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Boost Irradiation Integrated to Whole Brain Radiotherapy in the Management of Brain Metastases

  • Original Article
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Pathology & Oncology Research

Abstract

Our retrospective analysis aimed to evaluate the clinical value of dose intensification schemes: WBRT and consecutive, delayed, or simultaneous integrated boost (SIB) in brain metastasis (BM) management. Clinical data and overall survival (OS) of 468 patients with BM from various primaries treated with 10 × 3 Gy WBRT (n = 195), WBRT+ 10 × 2 Gy boost (n = 125), or simultaneously 15 × 2.2 Gy WBRT+0.7 Gy boost (n = 148) during a 6-year period were statistically analysed. Significant difference in OS could be detected with additional boost to WBRT (3.3 versus 6.5 months) and this difference was confirmed for BMs of lung cancer and melanoma and both for oligo- and multiplex lesions. The OS was prolonged for the RPA 2 and RPA3 categories, if patients received escalated dose, 4.0 vs. 7.7 months; (p = 0.002) in class RPA2 and 2.6 vs. 4.2 months; (p < 0.0001) in the class RPA 3 respectively. The significant difference in OS was also achieved with SIB. The shortened overall treatment time of SIB with lower WBRT fraction dose exhibited survival benefit over WBRT alone, and could be applied for patients developing BM even with unfavourable prognostic factors. These results warrant for further study of this approach with dose escalation using the lately available solutions for hippocampus sparing and fractionated stereotactic irradiation. The simultaneous delivery of WBRT with reduced fraction dose and boost proved to be advantageous prolonging the OS with shortened treatment time and reduced probability for cognitive decline development even for patients with poor performance status and progressing extracranial disease.

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Contributions

The contributions of the authors to the present study are as follows: (1) the conception and design of the study (Á.D., K.H.), (2) examination, therapy plans and follow-up of the patients (Á.D., Zs.E., A.M., K.H.), (4) radiological assessments (A.Cs.), (5) histopathological diagnostics (L.T., Z.R.), (6) neurosurgical treatment (P.B.), (7) radiotherapy planning physicist (E.F.), (8) collection and acquisition of data (Á.D.), (9) statistical analysis of data (Z.V.), (10) interpretation of data (Á.D., K.H.), (11) drafting the article (Á.D., K.H), (12) revising it critically for important intellectual content (K.H.).

All authors have approved the final version of the submission.

Funding

This project was supported by Analytic Healthcare Quality User Information Programme of the National Research, Development and Innovation Fund, Hungarian Government, Grant No. VKSZ 12–1- 2013-0012.

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Authors and Affiliations

  1. Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary

    Ágnes Dobi, Emese Fodor, Anikó Maráz, Zsófia Együd, Adrienne Cserháti, Zoltán Varga & Katalin Hideghéty

  2. Department of Pathology, University of Szeged, Állomás utca 1, Szeged, H-6725, Hungary

    László Tiszlavicz & Zita Reisz

  3. Department of Neurosurgery, University of Szeged, Semmelweis utca 8, Szeged, H-6725, Hungary

    Pál Barzó

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  1. Ágnes Dobi
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  2. Emese Fodor
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Correspondence to Ágnes Dobi.

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Informed consent was obtained from all individual participants included in the study.

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Dobi, Á., Fodor, E., Maráz, A. et al. Boost Irradiation Integrated to Whole Brain Radiotherapy in the Management of Brain Metastases. Pathol. Oncol. Res. 26, 149–157 (2020). https://doi.org/10.1007/s12253-018-0383-y

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