Background: Radiosurgery is employed for the treatment of brain metastases. The aim of this study is to evaluate the efficacy and tolerability of single-dose radiosurgery (SRS) compared to hypofractionated stereotactic radiotherapy (hFSRT).
Material and methods: Between 2004-2018 we analyzed treatments of 97 patients with 135 brain metastases. 56 patients were treated with SRS, and 41 patients were treated with hFSRT. Median dose was 16 Gy (12-20 Gy) for the SRS group and 30 Gy in 5-6 fractions for the hFSRT group. hFSRT was used for larger lesions and lesions located near critical structures. Kaplan-Meier curves were constructed for overall survival and local control.
Results: Median age was 64 years (range, 32–89 years). Median survival was 10 months (1-68 months). With a median follow up of 10 months, no significant differences in overall survival between groups were found (p = 0.21). Local control for all patients was 67%. Local progression-free survival (LPFS) at 6 months and 1 year were 71% and 60% for the SRS group, respectively, and 80% and 69% for the hFSRT group, respectively (p = 0.93). Although hFSRT was used for larger lesions and lesions in adverse locations, LPFS was not inferior compared to lesions treated with SRS. We observed acute toxicity grade 1-2 in 25 patients (25.8%). Late complications were observed in 11 patients (11.3%). Acute and late toxicity were similar in the SRS- and hFSRT-treated patients (p = 0.63 and p = 0.11, respectively). Brain recurrence occurred in 37.5% and 14.6% in the hFSRT and SRS group, respectively (p = 0.06).
Conclusions: Because patients treated with hFSRT exhibited similar survival and LPFS rates without differences in toxicity compared to those treated with SRS, hFSRT can be beneficial particularly for patients with brain metastases.
Relevance for Patients: Hypofractionated schemes in stereotactic radiosurgery offers treatment alternatives to patients with large lesions or lesions near critical structures.
1 Radiation Oncology, Ramón y Cajal Hospital, Madrid, Spain
2 Medical Physics, Ramón y Cajal Hospital, Madrid, Spain
Carolina de la Pinta Alonso.
Radiation Oncology Department. Ramón y Cajal Hospital, Madrid, Spain.
Department of Pharmaceutics, Utrecht University, the Netherlands
Department of Pharmaceutics, Jiaxing University Medical College, Zhejiang, China