Artikel
8-year results of robotic-guided SRS/SRT with central dose optimisation for single and multiple brain metastases
8-Jahres Ergebnisse der robotergestützten SRS/SRT mit zentraler Dosisoptimierung für einzelne und multiple Hirnmetastase
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Veröffentlicht: | 26. Juni 2020 |
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Objective: We retrospectively evaluated robotic-guided stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) with central dose optimization for single and multiple brain metastases (BM).
Methods: We treated 197 patients (m/w=102/95, age=28-86, lung=73, melanoma=57, breast=35, other=32) with 674 BM (75 with 1, 63 with >3, 29 with >5 and 10 with >10 BM) in 253 SRS/SRT series with median PTV of 0.6cc (0.01-78.8cc). Median PTV-BED10 was: D98% 50.8Gy10 (20.1-63.5Gy10), D2% 97.4Gy10 (27.8-135.4Gy10) and D50% 73.1Gy10 (24.8-96.1Gy10). Whole brain irradiation (WB) before SRS/SRT or simultaneous immune-/targeted-therapy (TT) was performed in 65 (33%) and 62 (31.5%) patients.
Results: Mean follow-up was 13.2 months (1-86 months) with median OS of 9.0 months. 6, 12, and 24-month OS was 64.2%, 40.3%, and 18.7% (1-year OS breast 44.1%, lung 39.7%, melanoma 39.6%, others 38.7%, ≤3 BM 44.9%, >3 BM 32.7%, TT 43.3%, no TT 38.8%, WB 37.1%, no WB 42.1%. 6, 12 and 24-month PFI was 52.4%, 26.2% and 9.0% and in 69.6% the progression was intracerebral (1-year PFI ≤3 BM 35.3%, >3 BM 9.5%, WB 31.0%, no WB 23.9%). 6, 12 and 24-month LC was 99.4%, 93.3% and 76.1%, with 98.4% absolute LC (1-year LC TT 95.4%, no TT 91.4%, WB 91.0%, no WB 94.4%) 1-year LC was better with higher PTV D98% (96.2% vs. 84.6%), which corresponded to the BM border recurrence pattern. 2.4% showed toxicity grade ≥3 (operated radionecrosis) and one patient died of intracerebral hemorrhage after local re-SRS concomitantly with BRAF inhibitors.
Conclusion: Robotic-guided SRS/SRT with central dose optimization w/wo TT/WB is safe and effective for new brain metastases. However, caution is advised when re-treating recurrences previously treated with SRS/SRT concomitant to TT. Further, close follow-up in patients with >3 brain metastases without WB is important in order to detect and treat new metastases early. To increase local control only the PTV prescription dose may be raised, however this may result in higher rates of radionecrosis.