AUTHOR=Martinage Geoffrey , Geffrelot Julien , Stefan Dinu , Bogart Emilie , Rault Erwan , Reyns Nicolas , Emery Evelyne , Makhloufi-Martinage Samira , Mouttet-Audouard Raphaelle , Basson Laurent , Mirabel Xavier , Lartigau Eric , Pasquier David 

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

JOURNAL=Frontiers in Oncology

VOLUME=9

YEAR=2019

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2019.00184

DOI=10.3389/fonc.2019.00184

ISSN=2234-943X

ABSTRACT=<p><bold>Purpose:</bold> 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).</p><p><bold>Materials and Methods:</bold> 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.</p><p><bold>Results:</bold> 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 (<italic>n</italic> = 52, 33%) and 30 Gy in 5 fractions (<italic>n</italic> = 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, <italic>p</italic> = 0.007), the number of extra-cerebral metastatic sites (HR = 1.26, <italic>p</italic> = 0.003) and planning target volumes (HR = 1.15, <italic>p</italic> = 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.</p><p><bold>Conclusions:</bold> 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.</p>