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MO_16_2879 - Treatment of complex brain metastases with helical Tomotherapy: Results of a phase II trial

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Treatment of complex brain metastases with helical Tomotherapy: Results of a phase II trial
S. Yang1, J. Xiao2, Y. Ma3, R. Zhao1, H. Zhang1, Q. Liu1, Y. Zhang4, N. Bi2, and Y. Li3; 1National Cancer Center/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 2National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 3National Cancer Canter/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 4Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Purpose/Objective(s): A prospective phase II trial was conducted to investigate the feasibility and safety of Tomotherapy for complex brain metastases (BMs).

Materials/Methods: Patients with ≥3 lesions and (or) the volume of the largest lesion ≥6cc belonged to complex BMs and enrolled. FSRT was conducted through Tomotherapy with or without concurrent whole brain radiotherapy (WBRT). TMZ was administrated 75mg/m2 concurrently, followed by 6 cycles of adjuvant TMZ (150mg/m2/d, d1-5, q28d) if necessary. The response was assessed by enhanced MRI after 2-3 months from treatment according to RTOG9508 criteria. Toxicity was recorded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE, version 4.0.3). The primary endpoint was local control (LC), and the secondary endpoints were intracranial progression-free survival (IPFS), brain metastasis- specific survival (BMSS) and overall survival (OS). Kaplan-Meier method was used.

Results: From 2014 to 2017, 82 patients were enrolled. The major primary diagnosis was non-small cell lung cancer (50 patients, 61.0%). For the entire group (Male: female=34:48), the median age was 57 years old (range, 31-81). The median number of lesions was 6 (range, 1-43), and the median whole gross tumor volume (GTV) was 10.56 cc (0.37-93.05 cc), while the median single GTV was 0.37cc(0.01-54.59cc). FSRT was administrated as initial treatment for WBRT with boost radiotherapy (median dose 40 Gy/20 f/28 d for WBRT and 60 Gy/20 f/28 d for boost; 48 patients, 58.5%), initial treatment for local lesions (median dose 52.5 Gy/15 f/20 d; 14 patients, 17.1%), salvage treatment after WBRT failure (median dose 52.5 Gy/15 f/20 d; 20 patients, 24.4%). 16 patients received concurrent perioral TMZ. The median number of lesions were 6 (range, 3-36), and the median GTV was 28.20 cc (0.89-80.4cc). Recent therapeutic evaluation reached CR (6.1%), PR (90.2%) and SD (3.7%), respectively. The median follow-up time was 12.3 months (range, 2.2-40.9 months). The 1-year LC, IPFS, BMSS and OS were 89.5%, 76.0%, 94.6% and 81.0%, respectively. Median survival time was 21.3 months. 30 patients died during follow-up. The main cause of death was extracranial metastases progression (33.3%), and only 5 patients died of BMs, most of which were due to new BMs. In the whole group, main toxicities were grade 1-2 nausea and vomiting, 2 patients (2.4%) experienced grade 3 myelosuppression, due to chemo or target therapy and had all finished entire course of treatment.

Conclusion: Tomotherapy represents accurate and effective treatment for large and multiple BMs and the toxicities were acceptable. Therefore, it could be a prior option for these patients.

Author Disclosure: S. Yang: None. Y. Ma: None. H. Zhang: None. Q. Liu: None.

Siran Yang, MD

Disclosure:
No relationships to disclose.

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