Treatment of brain oligometastases with hypofractionated stereotactic radiotherapy utilising volumetric modulated arc therapy.
Stereotactic radiosurgery (SRS) is commonly used to treat brain metastases, particularly in the oligometastatic setting. This study analyses our initial experience in treating oligometastatic brain disease using Volumetric Modulated Arc Therapy (VMAT) to deliver hypofractionated stereotactic radiotherapy (HFSRT). Sixty-one patients were treated with HFSRT with a median dose of 24 Gy (range 22-40 Gy) in a median of three fractions (range 2-10 fractions). With a median follow-up of 23 months, the local control rate was 74 % for the entire cohort. Local control was 87 % for patients who had surgery with no radiological evidence of residual disease followed by HFSRT compared with 69 % in patients treated with HFSRT alone. The overall median time post radiotherapy to local failure was 8.6 months and to extracranial failure was 7.9 months. The mean time to distant brain failure was 9.9 months. Twenty-two patients (36 %) died during the study with median time to death of 4.4 months. Median overall survival (OS) from treatment was 21 months and 12 month OS was 60 %. Our experience with HFSRT using VMAT for oligometastatic brain metastases in the post-operative setting demonstrates comparable local control and survival rates compared with international published data. In the intact brain metastasis setting, local control using the dose levels and delivery in this cohort may be inferior to radio-surgical series. Local control is independent of histology. Careful selection of patients remains critical.
Department of Radiation Oncology, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Gairdner Drive, Nedlands, WA, 6009, Australia. jeremycroker@hotmail.com.|School of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia. jeremycroker@hotmail.com.
Jeremy
J
Croker
School of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia. benjamin.chua@health.qld.gov.au.|Department of Radiation Oncology, Cancer Care Services, Royal Brisbane and Women's Hospital, Joyce Tweddell Building, Herston, QLD, 4029, Australia. benjamin.chua@health.qld.gov.au.
Benjamin
B
Chua
QFAB Bioinformatics, Institute for Molecular Bioscience, Queensland Bioscience Precinct, The University of Queensland, 306 Carmody Road, St Lucia, QLD, 4072, Australia. a.bernard@qfab.org.
Anne
A
Bernard
Department of Radiation Oncology, Division of Cancer Services, Princess Alexandra Hospital, University of Queensland, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia. maryse.allon@health.qld.gov.au.
Maryse
M
Allon
School of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia. matthew.foote@health.qld.gov.au.|Department of Radiation Oncology, Division of Cancer Services, Princess Alexandra Hospital, University of Queensland, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia. matthew.foote@health.qld.gov.au.
Matthew
M
Foote
D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies
Brain metastasis; Hypofractionation; Local control; Stereotactic radiosurgery; VMAT; Volumetric Modulated Arc Therapy