S930
Clinical - Mixed sites & palliation
ESTRO 2026
Sciences "M. Serio", University of Florence, Florence, Italy
Purpose/Objective: For resected brain metastases hypofractionated radiosurgery (HSRS) on the tumor bed has proven to be an effective local treatment less toxic to WBRT. Notwithstanding, there has been growing evidences that this treatment approach has an increased rates of leptomeningeal disease (LMD) up to 31%. Preoperative HSRS would seem a valid alternative to maximize local control reducing risk of leptomeningeal spread.Based on this background we designed a multicenter randomized double arm phase III trial comparing preoperative HSRS to postoperative HSRS in patients with BMs from solid tumors suitable for surgical resection. Primary endpoint is incidence of LMS, secondary endpoints Local control (LC), symptomatic radiation necrosis (RN) occurrence, surgical morbidity, Quality of life (QoL) and neurocognitive functions assessment, Brain distant progression (BDP), and Overall survival (OS) Material/Methods: Patients aged18-80 years, solid tumor malignancy diagnosis, clinical indication for surgery, KPS ≥ 70, oligometastatic disease were included. Stratification factors are based on histology of primary tumor (Breast, NSCLC, Melanoma, Other) (4 levels) and brain metastases location (sovra- or infra-tentorial) (2 levels). In Arm A (experimental), patients undergo preoperative HSRS consisting in 27 Gy in 3 daily fractions; within 1 weeks, patients undergo surgical resection The suggested timing for surgery is within 48-72 hours.In Arm B (control), patients undergo surgical resection and within 4-6 weeks, postoperative HSRS consisting in 27 Gy in 3 daily fractions. In case of multiple BMs the un-resected ones have to be treated before surgery in both arms. Patients are evaluated using MRI, Total body CT scan, neuropsychological test and QoL assessment after 1 month from the end of treatment and every 3 months thereafter. Setting a two sided type I error of 4.9% (allowing for interim analysis) and a power of 80%, to detect a relative reduction of 81% of risk of LMD events in the arm A compared to arm B, 16 events are requested and it will be necessary to randomize 138 patients (69 per arm) in order to get the required number of LMD events. Considering a drop-out rate £ 5% the total number of patients tobe randomized is 146 (73 per arm). Results: Characteristics of enrolled patient are shown in table 1
Conclusion: Promising results are waited by preoperative HSRS for resected brain metastases Keywords: Preoperative HSRS, brain metastases, surgery
Digital Poster 4974 Single vs Fractionated Stereotactic Radiotherapy for Brain Metastases: A comparative Study Lucrezia Toppi 1 , Carlo Greco 1,2 , Daniela Auteri 2 , Daniele Carlotti 1 , Valerio Marè 1 , Michele Fiore 1,2 , Edy Ippolito 1,2 , Aurelia Iurato 1 , Paolo Matteucci 1 , Sara Reina 1 , Lisa Vicenzi 1 , Sara Ramella 1,2 1 Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy. 2 Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy Purpose/Objective: This retrospective, observational, multicentre study aimed to compare the clinical efficacy and risk of brain radionecrosis between single-fraction stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (HFSRT) in patients with brain metastases.
Made with FlippingBook - Share PDF online