Treatment > Radiotherapy  

Meeting Abstract

Fractionated stereotactic radiotherapy for brain metastases from non small-cell lung cancer

R. Soffietti, G. Beltramo, A. Costanza, E. Laguzzi, C. Mantovani, M. Nobile, R. Ruda'

University and S.G. Battista Hospital, Torino, Italy; University of Torino, Torino, Italy

Objective. We have prospectively evaluated the efficacy and toxicity of Hypofractionated Stereotactic Radiotherapy (HSRT) in patients with brain metastases from non small-cell lung cancer (NSCLC).

Background. HSRT delivers a high conformal dose distribution in few fractions using a relocatable stereotactic frame. Modeling studies have demonstrated a potential biologic advantage for HSRT over radiosurgery in the treatment of brain metastases.

Design/Methods. Eligibility criteria for HSRT were: 1) age ³18 years; 2) Karnofsky Performance Score ³70; 3) controlled primary tumor and systemic disease; 4) 1-3 brain metastases on MRI; 5) lesion diameter £3.5 cm. From April 1998 to May 2002 we enrolled 40 patients (32 males, 8 females, with median age 59.5 years, range 43-77). We treated 46 lesions. The primary tumor histology was squamous cell carcinoma in 24 patients (60%), adeno-carcinoma in 12 (30%), large-cell carcinoma in 2 (5%) and mixed cell carcinoma in 2 (5%). A median dose of 24 Gy (range 16-36 Gy) was delivered in 3 fractions to the Gross Tumor Volume plus a 2mm margin with a X 6 MV linear accelerator. Local tumor control was defined as no increase in the tumor's maximal diameter on axial plane images on MRI.

Results. The median follow-up period was 12 months (range 2-35). The actuarial 1-year local tumor control rate was 69%, the actuarial overall survival rate at 12 and 24 months was of 54% and 33% respectively. The median survival time was 16 months. No significant acute toxicity was seen. Multivariate analysis revealed the following factors to be statistically significant predictor of local tumor control: histology (local control rate 65% in adeno-carcinoma vs 50% in squamous cell carcinoma at 30 months, p<0.002), location (local control rate 65% in supratentorial lesions vs 20% in infratentorial at 30 months, p<0.01) and volume (p<0.04).

Conclusions. Overall, high local control and low morbidity rates suggest that HSRT is an effective and safe modality, especially in patients with small lesions, supratentorial location and adenocarcinoma histotype.

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