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Efficacy of salvage stereotactic radiotherapy (SRT) for locally recurrent brain metastases after initial SRT and characteristics of target population

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Abstract

Objectives

Due to a steadily growing use of stereotactic radiotherapy (SRT) for treatment of brain metastases (BMs), the in-field failure after an initial stereotaxy is an increasingly frequent problem. Repeat stereotactic radiotherapy (re-SRT) shows encouraging results in terms of local control. However, the evidence on prognostic factors limiting the overall survival (OS) of re-treated patients is scarce. Here, we sought to analyze the patients’ and treatment characteristics influencing the survival outcomes after re-SRT.

Methods

Data of all patients with local failure of initial SRT treated from 2012 to 2019 were retrospectively reviewed and cases treated with salvage SRT were analyzed. We analyzed the impact of patients’ and treatment characteristics on overall survival after re-SRT by Kaplan–Meier method and Cox regression models. Local and distant brain control, cause of death, and radionecrosis rate were also assessed.

Results

Forty-seven patients with 55 BMs treated with re-SRT were evaluated. Median OS after re-SRT was 9.2 months and the overall local control was 83.6%. Nine BMs (16.4%) presented local relapse (LR), 12 (21.8%) radionecrosis, while 21 patients (44.7%) developed new BMs. Only absence of extracranial metastases at BMs diagnosis (HR 0.42, CI 95%; 0.18–0.97), extracranial disease progression (HR 2.39, CI 95%; 1.06–5.38) and distant brain failure (HR 3.94, CI 95%; 1.68–9.24) after re-SRT were significantly associated with patients’ survival. Extracranial progression following re-SRT was an independent prognosticator of worse OS.

Conclusion

Re-SRT after LR presented excellent local control with acceptable RN rate and improved patients’ survival, limited mainly by extracranial and distant brain progression.

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Availability of data and materials

The dataset supporting the conclusions of this article is available on request by contacting the authors.

Abbreviations

BMs:

Brain metastases

SRT:

Stereotactic radiotherapy

re-SRT:

Repeat stereotactic radiotherapy

WBRT:

Whole-brain radiotherapy

Gy:

Grays

fr:

Fractions

LFFS:

Local failure-free survival

mOS:

Median overall survival

NSCLC:

Non-small cell lung cancer

SCLC:

Small cell lung cancer

ORL:

Otorhinolaryngology site

HR:

Hazard ratio

IC:

Confidence interval

LR:

Local relapse

LF:

Local failure

DP:

Distal progression

GTV:

Gross target volume

PTV:

Planning target volume

RECIST:

Response Evaluation Criteria in Solid Tumors

MRI:

Magnetic resonance imaging

RN:

Radiation necrosis

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Acknowledgements

We would like to thank the Spanish Society of Radiation Oncology (SEOR) and the CRIS Foundation, whose financial support has made this study possible.

Funding

This study received grant from the Spanish Society of Radiation Oncology (SEOR) and CRIS Foundation.

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Authors and Affiliations

  1. Radiotherapy Department, Gustave Roussy Cancer Campus, Villejuif, France

    K. Holub & G. Louvel

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  1. K. Holub
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  2. G. Louvel
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Contributions

KH and GL contributed to this study design, carried out the acquisition of data, and drafted the manuscript. KH with IGR statistic support performed statistical analysis. GL and KH participated in data interpretation and manuscript review. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to K. Holub or G. Louvel.

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The authors declare no conflict of interest.

Ethical approval

This study was approved by the Gustave Roussy Ethics Committee and conducted in accordance with the Declaration of Helsinki.

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

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Holub, K., Louvel, G. Efficacy of salvage stereotactic radiotherapy (SRT) for locally recurrent brain metastases after initial SRT and characteristics of target population. Clin Transl Oncol 23, 1463–1473 (2021). https://doi.org/10.1007/s12094-020-02544-y

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  • DOI: https://doi.org/10.1007/s12094-020-02544-y

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