Abstract
BackgroundThe aim of this study was to determine the safety and efficacy of fractionated stereotactic radiotherapy (SRT) in combination with systemic therapies (ST) for brain metastases (BM).MethodsNinety-nine patients (171 BM) received SRT and concurrent ST (group 1) and 95 patients (131 BM) received SRT alone without concurrent ST (group 2). SRT was planned on a linear accelerator, using volumetric modulated arc therapy. All ST were allowed including chemotherapy (CT), immunotherapy (IT), targeted therapy (TT) and hormonotherapy (HT). Treatment was considered to be concurrent if the timing between the drug administration and SRT did not exceed 1 month. Local control (LC), freedom for distant brain metastases (FFDBM), overall survival (OS) and radionecrosis (RN) were evaluated.ResultsAfter a median follow-up of 11.9 months (range 0.7–29.7), there was no significant difference between the two groups. However, patients who received concurrent IT (n = 30) had better 1-year LC, OS, FFDBM but a higher RN rate compared to patients who did not: 96% versus 78% (p = 0.02), 89% versus 77% (p = 0.02), 76% versus 53% (p = 0.004) and 80% versus 90% (p = 0.03), respectively. In multivariate analysis, concurrent IT (p = 0.022) and tumor volume < 2.07 cc (p = 0.039) were significantly correlated with improvement of LC. The addition of IT to SRT compared to SRT alone was associated with an increased risk of RN (p = 0.03).ConclusionSRT delivered concurrently with IT seems to be associated with improved LC, FFDBM and OS as well as with a higher rate of RN.
Highlights
The aim of this study was to determine the safety and efficacy of fractionated stereotactic radiotherapy (SRT) in combination with systemic therapies (ST) for brain metastases (BM)
Patients were offered SRT if the following criteria were met: number of BM ≤ 6, larger diameter < 40 mm according to magnetic resonance imaging (MRI), life expectancy > 3 months according to Diagnosis-Specific Graded Prognostic Assessment (DSGPA), and non critical anatomic position
Radiation and systemic treatments A total of 194 patients treated with SRT for 302 BM were included in this study: the first group included 99 patients with a total of 171 BM
Summary
The aim of this study was to determine the safety and efficacy of fractionated stereotactic radiotherapy (SRT) in combination with systemic therapies (ST) for brain metastases (BM). Several studies have shown that RT, in response to antigen presentation, can induce immunomodulatory changes such as release of cytokines, increase in tumorinfiltrating lymphocytes and destruction of immunosuppressive stromal cells, allowing enhancement of immunogenic cell death [9, 10]. By enhancing the host’s immune response against tumor cells, immune checkpoint inhibitors such as anti programmed death-1 (PD-1)/anti programmed death ligand-1 (PD-L1) and anti-cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) monoclonal antibodies have revolutionized the treatment of multiple cancers including melanoma, non-small cell lung cancer and renal carcinoma [11,12,13]. Additional strategies are necessary to improve treatment efficacy. As these drugs increase tumor cells sensitivity to radiation, the synergy between these modalities represents a new therapeutic option [14, 15]
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