ESTRO 2024 - Abstract Book


Clinical - CNS

ESTRO 2024

1 General regional hospital F Miulli, Radiation Oncology, Acquaviva delle fonti, Italy. 2 LUM university, Radiation Oncology, Casamassima, Italy


Linac-based fractionated stereotactic radiotherapy (fSRT) and stereotactic radiosurgery (SRS) are increasingly being used to manage patients with multiple metastases. This retrospective cohort study aimed to evaluate safety and feasibility for linac-based fSRT and SRS in patients with multiple brain metastases (BMs).


From January 2021 to April 2023, patients with BMs were treated with Linac-based fSRT and SRS. Volumetric modulated arc therapy with Hyperarc were performed for all patients. The cumulative incidence with competing risks was used to estimate local control (LC), distant intracranial failure (DIF), and radiation necrosis (RN).


80 patients and 451 BMs were treated (SRS:3 patients, fSRT:77 patients). Thyrty-six out 80 patients (45%) were male and 44 were female, median brain mets were 6 (range 2-20). Primary tumors were as follow: 30% breast, 33% lung, 10% melanoma. Five patients had prior RT treatment: 3 of them whole brain RT and 2 FSRT. Median PTV in cc was 10 (0.5-66cc). Median dose was 24Gy (range 18-30) in 3 fractions (range 1-5). Median GI were 0.7 (range 0.3-1). No acute side effects were reported. 26 patients (27,5%) reported a progression of disease out of field and 23 out 26 underwent to a second course of stereotactic radiotherapy with the new brain metastases (median 8, range 1-16), Four patients out 23 underwent to another course of brain fSRT (median brain mets 10, range 3-20).


It seems reasonable to use linac-based fSRT and SRS in patients with multiple BMs due to the high feasibility and safety of the procedure without side effects. Second and third stereotactic RT could be proposed. Surely, robust data are needed.

Keywords: Brain metastases, stereotactic radiotherapy


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