Whole-Brain Radiation Therapy With Simultaneous Integrated Boost Versus Whole-Brain Radiation Therapy Plus Stereotactic Radiosurgery for the Treatment of Brain Metastasis From Lung Cancer.

Binwei Lin,Feng Gao,Dan Huang,Huan Du,Xiao Bo Du,Gang Feng,Yu Zhang,Jinjia Fan

doi:10.3389/fonc.2021.631422

Abstract

Radiotherapy is one of the most important treatments for brain metastasis (BM). This study aimed to assess whether whole-brain radiation therapy (WBRT) with simultaneous integrated boost (SIB) provided any therapeutic benefit compared to WBRT followed by stereotactic radiosurgery (SRS). Seventy-two consecutive cases of lung cancer with BM treated from January 2014 to June 2020 were analyzed retrospectively. Thirty-seven patients were treated with WBRT (30 Gy in 10 fractions) and SIB (45 Gy in 10 fractions), and 35 patients were treated with WBRT (30 Gy in ten fractions) followed by SRS (16–24 Gy according to the maximum tumor diameter). The primary endpoint was intracranial progression-free survival (PFS). The secondary endpoints were intracranial objective response (partial and complete responses), pattern of intracranial progression, overall survival (OS), and toxicity. The WBRT + SIB group had a significantly longer median intracranial PFS (9.1 vs. 5.9 months, P = 0.001) than the WBRT + SRS group. The intracranial objective response rate was 67.6% and 62.9% in the WBRT + SIB and in WBRT + SRS groups, respectively (P = 0.675). The incidence of progression outside the P-GTV in the WBRT + SIB group was significantly lower than that in the WBRT + SRS group (39.4% vs. 75.0%, P = 0.004). The median OS was 24.3 and 20.3 months in the WBRT + SIB and WBRT + SRS groups, respectively (P = 0.205). There was no significant difference in the incidence of grade 3 or worse adverse reactions between the two groups. Compared to treatment with WBRT + SRS, that with WBRT + SIB for BM appeared to contribute to local control.

Highlights

Lung cancer is the most common cause of cancer-related death worldwide [1], and up to 30% of lung cancer cases will develop brain metastasis (BM) during the course of the disease [2, 3]
Sex, number of BMs, maximum diameter of BM, pathological type of tumors, status of extracranial metastases, recursive partition analysis (RPA) classification, Karnofsky Performance Status (KPS) score before radiotherapy, best response during follow-up, whether chemotherapy or targeted therapy was administered after radiotherapy, dosage of radiotherapy, date of radiotherapy, date of intracranial progression, pattern of intracranial progression, date of death or final follow-up visit, and toxic reactions associated with radiotherapy were recorded
progression-free survival (PFS) was significantly longer in the whole-brain radiation therapy (WBRT) + simultaneous integrated boost (SIB) group than in the WBRT + stereotactic radiosurgery (SRS) group (9.1 vs. 5.9 months, P = 0.001)

Summary

Introduction

Lung cancer is the most common cause of cancer-related death worldwide [1], and up to 30% of lung cancer cases will develop brain metastasis (BM) during the course of the disease [2, 3]. Whole-brain radiation therapy (WBRT) avoiding the hippocampus is an important strategy, especially for patients with unresectable tumors or those in whom SRS is not indicated [5,6,7,8]. There are no criteria for administering SRS and WBRT is used an alternative strategy for patients with limited BM. WBRT alone only extends the median survival time by up to 6 months [9, 10]. WBRT plus in-field radiotherapy boost is an effective strategy for improving the intracranial control rate (ICR) and selecting patients who could experience significant survival benefits [11,12,13,14,15,16,17]. Andrews [12] and Aoyama [17] reported that WBRT + SRS had a better ICR and significantly prolonged the survival for patients with BM or graded prognostic assessment scores of 2.5–4.0 compared to WBRT alone

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Results

Conclusion