Multifraction Stereotactic Radiosurgery as a safe therapy for limited brain metastasis
Victoria Vera Barragán,
Spain
PO-1125
Abstract
Multifraction Stereotactic Radiosurgery as a safe therapy for limited brain metastasis
Authors: Victoria Vera Barragán1, Corral Fernández Carmen2, Gonzalez de Dueñas Maria1, Simón Silva Paula3, Rios Kavadoy Yesika1, Quirós Rivero Juan1, Rodriguez de Alarcón César4, Cabrera Rodriguez Joaquin1, Ropero Carmona Francisca1, Iglesias Garcia Teresa Pilar1, Muñoz García Julia Luisa1
1Hospital Universitario de Badajoz, Radiation Oncology, Badajoz, Spain; 2Hospital Universitario Badajoz, Radiation Oncology, Badajoz, Spain; 3Hospital Universitario Torrecardenas , Radiation Oncology, Almeria, Spain; 4Hospital Universitario de Badajoz, Radiophysics , Badajoz, Spain
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Purpose or Objective
Brain metastasis are the most frequent tumor of CNS in adult population. It represents between 20% to 40% in oncological patients along their life.
Their treatment is one of the challenge to get better overall survival and quality of life.
Since RTOG study, radio surgery in only one fraction or multi fraction (HSRS) for metastasis >2cm is the standard of care in patients with limited brain metastasis and good performance status.
To analyze the results in terms of overall survival, local or distance recurrence and associated toxicities, this study was realized.
Material and Methods
This retrospective study, analyses 53 brain metastasis in 39 patient treated in our hospital between July 2019 and June 2022 with a median age of 61 years (30-87).
The metastasis were treated with HSRS scheme of treatment between 3 to 10 fractions, every the other day or in consecutive days when the number of fractions were more than five.
The 16% of the metastases were located in cerebellum, 84% supratentorial metastases.
The 34,6% of the metastasis included were post-surgical cavities with complete resection and the 65% were intact brain metastasis.
The median volume of GTV was 12,94 mL (0,04-130mL).
The protocol includes surveillance with MRI in the 4 weeks before radiation treatment, as well as one MRI at 4-6 weeks after the last fraction of radiation therapy, and then, each 3 months during the next two years.
To analyses overall survival and time to progression free survival, Kaplan Meier curves was used.
Logistic regression multivariate was used to analyze the relationship between GTV volume and side effects, and between overall survival with any dose or side effects, specially edema symptomatic or radiologic during the surveillance.
Results
At follow up time of 31 months, we have observed an overall survival of 15%. The local failure was 36,5% and the 30,4% of the patients presented distance failure at the moment of the analyses.
One patients presented recurrence disease in the radiation field, which was treated with surgery resection.
The histology most frequent is NSCLC (61.5%). The 83.3% of the metastases did not have any side effects, 3.7% presented during the followup radio necrosis in MRI, without symptoms associated. Only one patient presented symptomatic edema.
Not significant statically relationship was observed between GTV volume (p 0.125) or total dose (p 0.135) and the incidence of edema.
Conclusion
The treatment of limited brain metastases with multi fraction radiosurgery is a safe option, which reduce the side effects and the risk of neurological impairment in oncological patients with good performance status. The risk of recurrence in other location inside the brain is high, and narrow followup with MRI each 3 months is necessary. In our experience the risk of edema or radionecrosis is low, and in the cases in which were appeared, the treatment with low doses of steroids were enough to control the symptoms.