143PD - Hypofractionated radiotherapy combined with temozolomide for large brain metastases: A prospective trial

Date 17 December 2016
Event ESMO Asia 2016 Congress
Session CNS tumours
Topics Anticancer Agents
Central Nervous System Malignancies
Surgical Oncology
Presenter Yuchao Ma
Citation Annals of Oncology (2016) 27 (suppl_9): ix42-ix45. 10.1093/annonc/mdw578
Authors Y. Ma, J. Xiao, N. Bi, Q. Liu, Y. Zhang, D. Liu, R. Zhao
  • Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), 100021 - Beijing/CN



A phase II trial was conducted to investigate the feasibility and safety of hypofractionated radiotherapy combined with temozolomide (TMZ) for large brain metastases (BMs).


Patients with BMs larger than 3cm or 6cc were enrolled. Radiotherapy (RT) was given by 52-52.5Gy/3.5-4Gy/13-15f. TMZ was administrated 75mg/m2 concurrently, followed by 6 cycles of adjuvant TMZ (150mg/m2/d, d1-5, q28d). Patients received MRI after 10-13 fractions of RT and would get replanned if GTV decreased>20%. The response was assessed after 2-3 months from treatment according to RTOG9508 criteria. Toxicity was recorded according to RTOG and CTCAE, v4.0 criteria. The primary end point was objective response Rate (ORR), and the secondary end points were local control (LC), intracranial progression-free survival (IPFS) and overall survival (OS) and toxicities.


From 2010 to 2015, 33 patients (Male: female=20:13) were analyzed. The median age was 56 years old (range, 39-74). The major primary diagnosis was non-small cell lung cancer (57.6%). The number of large BMs were 38, and median GTV was 15.3cc (5.7-142.8cc). The median KPS score before and after treatment were 70 and 80. Median follow-up time of 30.0 months (range, 5.8-54.2 months) and ORR was [1]97.0%. 1-year LC, IPFS and OS were 95.2%, 69.5%, and 61.5%, respectively. Median survival time was 15.3 months. 22 patients (66.7%) acquired replanning during the treatment, and the median GTV decrease rate was 44.3% (21.1%-87.8%). The main toxicities were grade 1-2 nausea and vomiting, 1 patient got grade 3 liver-function impairment.


Hypofractionated radiotherapy with TMZ represents a safe and effective option for patients with large BMs. More than 50 percent patients may need replanning to reduce damage of normal tissue and shorten treatment period.

Clinical trial indentification


Legal entity responsible for the study



Beijing Hope Marathon Special Fund (LC2011A07)


All authors have declared no conflicts of interest.