Science

Gustavo Viani: ESTRON Trial – Can We Skip WBRT After Brain Met Resection?

Gustavo Viani/sbradioterapia.com.br

Aug 10, 2025, 06:57

Gustavo Viani: ESTRON Trial – Can We Skip WBRT After Brain Met Resection?

Gustavo Viani, Associate Professor at Faculty of Medicine of Botucatu, São Paulo State University (UNESP), shared on LinkedIn about recent paper published in Neuro-Oncology.

“ESTRON Trial: Can We Skip WBRT After Brain Met Resection?

Objective

Compare hypofractionated stereotactic RT (HFSRT, 35 Gy/7 fx) vs. whole-brain RT (WBRT, 30 Gy/10 fx) after brain metastasis resection
Assess intracranial control, toxicity, and neurocognitive outcomes

Methods

Phase 2, randomized, single-center, 54 patients
≤10 additional unresected metastases allowed
HFSRT: Robotic radiosurgery, 3 mm CTV margin
WBRT: 3D-CRT, no hippocampal avoidance
Primary endpoint: Intracranial progression-free survival (ic-PFS)
Secondary endpoints: Local control (LC), overall survival (OS), leptomeningeal disease (LMD), toxicity (CTCAE v5.0), neurocognition (HVLT-R)

Key Results

2-yr LC: 94% (HFSRT) vs. 85% (WBRT)
Toxicity: 54 TRAEs (HFSRT) vs. 115 (WBRT)
Alopecia in 89% WBRT vs. 0% HFSRT
Better neurocognitive preservation with HFSRT; cognitive improvement over time vs. decline in WBRT
LMD: 27% (HFSRT) vs. 9% (WBRT)
OS median: 17.8 vs. 27.0 months (NS)

Takeaway

HFSRT provides excellent local control and lower toxicity while preserving cognition
Higher LMD risk requires vigilant MRI follow-up for early detection and salvage.”

Title: Hypofractionated Stereotactic Radiotherapy versus Whole-Brain Radiotherapy following Brain Metastasis Resection – Results of the ESTRON Randomized Phase 2 Trial

Authors: Rami A El Shafie, Denise Bernhardt, Thomas Welzel, Annabella Schiele, Daniela Schmitt, Paul Thalmann, Sinem Erdem, Tanja Eichkorn, Angela Paul, Kristin Lang, Laila König, Fabian Weykamp, Sebastian Adeberg, Adriane Lentz-Hommertgen, Cornelia Jäkel, Farastuk Bozorgmehr, Michael Thomas, Anja Sander, Meinhard Kieser, Jürgen Debus, Stefan Rieken