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Hypofractionated stereotactic radiotherapy for brain metastases from lung cancer

Evaluation of indications and predictors of local control

Hypofraktionierte stereotaktische Strahlentherapie bei Hirnmetastasen eines Lungenkarzinoms

Evaluierung von Indikationen und Prädiktoren der lokalen Kontrolle

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Abstract

Aim

To evaluate the efficacy and toxicity of hypofractionated stereotactic radiotherapy (HSRT) for brain metastases (BMs) from lung cancer, and to explore prognostic factors associated with local control (LC) and indication.

Patients and methods

We evaluated patients who were treated with linac-based HSRT for BMs from lung cancer. Lesions treated with stereotactic radiosurgery (SRS) in the same patients during the same periods were analysed and compared with HSRT in terms of LC or toxicity. There were 53 patients with 214 lesions selected for this analysis (HSRT: 76 lesions, SRS: 138 lesions). For HSRT, the median prescribed dose was 35 Gy in 5 fractions.

Results

The 1‑year LC rate was 83.6 % in HSRT; on multivariate analysis, a planning target volume (PTV) of <4 cm3, biologically effective dose (BED10) of ≥51 Gy, and adenocarcinoma were significantly associated with better LC. Moreover, in PTVs ≥ 4 cm3, there was a significant difference in LC between BED10 < 51 Gy and ≥ 51 Gy (p = 0.024). On the other hand, in PTVs < 4 cm3, both HSRT and SRS had good LC with no significant difference (p = 0.195). Radiation necrosis emerged in 5 of 76 lesions (6.6 %) treated with HSRT and 21 of 138 (15.2 %) lesions treated with SRS (p = 0.064).

Conclusion

Linac-based HSRT was safe and effective for BMs from lung cancer, and hence might be particularly useful in or near an eloquent area. PTV, BED10, and pathological type were significant prognostic factors. Furthermore, in BMs ≥ 4 cm3, a dose of BED ≥ 51 Gy should be considered.

Zusammenfassung

Ziel

Beurteilung von Wirksamkeit und Toxizität einer hypofraktionierten stereotaktischen Strahlentherapie (HSRT) zur Behandlung von Hirnmetastasen (HM) eines Lungenkarzinoms und Erforschung von mit der lokalen Kontrolle (LK) und der Indikation assoziierten Prognosefaktoren.

Patienten und Methoden

Analysiert wurden Daten von Patienten (n = 53), die sich einer Linearbeschleuniger-basierten HSRT unterzogen (mit HSRT behandelte Läsionen n = 76; Median der verordneten Dosis: 35 Gy in 5 Fraktionen). Analysiert wurden ferner bei den gleichen Patienten im gleichen Zeitraum mit stereotaktischer Strahlenchirurgie (SRS) behandelte Läsionen (n = 138). Die Ergebnisse wurden in Bezug auf LK oder Toxizität verglichen.

Ergebnisse

Nach einem Jahr betrug die LK nach HSRT 83,6 %; bei der multivariaten Analyse zeigte sich, dass ein „planning target volume“ (PTV) < 4 cm3, eine biologisch effektive Dosis (BED10) ≥ 51 Gy und ein Adenokarzinom signifikant mit einer besseren LK assoziiert waren. Darüber hinaus wurde bei einem PTV ≥ 4 cm3 ein signifikanter Unterschied in der LK zwischen BED10 < 51 Gy und ≥ 51 Gy beobachtet (p = 0,024). Andererseits wurde bei einem PTV < 4 cm3 sowohl mit der HSRT als auch mit der SRS eine gute LK erreicht, der Unterschied war nicht signifikant (p = 0,195). Bei 5 der 76 (6,6 %) mit HRST behandelten Läsionen und bei 21 der 138 (15,2 %) mit SRS behandelten Läsionen traten Strahlennekrosen auf (p = 0,064).

Schlussfolgerung

Die Linearbeschleuniger-basierte HSRT war eine sichere und effektive Behandlung von HM eines Lungenkarzinoms. Sie kann also besonders hilfreich sein bei Metastasen in einem eloquenten Hirnareal oder in der Nähe eines eloquenten Areals. Signifikante Prognosefaktoren waren PTV, BED 10 und der histopathologische Typ. Bei HM mit einer Ausdehnung ≥ 4 cm3 sollte eine BED ≥ 51 Gy erwogen werden.

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Correspondence to Takeaki Ishihara.

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T. Ishihara, K. Yamada, A. Harada, K. Isogai, Y. Tonosaki, Y. Demizu, D. Miyawaki, K. Yoshida, Y. Ejima, and R. Sasaki state that there are no conflicts of interest.

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Ishihara, T., Yamada, K., Harada, A. et al. Hypofractionated stereotactic radiotherapy for brain metastases from lung cancer. Strahlenther Onkol 192, 386–393 (2016). https://doi.org/10.1007/s00066-016-0963-2

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  • DOI: https://doi.org/10.1007/s00066-016-0963-2

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