The possibility of lapatinib treatment for breast cancer patients with central nervous system metastases. Case study and literature review

Methods and results of locoregional treatment of brain metastases in patients with non-small cell lung cancer

This article presents methods and results of surgery and radiotherapy of brain metastases from non-small cell lung cancer (BMF-NSCLC). Patients with single BMF-NSCLC, with Karnofsky score ≥ 70 and controlled extracranial disease are the best candidates for surgery. Stereotactic radiosurgery (SRS) is recommended in patients with 1-3 BMF-NSCLC below 3-3.5 cm, with minor neurological symptoms, located in parts of the brain not accessible to surgery, with controlled extracranial disease. Whole brain radiotherapy (WBRT) following SRS reduces the risk of local relapse; in selected patients median survival reaches more than 10 months. Whole brain radiotherapy alone is a treatment in patients with multiple metastases, poor performance status, uncontrolled extracranial disease, disqualified from surgery or SRS with median survival 3 to 6 months. There is no doubt that there are patients with BMF-NSCLC who should receive only the best supportive care. There is a debate in the literature on how to select these patients.

Feasibility of simultaneous integrated boost with forward intensity-modulated radiation therapy for multiple brain metastases

Aim of the study

To evaluate the feasibility of whole-brain radiotherapy (WBRT) with a simultaneous integrated boost (SIB) by forward intensity-modulated radiation therapy (IMRT) in patients with 1–3 brain metastases.

Material and methods

Two forward IMRT plans were implemented among 18 patients. In plan A, the prescribed dose was 30 Gy to the whole brain (PTV_WBRT) and 50 Gy to individual brain metastases (PTV_boost) delivered simultaneously in 10 fractions. In plan B, the prescribed dose was 30 Gy to the PTV_WBRT and 40 Gy to the PTV_boost. Plans were evaluated with regard to conformation number (CN), prescription isodose volume to target volume ratio (PITV), target coverage (TC), homogeneity index (HI), and the volume receiving at least 95% of the prescribed dose (V₉₅). Plan A was implemented for 5 of these patients, and plan B was used for the remaining patients.

Results

The mean values of CN, PITV, TC, and HI for the PTV_boost were 0.71, 1.32, 0.97, and 0.07, respectively, for plan A and 0.65, 1.47, 0.97, and 0.05, respectively, for plan B. The mean values of TC, HI, and V₉₅ for the PTV_WBRT were 0.98, 0.45, and 99.71%, respectively, for plan A and 0.97, 0.27, and 99.61%, respectively, for plan B. All patients completed the planned radiotherapy (RT) schedule with no acute and late RT-related toxicity greater than grade 2.

Conclusions

It is feasible to deliver WBRT with a SIB via forward IMRT for patients with 1–3 brain metastases with good dose conformity and acceptable toxicity.