Propensity score-matched analysis comparing hippocampus-avoidance whole-brain radiotherapy plus simultaneous integrated boost with hippocampus‑avoidance whole-brain radiotherapy alone for multiple brain metastases-a retrospective study in multiple institutions

Xiaoliang Wang; Jinping Chen; Zhanquan Lei; Haihong Chen; Yufang Zhang; Gang Liu; Shaomin Li; Zhenhua Zheng; Hui Wang

doi:10.1186/s12885-023-11286-3

Propensity score-matched analysis comparing hippocampus-avoidance whole-brain radiotherapy plus simultaneous integrated boost with hippocampus‑avoidance whole-brain radiotherapy alone for multiple brain metastases-a retrospective study in multiple institutions

BMC Cancer. 2023 Aug 24;23(1):796. doi: 10.1186/s12885-023-11286-3.

Authors

Xiaoliang Wang¹, Jinping Chen², Zhanquan Lei³, Haihong Chen⁴, Yufang Zhang⁵, Gang Liu⁶, Shaomin Li⁵, Zhenhua Zheng⁵, Hui Wang⁷

Affiliations

¹ Department of Radiotherapy, The Third Hospital of Zhangzhou, Zhangzhou Fujian, 363005, China. xiaoliang_wang@126.com.
² Department of Radiation Oncology, Army 73rd Group Military Hospital, Xiamen Fujian, 361003, China.
³ Department of Radiation Oncology, FuJian Children's Hospital, Fuzhou Fujian, 350100, China.
⁴ Information Department, Army 73rd Group Military Hospital, Xiamen Fujian, 361003, China.
⁵ Department of Radiation Oncology, XiaMen ChangGung Hospital, Xiamen Fujian, 361028, China.
⁶ Medical Examination Center, Army 73rd Group Military Hospital, Xiamen Fujian, 361003, China.
⁷ Department of Radiation Oncology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, 361003, Fujian, China.

Abstract

Background: The optimal treatment for multiple brain metastases has been recently controversially discussed.This study was aimed to explore the feasibility of Hippocampus-Avoidance Whole-Brain Radiotherapy plus a simultaneous integrated boost (HA-WBRT + SIB) in patients with multiple brain metastases and assess tumor control in comparison with Hippocampus-Avoidance Whole-Brain Radiotherapy (HA-WBRT) alone for brain metastases.

Methods: In this study, 63 patients with multiple brain metastases (≥ 4 metastases) had undergone HA-WBRT + SIB between January 2016 and December 2020 in the observation group:HA-WBRT (30 Gy in 12 fractions, the maximum dose of the hippocampus ≤ 14 Gy) plus a simultaneous integrated boost (48 Gy in 12 fractions) for brain metastases.Overall Survival (OS), Median survival,intracranial control (IC = control within the entire brain), intracranial progression-free survival (iPFS) and adverse events were compared with the control group (a HA-WBRT retrospective cohort) by propensity score matching analysis.

Results: After 1:1 propensity score matching,there were 56 patients in each group (the observation group, the control group). OS, median survival and iPFS were significantly longer in the observation group (18.4 vs. 10.9 months, P<0.001), (13.0 vs. 8.0 months, P<0.001), (13.9 vs.7.8 months, P<0.001). In comparison of 1-year-IC rates, the observation group also demonstrated higher than the control group (51.8% vs. 21.4%, P = 0.002), respectively. Seven hippocampal metastases were found in the control group (4/56,7.1%) and the observation group (3/56,5.4%) after HA-WBRT. The death rate of intracranial progression were 23.2% in the observation group and 37.5% in the control group.All adverse events were not significant difference between the two groups (P>0.05).

Conclusions: HA-WBRT + SIB resulted in better OS,median survival, IC, iPFS, an acceptable risk of radiation response, and a potential way of declining neurocognitive adverse events, which may be a better treatment for patients with multiple brain metastases.

Keywords: HA-WBRT; HA-WBRT + SIB; Hippocampus-avoidance; Multiple brain metastases; Propensity score-matched analysis.

MeSH terms

Brain Neoplasms* / radiotherapy
Brain*
Hippocampus
Humans
Propensity Score
Retrospective Studies