Acute toxicities and cumulative dose to the brain of repeated sessions of stereotactic radiotherapy (SRT) for brain metastases: a retrospective study of 184 patients

Radiation Oncology

Research

H. Cebula¹  A. Thiery²  P. Meyer³  D. Jarnet³  G. Noel⁴  A. Keller⁴  D. Antoni⁴  L. Kuntz⁴  C. Le Fèvre⁴ 

[1] Department of Neurosurgery, University Hospitals of Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France;Medical Information Department, Institut de Cancérologie Strasbourg Europe (ICANS), 3 rue de la Porte de L’Hôpital, 67065, Strasbourg Cedex, France;Medical Physics Unit, Institut de Cancérologie Strasbourg Europe (ICANS), 17 rue Albert Calmette, 67200, Strasbourg, France;Radiation Therapy University Department, Institut de Cancérologie Strasbourg Europe (ICANS), 17 rue Albert Calmette, 67200, Strasbourg, France;

关键词: Salvage radiation;    Stereotactic radiosurgery;    Brain metastases;    Side effect;    Acute toxicity;    Repeated radiosurgery;   

DOI  :  10.1186/s13014-022-02194-0

 received in 2022-03-02, accepted in 2022-12-28,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundStereotactic radiation therapy (SRT) is a focal treatment for brain metastases (BMs); thus, 20 to 40% of patients will require salvage treatment after an initial SRT session, either because of local or distant failure. SRT is not exempt from acute toxicity, and the acute toxicities of repeated SRT are not well known. The objective of this study was to analyze the acute toxicities of repeated courses of SRT and to determine whether repeated SRT could lead to cumulative brain doses equivalent to those of whole-brain radiotherapy (WBRT).Material and methodsBetween 2010 and 2020, data from 184 patients treated for 915 BMs via two to six SRT sessions for local or distant BM recurrence without previous or intercurrent WBRT were retrospectively reviewed. Patients were seen via consultations during SRT, and the delivered dose, the use of corticosteroid therapy and neurological symptoms were recorded and rated according to the CTCAEv4. The dosimetric characteristics of 79% of BMs were collected, and summation plans of 76.6% of BMs were created.Results36% of patients developed acute toxicity during at least one session. No grade three or four toxicity was registered, and grade one or two cephalalgy was the most frequently reported symptom. There was no significant difference in the occurrence of acute toxicity between consecutive SRT sessions. In the multivariate analysis, acute toxicity was associated with the use of corticosteroid therapy before irradiation (OR = 2.6; p = 0.01), BMV grade (high vs. low grade OR = 5.17; p = 0.02), and number of SRT sessions (3 SRT vs. 2 SRT: OR = 2.64; p = 0.01). The median volume equivalent to the WBRT dose (VWBRT) was 47.9 ml. In the multivariate analysis, the VWBRT was significantly associated with the total GTV (p < 0.001) and number of BMs (p < 0.001). Even for patients treated for more than ten cumulated BMs, the median BED to the brain was very low compared to the dose delivered during WBRT.ConclusionRepeated SRT for local or distant recurrent BM is well tolerated, without grade three or four toxicity, and does not cause more acute neurological toxicity with repeated SRT sessions. Moreover, even for patients treated for more than ten BMs, the VWBRT is low.

【 授权许可】

CC BY   
© The Author(s) 2023