Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Optimal dose and volume for postoperative radiotherapy in brain oligometastases from lung cancer: a retrospective study

  • Chung, Seung Yeun (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Chang, Jong Hee (Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Hye Ryun (Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Cho, Byoung Chul (Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Lee, Chang Geol (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Suh, Chang-Ok (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine)
  • Received : 2017.03.01
  • Accepted : 2017.03.24
  • Published : 2017.06.30
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Abstract

Purpose: To evaluate intracranial control after surgical resection according to the adjuvant treatment received in order to assess the optimal radiotherapy (RT) dose and volume. Materials and Methods: Between 2003 and 2015, a total of 53 patients with brain oligometastases from non-small cell lung cancer (NSCLC) underwent metastasectomy. The patients were divided into three groups according to the adjuvant treatment received: whole brain radiotherapy (WBRT) ${\pm}$ boost (WBRT ${\pm}$ boost group, n = 26), local RT/Gamma Knife surgery (local RT group, n = 14), and the observation group (n = 13). The most commonly used dose schedule was WBRT (25 Gy in 10 fractions, equivalent dose in 2 Gy fractions [EQD2] 26.04 Gy) with tumor bed boost (15 Gy in 5 fractions, EQD2 16.25 Gy). Results: The WBRT ${\pm}$ boost group showed the lowest 1-year intracranial recurrence rate of 30.4%, followed by the local RT and observation groups, at 66.7%, and 76.9%, respectively (p = 0.006). In the WBRT ${\pm}$ boost group, there was no significant increase in the 1-year new site recurrence rate of patients receiving a lower dose of WBRT (EQD2) <27 Gy compared to that in patients receiving a higher WBRT dose (p = 0.553). The 1-year initial tumor site recurrence rate was lower in patients receiving tumor bed dose (EQD2) of ${\geq}42.3Gy$ compared to those receiving <42.3 Gy, although the difference was not significant (p = 0.347). Conclusions: Adding WBRT after resection of brain oligometastases from NSCLC seems to enhance intracranial control. Furthermore, combining lower-dose WBRT with a tumor bed boost may be an attractive option.

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References

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