====== Renal cancer brain metastases ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1NksTF9hJayuugsbar7nIAVhIe2gOqDl_7UFL_Kh_vczo0L9BJ/?limit=15&utm_campaign=pubmed-2&fc=20241009111452}}

Until 50% of patients with renal [[cancer]] or [[melanoma]], develop [[brain metastases]] during the course of their [[disease]]. [[Stereotactic radiotherapy]] has become a standard of care for patients with a limited number of brain metastases. Given the radioresistant nature of melanoma and renal cancer, optimization of the fractionation of stereotactic radiotherapy is needed.

The purpose of a retrospective study of Lesueur et al., from [[Caen]], [[France]], was to elucidate if hypofractionated [[stereotactic radiotherapy]] (HFSRT) impacts local control of [[brain metastases]] from radioresistant tumors such as melanoma and renal cancer, in comparison with [[radiosurgery]] (SRS).

Between 2012 and 2016, 193 metastases, smaller than 3 cm, from patients suffering from radioresistant primaries (melanoma and renal cancer) were treated with HFSRT or SRS. The primary outcome was local [[progression free survival]] (LPFS) at 6, 12 and 18 months. [[Overall survival]] (OS) and cerebral progression free survival (CPFS) were secondary outcomes, and were evaluated per patient. Objective response rate and [[radionecrosis]] incidence were also reported. The statistical analysis included a supplementary propensity score analysis to deal with bias induced by non-randomized data.

After a median follow-up of 7.4 months, LPFS rates at 6, 12 and 18 months for the whole population were 83, 74 and 70%, respectively. With respect to fractionation, LPFS rates at 6, 12 and 18 months were 89, 79 and 73% for the SRS group and 80, 72 and 68% for the HFSRT group. The fractionation schedule was not statistically associated with LPFS (HR = 1.39, CI95% [0.65-2.96], p = 0.38). Time from planning MRI to first irradiation session longer than 14 days was associated with a poorer local control rate. Over this time, LPFS at 12 months was reduced from 86 to 70% (p = 0.009). Radionecrosis occurred in 7.1% for HFSRT treated metastases to 9.6% to SRS treated metastases, without any difference according to fractionation (p = 0.55). The median OS was 9.6 months. Six, 12 and 18 months CPFS rates were 54, 24 and 17%, respectively.

Fractionation does not decrease LPFS. Even for small radioresistant brain metastases (< 3 cm), HFSRT, with 3 or 6 fractions, leads to an excellent local control rate of 72% at 1 year with a rate of 7.1% of radionecrosis. HFSRT is a safe and efficient alternative treatment to SRS
((Lesueur P, Lequesne J, Barraux V, Kao W, Geffrelot J, Grellard JM, Habrand JL,
Emery E, Marie B, Thariat J, Stefan D. [[Radiosurgery]] or hypofractionated
[[stereotactic radiotherapy]] for [[brain metastases]] from radioresistant primaries
([[melanoma]] and [[renal cancer]]). Radiat Oncol. 2018 Jul 28;13(1):138. doi:
10.1186/s13014-018-1083-1. PubMed PMID: 30055640.
)).