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01-01-2020 | Original Article

Boost Irradiation Integrated to Whole Brain Radiotherapy in the Management of Brain Metastases

Authors: Ágnes Dobi, Emese Fodor, Anikó Maráz, Zsófia Együd, Adrienne Cserháti, László Tiszlavicz, Zita Reisz, Pál Barzó, Zoltán Varga, Katalin Hideghéty

Published in: Pathology & Oncology Research | Issue 1/2020

Abstract

Our retrospective analysis aimed to evaluate the clinical value of dose intensification schemes: WBRT and consecutive, delayed, or simultaneous integrated boost (SIB) in brain metastasis (BM) management. Clinical data and overall survival (OS) of 468 patients with BM from various primaries treated with 10 × 3 Gy WBRT (n = 195), WBRT+ 10 × 2 Gy boost (n = 125), or simultaneously 15 × 2.2 Gy WBRT+0.7 Gy boost (n = 148) during a 6-year period were statistically analysed. Significant difference in OS could be detected with additional boost to WBRT (3.3 versus 6.5 months) and this difference was confirmed for BMs of lung cancer and melanoma and both for oligo- and multiplex lesions. The OS was prolonged for the RPA 2 and RPA3 categories, if patients received escalated dose, 4.0 vs. 7.7 months; (p = 0.002) in class RPA2 and 2.6 vs. 4.2 months; (p < 0.0001) in the class RPA 3 respectively. The significant difference in OS was also achieved with SIB. The shortened overall treatment time of SIB with lower WBRT fraction dose exhibited survival benefit over WBRT alone, and could be applied for patients developing BM even with unfavourable prognostic factors. These results warrant for further study of this approach with dose escalation using the lately available solutions for hippocampus sparing and fractionated stereotactic irradiation. The simultaneous delivery of WBRT with reduced fraction dose and boost proved to be advantageous prolonging the OS with shortened treatment time and reduced probability for cognitive decline development even for patients with poor performance status and progressing extracranial disease.

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Title: Boost Irradiation Integrated to Whole Brain Radiotherapy in the Management of Brain Metastases
Authors: Ágnes Dobi
Emese Fodor
Anikó Maráz
Zsófia Együd
Adrienne Cserháti
László Tiszlavicz
Zita Reisz
Pál Barzó
Zoltán Varga
Katalin Hideghéty
Publication date: 01-01-2020
Publisher: Springer Netherlands
Published in: Pathology & Oncology Research / Issue 1/2020
Print ISSN: 1219-4956
Electronic ISSN: 1532-2807
DOI: https://doi.org/10.1007/s12253-018-0383-y

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