (HR = 0.48; <i>p</i> = 0.01) and brain metastasis velocity (high: HR = 13.83; <i>p</i> < 0.01; intermediate: HR = 4.93; <i>p</i> < 0.01). Conclusions: Lung cancer and melanoma were associated with a lower NDFS compared to breast cancer. A low KPS, a low number of SRT sessions, synchronous extracerebral metastases, synchronous BMs, extracerebral progression at SRT1, a high BMV grade, no WBRT and local recurrence were also associated with a lower NDFS. A high KPS at SRT1 and low BMV grade are prognostic factors for better OS, regardless of the number of BM recurrence events.https://www.mdpi.com/2072-6694/15/20/4948radiotherapysalvage radiationstereotactic radiosurgerybrain metastasesreirradiationrepeated radiosurgery |
| spellingShingle | Laure Kuntz Clara Le Fèvre Delphine Jarnet Audrey Keller Philippe Meyer Christophe Mazzara Hélène Cebula Georges Noel Delphine Antoni Repeated Stereotactic Radiotherapy for Local Brain Metastases Failure or Distant Brain Recurrent: A Retrospective Study of 184 Patients Cancers radiotherapy salvage radiation stereotactic radiosurgery brain metastases reirradiation repeated radiosurgery |
| title | Repeated Stereotactic Radiotherapy for Local Brain Metastases Failure or Distant Brain Recurrent: A Retrospective Study of 184 Patients |
| title_full | Repeated Stereotactic Radiotherapy for Local Brain Metastases Failure or Distant Brain Recurrent: A Retrospective Study of 184 Patients |
| title_fullStr | Repeated Stereotactic Radiotherapy for Local Brain Metastases Failure or Distant Brain Recurrent: A Retrospective Study of 184 Patients |
| title_full_unstemmed | Repeated Stereotactic Radiotherapy for Local Brain Metastases Failure or Distant Brain Recurrent: A Retrospective Study of 184 Patients |
| title_short | Repeated Stereotactic Radiotherapy for Local Brain Metastases Failure or Distant Brain Recurrent: A Retrospective Study of 184 Patients |
| title_sort | repeated stereotactic radiotherapy for local brain metastases failure or distant brain recurrent a retrospective study of 184 patients |
| topic | radiotherapy salvage radiation stereotactic radiosurgery brain metastases reirradiation repeated radiosurgery |
| url | https://www.mdpi.com/2072-6694/15/20/4948 |
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