Complications after late (delayed) stereotactic radiosurgery boost in patients with non-small cell lung and breast cancer

«Radiation and Risk», 2022, vol. 31, No. 3, pp.48-56

DOI: 10.21870/0131-3878-2022-31-3-48-56

Authors

Belikova A.A. – Physician
Gerasimov V.A. – Head of Dep.
Datsenko P.V. – Head of Dep., MD. P. Herzen MORI. Contacts: 3 2nd Botkynski proesd, Moscow, Russia, 125284. Tel: 8-903-187-60-58; e-mail This email address is being protected from spambots. You need JavaScript enabled to view it. .
Kaprin A.D. – General Director, Academician of RAS, MD, Prof. NMRRC.
P. Hertsen MORI, Moscow
¹ NMRRC, Moscow

Abstract

The purpose of the work is the assessment of the functional state and the main complications after the delayed boost, depending on the level of doses used and the number of irradiated metastases. In 30 patients with non-small cell lung cancer (n=11) and breast cancer (n=19) with metastatic brain lesion after the end of WBRT, in the long term a boost (SRS) was performed. The prescribed dose for the late boost ranged from 10 to 22 Gy with a median of 15 Gy. Irradiation for single-fraction was performed in 26 patients (86.7%), for 2 fractions – in 2 patients (6.7%), for 3 fractions – in 2 patients (6.7%), respectively. As of December 2021, 26 of 30 patients (86.7%) died, only 53.3% from progression in the central nervous system, from complications 0%. Local progression (growth in the boost zone) was noted in 7 patients (23.3%), distant progression (the appearance of new metastasis or carcinomatosis) – in 56.7%. Often, patients had a combined lesion. Increasing the dose with a delayed boost of ≥15 Gy did not affect the functional state of patients after 12 (p=0.767), 24 (p=0.820), and 36 months (p=1.0) after WBRT. The late boost did not lead to a significant increase in cognitive impairment (p=0.437), despite the larger number of radiosurgical targets and the high dose level compared to the standard boost. There were no significant differences (p=0.935) in the frequency of radionecrosis in groups with a boost dose of ≥15 Gy and <15 Gy (p=0.935); this complication was recorded in 6 out of 24 (23.1%) and 1 out of 4 (25%) patients. At an average dose level ≥20 Gy, the probability of developing radionecrosis was higher (p=0.002). The volume of the tumor mass (Vbust) did not affect the formation of radionecrosis in the future (p=0.213), there was no significance for such predictors as the maximum transverse size of metastasis (p=0.991), the number of metastases (p=0.224) and target (immune) therapy (p=0.289). The median overall survival in patients with devel-oped radionecrosis was 38.6 months (95% Cl: 25.5-51.7), in its absence – only 21.5 months (p=0.015). Late boost can be used for multiple (from 4 to 10) metastatic brain lesions or oligometas-tases that do not meet the criteria for radiosurgical treatment in size. In general, this treatment program is safe, the functional status of patients remains at a fairly high level. Even with the development of radionecrosis, the quality of life and overall survival rates do not decrease.

Key words
brain metastases, radiotherapy, late boost, local progression, distant progression, breast cancer, non-small cell lung cancer, whole-brain radiotherapy, stereotactic radiosurgery, prescribed dose, risk factors.

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