Radiosurgery or hypofractionated stereotactic radiotherapy for brain metastases from radioresistant primaries (melanoma and renal cancer)
Abstract Background Until 50% of patients with renal cancer or melanoma, develop brain metastases during the course of their disease. Stereotactic radiotherapy has become a standard of care for patients with a limited number of brain metastases. Given the radioresistant nature of melanoma and renal...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-07-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13014-018-1083-1 |
| _version_ | 1818957480741306368 |
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| author | Paul Lesueur Justine Lequesne Victor Barraux William Kao Julien Geffrelot Jean-Michel Grellard Jean-Louis Habrand Evelyne Emery Brigitte Marie Juliette Thariat Dinu Stefan |
| author_facet | Paul Lesueur Justine Lequesne Victor Barraux William Kao Julien Geffrelot Jean-Michel Grellard Jean-Louis Habrand Evelyne Emery Brigitte Marie Juliette Thariat Dinu Stefan |
| author_sort | Paul Lesueur |
| collection | DOAJ |
| description | Abstract Background Until 50% of patients with renal cancer or melanoma, develop brain metastases during the course of their disease. Stereotactic radiotherapy has become a standard of care for patients with a limited number of brain metastases. Given the radioresistant nature of melanoma and renal cancer, optimization of the fractionation of stereotactic radiotherapy is needed. The purpose of this retrospective study was to elucidate if hypofractionated stereotactic radiotherapy (HFSRT) impacts local control of brain metastases from radioresistant tumors such as melanoma and renal cancer, in comparison with radiosurgery (SRS). Methods Between 2012 and 2016, 193 metastases, smaller than 3 cm, from patients suffering from radioresistant primaries (melanoma and renal cancer) were treated with HFSRT or SRS. The primary outcome was local progression free survival (LPFS) at 6, 12 and 18 months. Overall survival (OS) and cerebral progression free survival (CPFS) were secondary outcomes, and were evaluated per patient. Objective response rate and radionecrosis incidence were also reported. The statistical analysis included a supplementary propensity score analysis to deal with bias induced by non-randomized data. Results After a median follow-up of 7.4 months, LPFS rates at 6, 12 and 18 months for the whole population were 83, 74 and 70%, respectively. With respect to fractionation, LPFS rates at 6, 12 and 18 months were 89, 79 and 73% for the SRS group and 80, 72 and 68% for the HFSRT group. The fractionation schedule was not statistically associated with LPFS (HR = 1.39, CI95% [0.65–2.96], p = 0.38). Time from planning MRI to first irradiation session longer than 14 days was associated with a poorer local control rate. Over this time, LPFS at 12 months was reduced from 86 to 70% (p = 0.009). Radionecrosis occurred in 7.1% for HFSRT treated metastases to 9.6% to SRS treated metastases, without any difference according to fractionation (p = 0.55). The median OS was 9.6 months. Six, 12 and 18 months CPFS rates were 54, 24 and 17%, respectively. Conclusion Fractionation does not decrease LPFS. Even for small radioresistant brain metastases (< 3 cm), HFSRT, with 3 or 6 fractions, leads to an excellent local control rate of 72% at 1 year with a rate of 7.1% of radionecrosis. HFSRT is a safe and efficient alternative treatment to SRS. |
| first_indexed | 2024-12-20T11:10:31Z |
| format | Article |
| id | doaj.art-9a309d49286249a88fcdc799f66bb083 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-12-20T11:10:31Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-9a309d49286249a88fcdc799f66bb0832022-12-21T19:42:47ZengBMCRadiation Oncology1748-717X2018-07-0113111010.1186/s13014-018-1083-1Radiosurgery or hypofractionated stereotactic radiotherapy for brain metastases from radioresistant primaries (melanoma and renal cancer)Paul Lesueur0Justine Lequesne1Victor Barraux2William Kao3Julien Geffrelot4Jean-Michel Grellard5Jean-Louis Habrand6Evelyne Emery7Brigitte Marie8Juliette Thariat9Dinu Stefan10Radiotherapy department, Centre François BaclesseClinical research department, Centre François BaclesseMedical physics department, Centre François BaclesseRadiotherapy department, Centre François BaclesseRadiotherapy department, Centre François BaclesseClinical research department, Centre François BaclesseRadiotherapy department, Centre François BaclesseNeurosurgery department, CHU Côte de NacreImaging department, Centre François BaclesseRadiotherapy department, Centre François BaclesseRadiotherapy department, Centre François BaclesseAbstract Background Until 50% of patients with renal cancer or melanoma, develop brain metastases during the course of their disease. Stereotactic radiotherapy has become a standard of care for patients with a limited number of brain metastases. Given the radioresistant nature of melanoma and renal cancer, optimization of the fractionation of stereotactic radiotherapy is needed. The purpose of this retrospective study was to elucidate if hypofractionated stereotactic radiotherapy (HFSRT) impacts local control of brain metastases from radioresistant tumors such as melanoma and renal cancer, in comparison with radiosurgery (SRS). Methods Between 2012 and 2016, 193 metastases, smaller than 3 cm, from patients suffering from radioresistant primaries (melanoma and renal cancer) were treated with HFSRT or SRS. The primary outcome was local progression free survival (LPFS) at 6, 12 and 18 months. Overall survival (OS) and cerebral progression free survival (CPFS) were secondary outcomes, and were evaluated per patient. Objective response rate and radionecrosis incidence were also reported. The statistical analysis included a supplementary propensity score analysis to deal with bias induced by non-randomized data. Results After a median follow-up of 7.4 months, LPFS rates at 6, 12 and 18 months for the whole population were 83, 74 and 70%, respectively. With respect to fractionation, LPFS rates at 6, 12 and 18 months were 89, 79 and 73% for the SRS group and 80, 72 and 68% for the HFSRT group. The fractionation schedule was not statistically associated with LPFS (HR = 1.39, CI95% [0.65–2.96], p = 0.38). Time from planning MRI to first irradiation session longer than 14 days was associated with a poorer local control rate. Over this time, LPFS at 12 months was reduced from 86 to 70% (p = 0.009). Radionecrosis occurred in 7.1% for HFSRT treated metastases to 9.6% to SRS treated metastases, without any difference according to fractionation (p = 0.55). The median OS was 9.6 months. Six, 12 and 18 months CPFS rates were 54, 24 and 17%, respectively. Conclusion Fractionation does not decrease LPFS. Even for small radioresistant brain metastases (< 3 cm), HFSRT, with 3 or 6 fractions, leads to an excellent local control rate of 72% at 1 year with a rate of 7.1% of radionecrosis. HFSRT is a safe and efficient alternative treatment to SRS.http://link.springer.com/article/10.1186/s13014-018-1083-1Stereotactic radiotherapyBrain metastasesRadioresistantMelanomaFractionationRenal Cancer |
| spellingShingle | Paul Lesueur Justine Lequesne Victor Barraux William Kao Julien Geffrelot Jean-Michel Grellard Jean-Louis Habrand Evelyne Emery Brigitte Marie Juliette Thariat Dinu Stefan Radiosurgery or hypofractionated stereotactic radiotherapy for brain metastases from radioresistant primaries (melanoma and renal cancer) Radiation Oncology Stereotactic radiotherapy Brain metastases Radioresistant Melanoma Fractionation Renal Cancer |
| title | Radiosurgery or hypofractionated stereotactic radiotherapy for brain metastases from radioresistant primaries (melanoma and renal cancer) |
| title_full | Radiosurgery or hypofractionated stereotactic radiotherapy for brain metastases from radioresistant primaries (melanoma and renal cancer) |
| title_fullStr | Radiosurgery or hypofractionated stereotactic radiotherapy for brain metastases from radioresistant primaries (melanoma and renal cancer) |
| title_full_unstemmed | Radiosurgery or hypofractionated stereotactic radiotherapy for brain metastases from radioresistant primaries (melanoma and renal cancer) |
| title_short | Radiosurgery or hypofractionated stereotactic radiotherapy for brain metastases from radioresistant primaries (melanoma and renal cancer) |
| title_sort | radiosurgery or hypofractionated stereotactic radiotherapy for brain metastases from radioresistant primaries melanoma and renal cancer |
| topic | Stereotactic radiotherapy Brain metastases Radioresistant Melanoma Fractionation Renal Cancer |
| url | http://link.springer.com/article/10.1186/s13014-018-1083-1 |
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