stereotactic radiotherapy for cerebral metastases with recent hemorrhagic signal

Conditions: Hemorrhagic Brain Metastases

Summary: this prospective 2-stage, non-randomized phase 2 trial evaluates the safety and efficacy of fsrt for the management of hemorrhagic brain metastases


Eligibility criteria:
inclusion criteria: * age\> 18 years * performance status 0 or 1 * patient with less than 4 brain metastases \[of a solid tumor, including melanoma, with a histologically proven diagnosis for the solid tumor; patients who have had a metastasectomy and 1 to 3 brain metastatic lesions are eligible. * brain injury (s) measuring between 5 and 30 mm in diameter * patient eligible for stereotactic radiotherapy after a decision of the multidisciplinary committee * presence of intra-tumor bleeding signals on at least one brain injury before stereotactic irradiation and defined by : * hyperdense lesion on the non-injected ct (treatment scanner) and / or, * spontaneously hyperintense lesion on t1 mri sequences without gadolinium injection and / or, * lesion with hypo signal on t2 sequences \* * absence of meningeal tumor invasion * absence of brainstem metastasis * ds-gpa depending on the histological type (https://brainmetgpa.com/#start): * lung adecarcinoma: ds-gpa 2 or + * non-adenocarcinoma lung: ds-gpa 2.5 or + * kidney: ds-gpa 2.5 or + * breast: ds-gpa 2.5 or + * digestive cancer: ds-gpa 3 or + * melanoma: ds-gpa 1.5 or + * patient without concomitant anti-cancer therapy (chemotherapy, hormone therapy, anti-angiogenic or other anti-cancer treatments). treatments should be suspended for at least 7 days before the start of fsrt radiotherapy. the treatment can be resumed 7 days after the end of radiotherapy. it's not mandatory to suspend immunotherapy * life expectancy estimated at over 6 months * patient cooperating sufficiently to perform the treatment with the use of a thermoformed mask * patient whose neuropsychological capacities make it possible to follow the requirements of the protocol * patient affiliated to a social security scheme * patient giving written consent exclusion criteria: * patient with small cell lung cancer, germ cell tumors, lymphoma, leukemia and multiple myeloma * patient with a concomitant neurodegenerative disease * any symptoms not attributable to cerebral metastasis or cancerous pathology and requiring long-term use of corticosteroids (regardless of dose) * contraindication to brain mri or gadolinium injection * hemorrhagic disorders other than intra-tumor bleeding from brain lesion (s) * radiosensitizing systemic disease (neurofibromatosis ...) * thrombocytopenia less than 100,000 cells / mm3 * anticoagulant treatment, and / or anti-platelet aggregation with curative et prophylaxic dose during fsrt. if treatment can be delayed for at least 5 days before starting fsrt and resumed 2 weeks after completion of fsrt, the patient is eligible. * hemorrhagic metastasis (s) of the brainstem * planning of the treatment on the target metastasis delivering a dose\> 5 gy on other metastases concomitant * patient with prior cerebral stereotactic irradiation * history of total brain irradiation * any associated geographical, social or psychopathological condition that could compromise the patient's ability to participate in the study * participation in a therapeutic trial that could compromise the conduct of study * patient deprived of liberty or under guardianship

Keywords: hemorrhagic brain metastases fsrt stereotactic radiation therapy