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Local progression and pseudo progression after single fraction or fractionated stereotactic radiotherapy for large brain metastases

A single centre study

Lokale Progression und Pseudoprogression bei großen Hirnmetastasen nach stereotaktischer Radiotherapie mit einer oder mehreren Fraktionen

Eine monoinstitutionelle Studie

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Abstract

Purpose

The 1-year local control rates after single-fraction stereotactic radiotherapy (SRT) for brain metastases > 3 cm diameter are less than 70%, but with fractionated SRT (FSRT) higher local control rates have been reported. The purpose of this study was to compare our treatment results with SRT and FSRT for large brain metastases.

Materials and methods

In two consecutive periods, 41 patients with 46 brain metastases received SRT with 1 fraction of 15 Gy, while 51 patients with 65 brain metastases received FSRT with 3 fractions of 8 Gy. We included patients with brain metastases with a planning target volume of > 13 cm3 or metastases in the brainstem.

Results

The minimum follow-up of patients still alive was 22 months. Comparing 1 fraction of 15 Gy  with 3 fractions of 8 Gy, the 1-year rates of freedom from any local progression (54% and 61%, p = 0.93) and pseudo progression (85% and 75%, p = 0.25) were not significantly different. Overall survival rates were also not different.

Conclusion

The 1-year local progression and pseudo progression rates after 1 fraction of 15 Gy or 3 fractions of 8 Gy for large brain metastases and metastases in the brainstem are similar. For better local control rates, FSRT schemes with a higher biological equivalent dose may be necessary.

Zusammenfassung

Hintergrund

Die einjährige lokale Tumorkontrollrate von Hirnmetastasen mit einem Durchmesser von mind. 3 cm beträgt nach stereotaktischer Bestrahlung mit einer Fraktion (SRT) weniger als 70%. Höhere lokale Tumorkontrollraten sind nach fraktionierter stereotaktischer Bestrahlung (FSRT) beschrieben worden. In dieser Studie werden die Behandlungsergebnisse der SRT und der FSRT für größere Hirnmetastasen verglichen.

Material und Methoden

In 2 aufeinanderfolgenden Perioden wurden 41 Patienten mit 46 Hirnmetastasen mit 1 -mal  15 Gy SRT und 51 Patienten mit 65 Hirnmetastasen mit 3 -mal  8 Gy FSRT behandelt. Alle inkludierten Patienten hatten einen PTV von mindestens 13 cm3 oder Metastasen im Hirnstammbereich.

Ergebnisse

Das minimale Follow-up von überlebenden Patienten betrug 22 Monate. Beim Vergleich der Resultate von 1 -mal 15 Gy mit 3 -mal  8 Gy ergaben sich nach einem Jahr keine signifikanten Unterschiede bei den Raten ohne lokale Progression (54% bzw. 61%; p = 0,93), der Pseudoprogression (85% bzw. 75%; p = 0,25) und im Gesamtϋberleben.

Schlussfolgerung

Die lokale Progression und Pseudoprogression von großen Hirnmetastasen oder Hirnstammmetastasen sind ein Jahr nach Behandlung mit 1 -mal 15 Gy oder 3 -mal 8 Gy vergleichbar. Fϋr eine bessere lokale Kontrolle sind vielleicht FSRT-Regime mit höherer biologischer Äquivalentdosis notwendig.

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Authors and Affiliations

  1. Radiotherapy Centre West, Lijnbaan 32, 2512 VA, The Hague, The Netherlands

    R. Wiggenraad, A. Verbeek-de Kanter, M. Mast & H. Struikmans

  2. Department of Neurology, Diaconessenhuis, Leiden, The Netherlands

    R. Molenaar

  3. -, Maassluis, The Netherlands

    H.B. Kal

  4. Department of Radiology, Medical Centre Haaglanden, The Hague, The Netherlands

    G. Lycklama à Nijeholt

  5. Department of Neurology, Medical Centre Haaglanden, The Hague, The Netherlands

    C. Vecht

  6. Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands

    H. Struikmans

Authors
  1. R. Wiggenraad
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  2. A. Verbeek-de Kanter
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  3. M. Mast
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  4. R. Molenaar
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  5. H.B. Kal
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  6. G. Lycklama à Nijeholt
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Correspondence to R. Wiggenraad.

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Wiggenraad, R., Verbeek-de Kanter, A., Mast, M. et al. Local progression and pseudo progression after single fraction or fractionated stereotactic radiotherapy for large brain metastases. Strahlenther Onkol 188, 696–701 (2012). https://doi.org/10.1007/s00066-012-0122-3

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  • DOI: https://doi.org/10.1007/s00066-012-0122-3

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