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Stereotactic radiosurgery and hypofractionated stereotactic radiotherapy are standard treatments for brain metastases when they are small in size (at the most 3 cm in diameter) and limited in number, in patients with controlled extracerebral disease and a good performance status. Large inoperable brain metastases usually undergo hypofractionated stereotactic radiotherapy while haemorrhagic brain metastases have often been contraindicated for both stereotactic radiosurgery or hypofractionated stereotactic radiotherapy. The objective of this retrospective study was to assess a six 6 Gy-fractions hypofractionated stereotactic radiotherapy scheme in use at our institution for haemorrhagic brain metastases, large brain metastases (size greater than 15 cm3) or brain metastases located next to critical structures. Patients with brain metastases treated with the 6 × 6 Gy scheme since 2012 to 2016 were included. Haemorrhagic brain metastases were defined by usual criteria on CT scan and MRI. Efficacy, acute and late toxicity were evaluated. Sixty-two patients presenting 92 brain metastases were included (32 haemorrhagic brain metastases). Median follow up was 10.1 months. One-year local control rate for haemorrhagic brain metastases, large brain metastases, or brain metastases next to critical structures were 90.7%, 73% and 86.7% respectively. Corresponding overall survival rates were 61.2%, 32% and 37.8%, respectively. Haemorrhagic complications occurred in 5.3% of patients (N = 5), including two cases of brain metastases with pretreatment haemorrhagic signal. Tolerance was good with only one grade 3 acute toxicity. The 6 × 6 Gy hypofractionated stereotactic radiotherapy scheme seems to yield quite good results in patients with haemorrhagic brain metastases, which must be confirmed in a prospective way. [ABSTRACT FROM AUTHOR]

Résumé Trente pour cent des patients atteints d’un cancer ORL ont plus de 70 ans. La radiothérapie des patients âgés atteints d’un cancer ORL est un défi. En effet, les effets secondaires de la radiothérapie, ainsi que le nombre de déplacements nécessaires, sont problématiques pour la population âgée. Cependant, l’absence de traitement local est difficilement envisageables en raison du caractère hautement symptomatique de l’évolution locale. Si les patients âgés en bon état général peuvent recevoir une radiothérapie en fractionnement standard, pour les patients plus fragiles, la radiothérapie hypofractionnée est largement utilisée en pratique quotidienne. Le choix du fractionnement doit être adapté à l’objectif du traitement. En cas de traitement palliatif, une irradiation hypofractionnée avec une seule série à dose palliative est suffisante. Si l’état général du patient s’améliore en cours de la radiothérapie, une à deux séries supplémentaires d’irradiation peuvent être envisagées pour atteindre une dose curative. Pour les patients traités dans un but curatif, l’hypofractionnement choisi dépend de l’état général : hypofractionnement en split course pour les patients fragiles, et radiothérapie accélérée avec boost concomitant pour les patients non fragiles. Dans tous les cas, une technique d’irradiation rigoureuse et des soins de support adaptés sont impératifs afin de minimiser les risques d’effets secondaires. L’essai ELAN RT ((ELderly heAd and Neck cancer RadioTherapy), bientôt achevé, statuera sur la non-infériorité de la radiothérapie hypofractionnée par rapport à une radiothérapie standard chez les patients âgés fragiles. Abstract Thirty percent of patients with head and neck cancer are over 70 years. Radiotherapy approach in elderly is a challenge. On one hand, radiotherapy side effects, as well as the number of sessions required, could be a burden. On the other hand, omission of local treatment is not an option due to the symptoms of the tumor. Patients in good general condition may receive standard fractionnated radiotherapy. For frail patients unsuitable for standard fractionated radiotherapy, more convenient shorter course of radiotherapy are commonly used. Physicians have to choose the best radiotherapy schedule according to the objective of the treatment. In case of palliative intend: hypofractionated radiotherapy delivered with a single short course could be recommanded. This course could be followed by other subsequent courses if the patient's condition improves during the treatment. For patients treated in curative intend, the choice of hypofractionation schedule depends on the general condition: split course hypofractionated radiotherapy for unfit patients, or accelerated radiotherapy with concomitant boost for fit patients. In all cases, a high-quality radiotherapy technique and appropriate supportive care are mandatory to minimize the side effects. The ELAN RT trial, soon to be completed, will rule on the non-inferiority of hypofractionated radiotherapy compared to standard radiotherapy for unfit patients. [ABSTRACT FROM AUTHOR]