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. 2024 Mar 28;97(1156):820-827.
doi: 10.1093/bjr/tqae029.

The dosimetric parameters impact on local recurrence in stereotactic radiotherapy for brain metastases

Camille Berthet  1 , François Lucia  2 , Vincent Bourbonne  2 , Ulrike Schick  2 , Isabelle Lecouillard  1 , Coralie Le Deroff  1 , Anais Barateau  1   3 , Renaud de Crevoisier  1   3 , Joel Castelli  1   3
Affiliations

The dosimetric parameters impact on local recurrence in stereotactic radiotherapy for brain metastases

Camille Berthet et al. Br J Radiol. .

Erratum in

Abstract

Objectives: Stereotactic radiotherapy (SRT) for brain metastases (BM) allows very good local control (LC). However, approximately 20%-30% of these lesions will recur. The objective of this retrospective study was to evaluate the impact of dosimetric parameters on LC in cerebral SRT.

Methods: Patients treated with SRT for 1-3 BM between January 2015 and December 2018 were retrospectively included. A total of 349 patients with 538 lesions were included. The median gross tumour volume (GTV) was 2 cm3 (IQR, 0-7). The median biological effective dose with α/β = 10 (BED10) was 60 Gy (IQR, 32-82). The median prescription isodose was 71% (IQR, 70-80). Correlations with LC were examined using the Cox regression model.

Results: The median follow-up period was 55 months (min-max, 7-85). Median overall survival was 17.8 months (IQR, 15.2-21.9). There were 95 recurrences and LC at 1 and 2 years was 87.1% (95% CI, 84-90) and 78.1% (95% CI, 73.9-82.4), respectively. Univariate analysis showed that systemic treatment, dose to 2% and 50% of the planning target volume (PTV), BED10 > 50 Gy, and low PTV and GTV volume were significantly correlated with better LC. In the multivariate analysis, GTV volume, isodose, and BED10 were significantly associated with LC.

Conclusion: These results show the importance of a BED10 > 50 Gy associated with a prescription isodose <80% to optimize LC during SRT for BM.

Advances in knowledge: Isodose, BED, and GTV volume were significantly associated with LC. A low isodose improves LC without increasing the risk of radionecrosis.

Keywords: brain metastases; dosimetric parameters; local recurrence; stereotactic radiotherapy.

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Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Cox regression univariate analysis of clinical factors for local recurrence. Abbreviations: HR = hazard ratio, RPA = recursive partitioning analysis.
Figure 2.
Figure 2.
Cox regression univariate analysis of dosimetrics factors for local recurrence. Abbreviations: HR = hazard ratio, GTV = gross tumour volume, PTV = planning target volume, Dmean = mean dose to the PTV, DX% = dose to X% of the PTV, Gy = grey.
Figure 3.
Figure 3.
Cox regression multivariate analysis of dosimetrics factors for local recurrence. Abbreviations: HR = hazard ratio, GTV = gross tumour volume, Gy = grey.
Figure 4.
Figure 4.
Kaplan-Meier curves for LC according to isodose (A) and BED10 (B). Abbreviations: BED = biological effective dose, Gy = grey, LC = local control.
See this image and copyright information in PMC

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