3D radiation therapy boost improves the outcome of whole brain radiation therapy treated RPA II patients with one or two brain metastases.

Delphine Antoni,Jean-Baptiste Clavier,François Lefebvre,Marius Pop,Catherine Schumacher,Georges Noël

doi:10.3390/ijms15057554

Delphine Antoni, Jean-Baptiste Clavier + Show 4 more

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https://doi.org/10.3390/ijms15057554

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Abstract

Purposeto evaluate the role of whole brain radiotherapy (WBRT) and radiation boost (RB) for 208 patients recursive partitioning analysis (RPA) II with 1 or 2 brain metastases (BM) at a single institution.Methods and Materialsthe dose of WBRT was 30 Gy (10 fractions of 3 Gy). One hundred thirty-two patients (63.5%) benefited from RB of 9 Gy in 3 fractions of 3 Gy at the metastatic site. Patients had 1 or 2 BM in 122 (58.7%) and 86 cases (41.3%), respectively.Resultspatients with one or two metastases had similar survival (4.6 and 5.1 months, respectively) (p = 0.4). Median overall survival (OS) for patients treated with WBRT and RB, and with WBRT alone was 5.9 and 3.7 months, respectively (p = 0.03). The 6-, 12- and 24-month OS rates after WBRT and RB were 48.5%, 25% and 10.6%, respectively, while WBRT alone resulted in OS rates of 34%, 22.4% and 3.2%, respectively (p = 0.03). After WBRT and RB, the 6-, 12- and 24-month local control rates were 92%, 82% and 67%, respectively, while they were 81.2%, 75% and 37.5%, respectively, after WBRT alone (p = 0.03). The 6-, 12- and 24-month brain control rates after WBRT and RB were 88.7%, 75.8% and 62%, respectively, and after WBRT alone they were 78.5%, 59% and 37.7%, respectively (p = 0.03).Conclusionadditional boost delivered with 3D conformal radiotherapy improves local and brain control rates significantly as well as overall survival for RPA II patients with 1 or 2 unresectable BM.

Highlights

Brain metastases (BM) remain a clinical and therapeutic challenge, and the optimal treatment remains a controversial subject
The purpose of this study was to evaluate the role of a 3D-radiation therapy (RT) boost at the metastatic site combined with Whole brain radiation therapy (WBRT) in the management of 1 or 2 brain metastases (BM) in recursive partitioning analysis (RPA) II patients
Two hundred and eight patients with a median age of 64 years (20.9–86.2) at diagnosis were treated with whole brain radiotherapy; 132 patients (63.5%) received WBRT with a radiation boost at the metastatic site, and 76 patients

Summary

Introduction

Brain metastases (BM) remain a clinical and therapeutic challenge, and the optimal treatment remains a controversial subject. Whole brain radiation therapy (WBRT) has been the most common treatment for years, but this standard of care is becoming inappropriate for many patients due to the development of new treatment modalities like radiosurgery and because the outcomes of patients with BM depend on the tumor type [3,4,5]. Patients with a few BM and a controlled primary tumor may benefit from local treatment such as surgery or radiosurgery in addition to WBRT [6,7,8]. The EORTC 22952-26001 study showed that combined therapy (surgery or radiosurgery and adjuvant WBRT) compared to surgery or radiosurgery alone improved the 2-year local control rate (p = 0.04) and the brain control rate (p = 0.02) [9]. The purpose of this study was to evaluate the role of a 3D-radiation therapy (RT) boost at the metastatic site combined with WBRT in the management of 1 or 2 BM in recursive partitioning analysis (RPA) II patients

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