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CNS METASTASIS SRS should be ‘the’ First-line Treatment Dr Dhermain MD PhD Head of the Brain Tumor Board Gustave Roussy University Hospital [email protected]
CNS METASTASIS
SRS should be‘the’
First-line Treatment
Dr Dhermain MD PhDHead of the Brain Tumor Board
Gustave Roussy University [email protected]
+ 400 cases / Yr at Gustave
SRS should be ‘the’ First-line Treatment
NEVER SAY ‘ALWAYS’!
A ‘Case by case’ … Multi-Disciplinary Discussion
A Benefit / Risk decision … not fully predictable
After WBRT: SRS as a boost / in salvage
After SURGERY: SRS
SRS should be ‘the’ First-line TreatmentTOP 4 reasons FOR SRS
N°1 + N°2: AVAILABILITY & EFFICACY è 8 BMs, High Doses + Molecularly / Volume ‘adapted’: 18-24 Gy, 1 - 5 Fractions
N°3: TOXICITIES . Less Acute Toxicity + Best ‘hippocampal sparing’. < 5% of Severe Radionecrosis (1 Yr) + BVZ active !
N°4: COMBINATIONSRS + Precision medicine è Lung, Melanoma: SRS + targeted-drug, immunoTT
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3 Gy Isodose in BLUE !
SRS should be ‘the’ First-line TreatmentTOP 3 reasons AGAINST WBRT
N°1: EFFICACYNot ‘Risk-adapted’ : 30 Gy / 10 fractions, Not for Radioresistant T: Melanoma
N°2: TOXICITIES. Always More ‘Normal Brain’ irradiated
. Memantine Activity & Hippocampal Sparing ‘questionable’ in clinic
N°3: COMBINATIONWBRT + Precision Medicine ?
SRS should be ‘the’ First-line Treatment
SRS after WBRT
WBRT 1st line è SRS ‘as a BOOST’ / ‘in Salvage’
Still good indications for WBRT è Giuseppe !
