Impact of concomitant systemic treatments on toxicity and intracerebral response after stereotactic radiotherapy for bra
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RESEARCH ARTICLE
Open Access
Impact of concomitant systemic treatments on toxicity and intracerebral response after stereotactic radiotherapy for brain metastases Morgan Guénolé1, François Lucia1,2* , Vincent Bourbonne1,2, Gurvan Dissaux1,2, Emmanuelle Reygagne1, Gaëlle Goasduff1, Olivier Pradier1,2 and Ulrike Schick1,2
Abstract Background: 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). Methods: Ninety-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. Results: After 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). Conclusion: SRT delivered concurrently with IT seems to be associated with improved LC, FFDBM and OS as well as with a higher rate of RN. Keywords: Stereotactic radiotherapy, Brain metastases, Systemic therapies, Immunotherapy, Radioimmunotherapy
Background Brain metastases (BM) are frequent in the natural history of several solid tumors and represent an important cause of morbidity and mortality despite active treatments [1]. For several decades, palliative whole * Correspondence: [email protected] 1 Radiation Oncology Department, University Hospital Morvan, 2 Avenue Foch, F-29200 Brest, France 2 Latim INSERM UMR 1101, UBO, Brest, France
brain radiotherapy (RT) has been the standard of care in these patients, allowing however only minor improvement in overall survival (OS) at the price of substantial neurotoxicity [2–4]. In the last decade, stereotactic radiotherapy (SRT) has emerged as a local and potentially curative treatment in a subset of patients with a limited number of BM. This approach indeed improves local control rates and reduces toxicity compared to whole brain RT [5–7].
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduc
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