Hypofractionated frameless stereotactic intensity-modulated radiotherapy with whole brain radiotherapy for the treatment of 1-3 brain metastases.

The aim of the study is to evaluate the efficacy and toxicity of hypofractionated frameless stereotactic radiotherapy (HSRT) with whole brain radiotherapy (WBRT) for the treatment of 1-3 brain metastases. 38 patients with a total of 58 brain metastases were treated at Ghent University Hospital with WBRT (10 × 3 Gy) followed by HSRT (5 × 6 Gy). Patients with RPA class I (n = 8) and II (n = 30) were eligible for HSRT. Acute toxicity was scored with the RTOG toxicity criteria. Response rates were scored every 3 months using the McDonald criteria. Overall survival (OS), brain-specific survival, local and distant brain control were calculated using the Kaplan-Meier method. Patient (age, Karnofsky performance score, KPS, RPA class) and tumor characteristics (number of lesions, extracranial metastases, brain tumor volume, primary cancer status, histology) were tested in univariate and multivariate analysis. Survival at 6 and 12 months was 65 and 35 %, respectively. On univariate analysis KPS < 90, number of lesions, a histologic diagnosis of adenocarcinoma and uncontrolled primary cancer status were statistic significant predictors for poor OS. Four patients (11 %) developed a grade 3 toxicity. Rates of complete remission, partial remission, no change and progressive disease were 30, 40, 23 and 5 %, respectively. Median survival was 7.6 months. The actuarial brain-specific survival was 97 % at 6 months and 91 % at 1 year of follow-up. The 1-year actuarial local and distant brain control was 66 and 75 %, respectively. WBRT + HSRT is an effective treatment for patients with up to three brain metastases.