ESTRO 2024 - Abstract Book

S768

Clinical - CNS

ESTRO 2024

Toscana Centro, Radiation Oncology, Firenze, Italy. 4 Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, Radiation Oncology, Roma, Italy. 5 Humanitas Research Hospital, Radiation Oncology, Rozzano - Milano, Italy. 6 Fondazione IRCCS Policlinico San Matteo and University of Pavia, Radiation Oncology, Pavia, Italy. 7 Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Radiation Oncology, Firenze, Italy. 8 Azienda AUSL Bologna, Ospedale Bellaria, Radiation Oncology, Bologna, Italy. 9 ASST Spedali Civili and Brescia University, Radiation Oncology, Brescia, Italy. 10 Sapienza University of Rome, Policlinico Umberto I, Radiation Oncology, Roma, Italy. 11 Fondazione Instituto Oncologico del Mediterraneo, Radiation Oncology, Viagrante, Italy

Purpose/Objective:

The Central Nervous System Study Group of the Italian Association of Radiotherapy and Clinical Oncology proposed a nationwide survey, with the purposes to investigate: the management of postoperative RT in patient with single/multiple brain metastasis, the definition of treatment doses and volumes, the treatment timing and follow up.

Material/Methods:

In 2023, the survey was distributed online to 24 members expert in brain cancer. The questionary was divided into 4 sections: general aspects (5 questions), clinical aspect (6 questions), treatment volumes (13 questions), techniques doses-timing (6 questions).

Results:

The response rate was 100%. In case of patients with single surgically removed brain metastases, all participants (100%) voted for stereotactic radiosurgery (SRS) or stereotactic fractionated radiotherapy (SFRT) on surgical bed. For asymptomatic patients with multiple brain metastasis and one surgically removed, 87% voted for SRS/SFRT on surgical bed and the other metastasis. The characteristics most considered for the indication to this treatment were: cumulative volume of intracranial disease (77%) and patient performance status (77%). The 68% voted that the correct timing for treatment could be within 30 days from surgery. SFRT treatment was voted by 95% of participants as preferred treatment approach vs SRS. The 86% of responders voted that GTV should include the surgical bed and any areas of contrast enhancement. While there is more variability in the definition of the CTV margin, especially in clinical situations such as contact with the dura and/or sinus venosus (1-5 mm was voted by 59%; 5-10 mm by 36%; >10mm by 5%). The indication for immuno- or target- therapy was voted as “not influencing the timing of SRS/SFRT treatment” by 81% participants in case of single metastasis and 59% in case of multiple metastasis. Regarding the follow-up, 86% of the responders voted that the contrast MRI every 60-90 days should be mandatory.

Conclusion:

There was a strong agreement in the clinical aspects regarding the management of patients with single or multiple brain metastasis. A heterogeneity was highlighted in the treatment timing and volume definition. Following these crucial points, a virtual contouring lab of 5 cases and an educational webinar were promoted in the same project. The achievement of a National Consensus may represent an interesting future goal.