[논문]Radiothérapie stéréotaxique hypofractionnée des métastases cérébrales : bénéfice de l’irradiation encéphalique totale ?

Royer, P.; Salleron, J.; Vogin, G.; Taillandier, L.; Clé; ment-Duchê; ne, C.; Klein, O.; Faivre, J.-C.; Peiffert, D.; Bernier, V.

doi:10.1016/j.canrad.2017.02.005

Radiothérapie stéréotaxique hypofractionnée des métastases cérébrales : bénéfice de l’irradiation encéphalique totale ?
Hypofractionated stereotactic radiotherapy for brain metastasis: Benefit of additional whole brain radiotherapy?

Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, v.21 no.8, 2017년, pp.731 - 740

Royer, P. (Dé) , Salleron, J. (partement universitaire de radiothé) , Vogin, G. (rapie–) , Taillandier, L. (curiethé) , Clément-Duchêne, C. (rapie, institut de cancé) , Klein, O. (rologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lè) , Faivre, J.-C. (s-Nancy, France) , Peiffert, D. (Cellule datamanagement et biostatistiques, institut de cancé) , Bernier, V. (rologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lè)

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Abstract Purpose To study overall survival, risk of neurological death, local recurrence and development of new brain metastasis in patients treated for brain oligometastases with hypofractionated stereotactic radiotherapy with CyberKnife®, according to the association or not with an additional whole brain irradiation. Patients and methods Institutional retrospective study of 102 patients treated for one to three brain metastasis: 76 with exclusive hypofractionated stereotactic radiotherapy and 26 with hypofractionated stereotactic radiotherapy and whole brain irradiation. Objectives were assessed and compared between these two groups according to the Kaplan–Meier method and Cox model. Results Median follow-up was 18.8 months. There were no difference between exclusive hypofractionated stereotactic radiotherapy and hypofractionated stereotactic radiotherapy with whole brain irradiation for overall survival (respective median 21.5 and 20.1 months), risk of neurological death (respectively 9.2% and 15.4% at one year). At one year: the risk of cerebral progressive disease was greater in the group receiving exclusive hypofractionated stereotactic radiotherapy (respectively 43.4% vs. 26.2%, P =0.043), the risk of local recurrence was 25% versus 17.6% (P =0.28) and the development of new brain metastasis was 23.7% versus 11.5% (P =0.27). After salvage treatments, crude local control was similar in the two groups, respectively 78.6% and 73.5%. Whole brain irradiation has been avoided for 72.4% of patients in the group receving exclusive hypofractionated stereotactic radiotherapy. Conclusion Whole brain irradiation improves local control of brain metastatic disease in addition to hypofractionated stereotactic radiotherapy. Sparing whole brain irradiation for salvage treatments only does not affect overall survival or risk of neurological death in selected patients with favourable prognosis.

Abstract

Résumé Objectifs Étude de la survie globale, du risque de décès neurologique, de la progression locale et de l’apparition de nouvelles métastases cérébrales chez des patients pris en charge pour des oligométastases cérébrales par irradiation stéréotaxique hypofractionnée par CyberKnife®, selon l’association ou non à une irradiation encéphalique totale complémentaire. Patients et méthodes Étude rétrospective institutionnelle sur 102 patients pris en charge pour une à trois métastases cérébrales : 76 par irradiation stéréotaxique hypofractionnée exclusive et 26 par irradiation stéréotaxique hypofractionnée et irradiation encéphalique totale. Les objectifs ont été évalués et comparés entre ces deux groupes selon la méthode de Kaplan–Meier et le modèle de Cox. Résultats Le suivi médian était de 18,8 mois. Il n’y avait pas de différence entre les groupes traités par irradiation stéréotaxique hypofractionnée exclusive et ceux traités par irradiation stéréotaxique hypofractionnée et irradiation encéphalique totale en termes de survie globale (médianes respectives de 21,5 mois et 20,1 mois), ni de risque de décès neurologique (9,2 % et 15,4 % à un an). Le risque de progression cérébrale à un an était plus important dans le groupe traité par irradiation stéréotaxique hypofractionnée exclusive (43,4 % contre 26,2 %, p =0,043), avec un risque de progression locale de 25 % contre 17,6 % (p =0,28) et d’apparition de nouvelles métastases cérébrales de 23,7 % contre 11,5 % (p =0,28). Après traitements de rattrapage, le taux de contrôle local brut était identique entre les deux groupes, respectivement 78,6 % et 73,5 %. La radiothérapie encéphalique totale a pu être évitée pour 72,4 % des patients du groupe traité par irradiation stéréotaxique hypofractionnée exclusive. Conclusion L’irradiation encéphalique totale améliore le taux de contrôle local de la maladie métastatique cérébrale en complément de l’irradiation stéréotaxique hypofractionnée. Ne pas la réaliser d’emblée pour la réserver aux seuls traitements de rattrapage n’altère ni la survie globale ni le risque de décès neurologique chez les patients sélectionnés, atteints de cancer de pronostic favorable.

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Radiothérapie stéréotaxique hypofractionnée des métastases cérébrales : bénéfice de l’irradiation encéphalique totale ?
Hypofractionated stereotactic radiotherapy for brain metastasis: Benefit of additional whole brain radiotherapy?

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Radiothérapie stéréotaxique hypofractionnée des métastases cérébrales : bénéfice de l’irradiation encéphalique totale ? Hypofractionated stereotactic radiotherapy for brain metastasis: Benefit of additional whole brain radiotherapy?

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Radiothérapie stéréotaxique hypofractionnée des métastases cérébrales : bénéfice de l’irradiation encéphalique totale ?
Hypofractionated stereotactic radiotherapy for brain metastasis: Benefit of additional whole brain radiotherapy?