A Phase II Multi-institutional Clinical Trial Assessing Fractionated Simultaneous In-Field Boost Radiotherapy for Brain Oligometastases

Abstract

Purpose/Objective Published preclinical and phase I clinical trial data suggest that fractionated lesional radiotherapy with 60 Gy in 10 fractions can serve as an alternative approach to single fraction radiosurgical boost for brain oligometastases. Methods and Materials A phase II clinical trial (NCT01543542) of a total of 60 Gy in 10 fractions of lesional (one to three) radiotherapy (given simultaneously with whole-brain helical tomotherapy with 30 Gy in 10 fractions) was conducted at five institutions. We hypothesized that fractionated radiotherapy would be considered unsuitable if the median overall survival (OS) was degraded by two months or if six-month intracranial control (ICC) and intracranial lesion (ILC) were inferior by 10% compared with the published RTOG 9508 results.

Case of a Long-Time Survivor with Recurrent Multiple Brain Metastases from Lung Cancer: Terminal Stage Cancer or Chronic Disease

“…One to three brain metastases received 60-Gy WBI in 10 fractions simultaneously with 30-Gy WBI in 10 fractions at five institutions. Median OS was 5.4 months, and 6-month actuarial estimates of intracranial control (ICC) was 78%, demonstrating non-inferiority to the RTOG 9508 historical controls (OS: p = 0.09; ICC = 0.31) [12].…”

Radionecrosis and Complete Response After Multiple Reirradiations to Recurrent Brain Metastases From Lung Cancer Over 10 Years: Is There a Limit?

“…WBI can cause severe neurotoxicity. The current trend is to do SRS or HSRT whenever possible for cancer patients who had limited number of brain metastases due to equivalent OS with reduced toxicity most notably involving neurocognition [4][5][6][7][8][11][12][13][14][15][16][17][18]. However, even though well tolerated, SRS does have side effects including most concerning radionecrosis (low rate) [14].…”

“…The current trend is to use SRS or HSRT whenever possible for patients with cancer who have a limited number of brain metastases due to equivalent OS with reduced toxicity, most notably involving neurocognition. 4 , 5 , 6 , 7 , 8 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 However, even though well tolerated, SRS does have adverse effects, including radionecrosis (low rate). 14 There are questions as to whether current low radionecrosis rates apply to metastatic patients who are living longer owing to improvements in systemic therapy, because in the past these patients would have passed away before developing late neurotoxicity.…”