Silvia Scoccianti1, Emanuela Olmetto2, Valentina Pinzi3, Mattia Falchetto Osti4, Rossella Di Franco5, Saverio Caini6, Paola Anselmo7, Paolo Matteucci5, Davide Franceschini8, Cristina Mantovani9, Giancarlo Beltramo10, Francesco Pasqualetti11, Alessio Bruni12, Paolo Tini13, Emilia Giudice14, Patrizia Ciammella15, Anna Merlotti16, Sara Pedretti17, Marianna Trignani18, Marco Krengli19, Niccolò Giaj-Levra20, Isacco Desideri2, Guido Pecchioli21, Paolo Muto22, Ernesto Maranzano7, Laura Fariselli3, Pierina Navarria8, Umberto Ricardi23, Vieri Scotti2, Lorenzo Livi2. 1. Radiation Oncology Unit, Ospedale Santa Maria Annunziata, Department of Oncology, Bagno a Ripoli, Florence, Italy. 2. Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences "Mario Serio," Florence, Italy. 3. U.O Radioterapia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Neurosurgery, Milan, Italy. 4. U.O.C Radioterapia, A.O.U Sant'Andrea Facoltà Medicina e Psicologia Università Sapienza, Department of Medicine, Surgery and Translational Medicine, Rome, Italy. 5. Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, Department of Radiotherapy, N aples, Italy. 6. Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Cancer Risk Factors and Life-Style Epidemiology Unit, Florence, Italy. 7. Radiotherapy Oncology Center, S. Maria Hospital, Department of Oncology, Terni, Italy. 8. Humanitas Research Hospital, Radiotherapy and Radiosurgery Department, Rozzano, Italy. 9. Radiotherapy unit, Department of Oncology, Turin, Italy. 10. Cyberknife Centro Diagnostico Italiano, Department of Radiology, Milan, Italy. 11. Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, Department of Translational Medicine, Pisa, Italy. 12. Radiotherapy Unit, University Hospital of Modena, Department of Oncology and Hematology, Modena, Italy. 13. Radiotherapy Unit, University of Siena, Department of Radiotherapy and Oncology, Siena, Italy. 14. UOC di Radioterapia, Policlinico Universitario Tor Vergata, Department of Onco-Haematology, Rome, Italy. 15. Radioterapia Oncologica "G. Prodi," AO-IRCCS Arcispedale S. Maria Nuova, Department of Oncology and Advanced Technology, Reggio Emilia, Italy. 16. Radiation Oncology A.S.O. S.Croce e Carle, Department of Radiation Oncology, Cuneo, Italy. 17. U.O. Radioterapia oncologica, Department of Radiation Oncology, ASST Spedali Civili di Brescia e Università degli studi di Brescia, Brescia, Italy. 18. U.O.C. Radioterapia Oncologica, Ospedale Clinicizzato SS Annunziata- Università Chieti G. D'Annunzio, Department of Radiation Oncology, Chieti, Italy. 19. Radiation Oncology, University Hospital Maggiore della Carità, Department of Translational Medicine, Novara, Italy. 20. IRCCS Ospedale Sacro Cuore Don Calabria, Department of Advanced Radiation Oncology, Verona, Italy. 21. Neurosurgery Unit, Azienda Ospedaliero Universitaria Careggi, Department of Neurosurgery, Florence, Italy. 22. Radioterapia Oncologica, Campus Biomedico, Department of Radiation Oncology, Rome, Italy. 23. University of Turin, Department of Oncology, Turin, Italy.
Abstract
BACKGROUND: To define efficacy and toxicity of Immunotherapy (IT) with stereotactic radiotherapy (SRT) including radiosurgery (RS) or hypofractionated SRT (HFSRT) for brain metastases (BM) from non-small cell lung cancer (NSCLC) in a multicentric retrospective study from AIRO (Italian Association of Radiotherapy and Clinical Oncology). METHODS: NSCLC patients with BM receiving SRT + IT and treated in 19 Italian centers were analyzed and compared with a control group of patients treated with exclusive SRT. RESULTS: One hundred patients treated with SRT + IT and 50 patients treated with SRT-alone were included. Patients receiving SRT + IT had a longer intracranial Local Progression-Free Survival (iLPFS) (propensity score-adjusted P = .007). Among patients who, at the diagnosis of BM, received IT and had also extracranial progression (n = 24), IT administration after SRT was shown to be related to a better overall survival (OS) (P = .037). A multivariate analysis, non-adenocarcinoma histology, KPS = 70 and use of HFSRT were associated with a significantly worse survival (P = .019, P = .017 and P = .007 respectively). Time interval between SRT and IT ≤7 days (n = 90) was shown to be related to a longer OS if compared to SRT-IT interval >7 days (n = 10) (propensity score-adjusted P = .008). The combined treatment was well tolerated. No significant difference in terms of radionecrosis between SRT + IT patients and SRT-alone patients was observed. The time interval between SRT and IT had no impact on the toxicity rate. CONCLUSIONS: Combined SRT + IT was a safe approach, associated with a better iLPFS if compared to exclusive SRT.
BACKGROUND: To define efficacy and toxicity of Immunotherapy (IT) with stereotactic radiotherapy (SRT) including radiosurgery (RS) or hypofractionated SRT (HFSRT) for brain metastases (BM) from non-small cell lung cancer (NSCLC) in a multicentric retrospective study from AIRO (Italian Association of Radiotherapy and Clinical Oncology). METHODS: NSCLC patients with BM receiving SRT + IT and treated in 19 Italian centers were analyzed and compared with a control group of patients treated with exclusive SRT. RESULTS: One hundred patients treated with SRT + IT and 50 patients treated with SRT-alone were included. Patients receiving SRT + IT had a longer intracranial Local Progression-Free Survival (iLPFS) (propensity score-adjusted P = .007). Among patients who, at the diagnosis of BM, received IT and had also extracranial progression (n = 24), IT administration after SRT was shown to be related to a better overall survival (OS) (P = .037). A multivariate analysis, non-adenocarcinoma histology, KPS = 70 and use of HFSRT were associated with a significantly worse survival (P = .019, P = .017 and P = .007 respectively). Time interval between SRT and IT ≤7 days (n = 90) was shown to be related to a longer OS if compared to SRT-IT interval >7 days (n = 10) (propensity score-adjusted P = .008). The combined treatment was well tolerated. No significant difference in terms of radionecrosis between SRT + IT patients and SRT-alone patients was observed. The time interval between SRT and IT had no impact on the toxicity rate. CONCLUSIONS: Combined SRT + IT was a safe approach, associated with a better iLPFS if compared to exclusive SRT.
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