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Risk of radiation necrosis after hypofractionated stereotactic radiotherapy (HFSRT) for brain metastases: a single center retrospective study

Journal of Neuro-Oncology volume 149, pages 447–453 (2020)Cite this article

Abstract

Introduction

While hypofractionated stereotactic radiotherapy (HFSRT) is being increasingly used for treating brain metastases, clinical data concerning the incidence and risk factors of its main side-effect, namely radiation necrosis (RN), remain limited. In this context, we assessed risk factors of RN in a single center series of patients with brain metastases treated with three common HFSRT dose regimens: 27 Gy in 3 fractions (27 Gy/3#), 30 Gy in 5 fractions (30 Gy/5#), and 35 Gy in 5 fractions (35 Gy/5#).

Methods

In total, 360 HFSRT treatments in 294 consecutive patients were retrospectively analysed. Univariable analysis (UVA) and multivariable analysis (MVA) were performed to evaluate the relationship between clinical and dosimetric factors and RN risk.

Results

The 12-month RN rate was 8.8%. On MVA, risk was higher in lesions receiving 27 Gy/3# (HR 3.07 95%CI [1.13;8.36], p = 0.03) and 35 Gy/5# (HR 4.22 95%CI [1.46,12.21], p < 0.01) than in lesions receiving 30 Gy/5#. Risk was also higher in patients having received immunotherapy within 3 months of HFSRT (HR 2.69 95%CI [1.10;6.56], p = 0.03) compared with those who did not. We found no association between RN risk and other tested factors, in particular prior irradiation, lesion histology, lesion location, lesion volume, or brain dosimetric factors.

Conclusion

In the present series, HFSRT was associated with limited RN risk. Incidence of RN was higher with dose regimens delivering a higher biologically effective dose, as well as in patients having received immunotherapy within 3 months of HFSRT.

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Funding

Dario Di Perri’s work is supported by a Grant from Fondation Saint-Luc, Belgium.

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Affiliations

  1. Department of Radiation Oncology, Centre Léon Bérard, Lyon, France

    Dario Di Perri, Ronan Tanguy, Claude Malet & Marie-Pierre Sunyach

  2. Pole of Epidemiology and Biostatistics (EPID), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium

    Annie Robert

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  1. Dario Di Perri
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  2. Ronan Tanguy
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  3. Claude Malet
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  4. Annie Robert
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  5. Marie-Pierre Sunyach
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Correspondence to Dario Di Perri.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was conducted retrospectively from data obtained for clinical purposes. The study was approved by the Institutional Review Board and registered under the reference R201-004-053.

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Di Perri, D., Tanguy, R., Malet, C. et al. Risk of radiation necrosis after hypofractionated stereotactic radiotherapy (HFSRT) for brain metastases: a single center retrospective study. J Neurooncol 149, 447–453 (2020). https://doi.org/10.1007/s11060-020-03628-z

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  • DOI: https://doi.org/10.1007/s11060-020-03628-z

Keywords

  • Brain metastasis
  • Hypofractionated stereotactic radiotherapy
  • Radiation necrosis