title: [Stereotactic radiotherapy in brain metastases].
abstract: Stereotactic radiotherapy of brain metastases is increasingly proposed after polydisciplinary debates among experts. Its definition and modalities of prescription, indications and clinical interest regarding the balance between efficacy versus toxicity need to be discussed. Stereotactic radiotherapy is a 'high precision' irradiation technique (within 1mm), using different machines (with invasive contention or frameless, photons X or gamma) delivering high doses (4 to 25Gy) in a limited number of fractions (usually 1 to 5, ten maximum) with a high dose gradient. Dose prescription will depend on materials, dose constraints to organs at risk varying with fractionation. Stereotactic radiotherapy may be proposed: (1) in combination with whole brain radiotherapy with the goal of increasing (modestly) overall survival of patients with a good performance status, 1 to 3 brain metastases and a controlled extracranial disease; (2) for recurrence of 1-3 brain metastases after whole brain radiotherapy; (3) after complete resection of a large and/or symptomatic brain metastases; (4) after diagnosis of 3-5 asymptomatic new or progressing brain metastases during systemic therapy, with the aim of delaying whole brain radiotherapy (avoiding its potential neurotoxicity) and maintaining a high focal control rate. Only a strict follow-up with clinical and MRI every 3 months will permit to deliver iterative stereotactic radiotherapies without jeopardizing survival. Simultaneous delivering of stereotactic radiotherapy with targeted medicines should be carefully discussed.
authors: Département de radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Réunion de concertation polydisciplinaire de neuro-oncologie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France. Electronic address: frederic.dhermain@gustaveroussy.fr.
authors: F
authors: F
authors: Dhermain
authors: Département de neurochirurgie, hôpital Roger-Salengro, CHRU, rue Émile-Laine, 59037 Lille cedex, France.
authors: N
authors: N
authors: Reyns
authors: Département de radiothérapie, institut du cancer Courlancy-Reims, 38, rue de Courlancy, 51100 Reims, France.
authors: P
authors: P
authors: Colin
authors: Département de neurochirurgie, centre hospitalo-universitaire La-Timone, APHM, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
authors: P
authors: P
authors: Métellus
authors: Département de radiothérapie, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
authors: F
authors: F
authors: Mornex
authors: Département universitaire de radiothérapie, centre de lutte contre le cancer Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, BP 42, 67065 Strasbourg cedex, France; Laboratoire EA 3430, fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France.
authors: G
authors: G
authors: Noël
mesh_terms: D001921:Brain / Q000473:pathology / Q000528:radiation effects; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery; D019583:Dose Fractionation, Radiation; D006801:Humans; D009336:Necrosis; D011832:Radiation Injuries / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects / Q000295:instrumentation; D011879:Radiotherapy Dosage
keywords: Brain metastasis; Métastases cérébrales; Radiothérapie en conditions stéréotaxiques; Stereotactic radiotherapy