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    Local control and toxicity after stereotactic radiotherapy in brain metastases patients and the impact of novel systemic treatments

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    Authors
    van Schie, P.
    Huisman, R. G.
    Wiersma, T.
    Knegjens, J. L.
    Navran, A.
    Brandsma, D.
    Compter, A.
    Bot, M.
    Hoogmoed, J.
    de Witt Hamer, P. C.
    Post, R.
    Borst, Gerben R
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    Affiliation
    Division of Cancer Sciences, School of Medical Sciences; School of Biological Sciences, Faculty of Biology, Medicine and Health & Manchester Cancer Research Centre, Manchester Academic Health Science Centre (MAHSC), University of Manchester, United Kingdom; Departments of Clinical Oncology; The Christie NHS Foundation Trust, Manchester, United Kingdom.
    Issue Date
    2024
    
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    Abstract
    BACKGROUND AND PURPOSE: Treatment modalities for patients with brain metastases consist of surgery, radiotherapy, and systemic treatments such as immunotherapy and targeted therapy. Although much is known about local control of brain metastases after radiotherapy and surgery alone, more understanding is needed of the additional effect of new systemic treatments. Our study presents real-world data about the combined effects of different local and systemic treatment strategies on local response of irradiated brain metastases. MATERIALS AND METHODS: We performed a retrospective consecutive cohort study of patients that presented with brain metastases in our institution between June 2018 and May 2020, reporting the impact of radiotherapy alone versus radiotherapy combined with systemic treatment on local control of irradiated brain metastases and toxicity. Chemotherapy and targeted therapy were temporarily discontinued around irradiation. RESULTS: 262 consecutively treated patients were included in the study. Median time to local failure of irradiated brain metastases was 18 months (IQR 9-34), median overall survival was 20 months (IQR 10-36). 211 (81 %) patients received systemic treatment. Patients with breast cancer had a worse local control (HR 2.3, 95 % CI 1.0-5.0, p = 0.038), as did patients without any systemic treatment (HR 2.1, 95 % CI 1.1-4.3, p = 0.034). Symptomatic radiation necrosis occurred in 36 (14 %) patients. A diameter > 2.5 cm was associated with a higher risk of radiation necrosis. No association was found between systemic treatment in combination with local radiotherapy and symptomatic radiation necrosis. CONCLUSION: Patients who received any form of systemic treatment had better local control after stereotactic radiosurgery for brain metastases. We did not find an association between systemic treatment and the incidence of radiation necrosis.
    Citation
    van Schie P, Huisman RG, Wiersma T, Knegjens JL, Navran A, Brandsma D, et al. Local control and toxicity after stereotactic radiotherapy in brain metastases patients and the impact of novel systemic treatments. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2024 Nov;200:110540. PubMed PMID: 39293720. Epub 2024/09/19. eng.
    Journal
    Radiotherapy and Oncology
    URI
    http://hdl.handle.net/10541/627241
    DOI
    10.1016/j.radonc.2024.110540
    PubMed ID
    39293720
    Additional Links
    https://dx.doi.org/10.1016/j.radonc.2024.110540
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.radonc.2024.110540
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