Results of a phase II study of Short-course Accelerated Radiation Therapy (SHARON) for multiple brain metastases

• Published in: American journal of clinical oncology Vol. 38; no. 4; p. 395
• Main Authors: Caravatta, Luciana, Deodato, Francesco, Ferro, Marica, Macchia, Gabriella, Massaccesi, Mariangela, Cilla, Savino, Tambaro, Rosa, Mignogna, Samantha, Padula, Gilbert D A, Musacchio, Michela, Flocco, Mariano, Cantore, Giampaolo, Scapati, Andrea, Bogale, Solomon, Balducci, Mario, Valentini, Vincenzo, Cellini, Numa, Morganti, Alessio G
• Format: Journal Article
• Language: English
• Published: United States 01.08.2015
• Subjects: Aged; Aged, 80 and over; Brain Neoplasms - radiotherapy; Brain Neoplasms - secondary; Carcinoma - radiotherapy; Carcinoma - secondary; Disease-Free Survival; Dose Fractionation; Female; Humans; Male; Middle Aged; Neoplasms - pathology; Radiation Injuries - etiology; Radiodermatitis - etiology; Radiotherapy - adverse effects; Radiotherapy - methods; Treatment Outcome
• ISSN: 1537-453X
• DOI: 10.1097/COC.0b013e3182a0e826

To assess the effectiveness of a SHort-course Accelerated RadiatiON therapy (SHARON) in the treatment of patients with multiple brain metastases. A phase II clinical trial was designed. Eligibility criteria included patients with at least 3 brain metastases or metastatic disease in >3 organ systems, and Eastern Cooperative Oncology Group performance status of ≤3. Fifty patients were treated with whole brain radiotherapy at 18 Gy (4.5 Gy per fraction) in 2 days with a twice daily fractionation. The primary endpoint was the assessment of efficacy in terms of overall survival. Characteristics of the 50 enrolled patients were: male/female: 24/26; median age: 65 years (range, 45 to 80 y). Eastern Cooperative Oncology Group performance status was <3 in 42 patients (84%). Nineteen patients (38%) were considered to have recursive partitioning analysis class 3 disease. Grade 1-2 acute neurological (46%) and skin (24%) toxicities were recorded. Three patients (6%) experienced neurological grade 3 acute toxicity. With a median follow-up time of 6 months (range, 1 to 18 mo) 2 skin grade 1 late toxicities has been observed. Seventeen of 27 symptomatic patients showed an improvement or resolution of baseline symptoms (overall palliative response rate: 63.0%; 95% confidence interval, 36.6%-82.4%).Two-month overall survival was 86% (median survival time=7 mo). Short-course accelerated whole brain radiotherapy of 18 Gy in twice daily fractions for 2 consecutive days is tolerated and effective in terms of symptom relief and median survival time. These results justify a phase III comparison against the standard-of-care in this patient population (30 Gy in 10 fractions).