Optimising Brain Metastases Management in Resource-Limited Settings: Experience with Hypofractionated Stereotactic Radiotherapy at the Salah Azaiez Institute

INTRODUCTION: Radiotherapy remains a cornerstone in the palliative management of brain metastases (BM), a highly technical and evolving fieldtreatment is increasingly personalized. Stereotactic radiotherapy (SRT) has emerged as a precise and effective alternative to whole-brain radiotherapy (WBRT), offering better neurocognitive preservation and improved local control. This study aims to evaluate the efficacy and tolerance of SRT in the management of BM at the Salah Azaiez Institute. METHODOLOGY: We conducted a single-center, retrospective, analyticalstudy in the radiotherapy department of the Salah Azaiez Institute between 2015 and 2022. Treatment planning was performed using the iPlan (BrainLab) and Eclipse (Varian) systems, utilizing the Conical Cone and AAA 13.7 algorithms, respectively. Techniques such as Dynamic Conformal Arc (DCA) and Volumetric Modulated Arc Therapy (VMAT) were employed. The ClinaciX (Varian), equipped with a Multi-Leaf Collimator (MLC), enabled precise beam modulation. Hypofractionated SRT was administered in three fractions of 9 Gy or five fractions of 5-6 Gy at the 80% isodose line depending of the lesion volume and site. RESULTS: A total of 45 patients (25 men, 20 women; median age: 57 years) were included. The primary tumors were predominantly bronchopulmonary carcinoma (60%) and breast cancer (17.8%). Solitary BM was observed in 66.6% of cases, while 33.4% had 2-3 lesions. BM presented synchronously in 35.5% and metachronously in 64.5% of cases. Two patients (4.44%) had prior prophylactic cranial irradiation for small-cell lung cancer. BM were treated in situ in 66.7% of cases. In the remaining 33.3%, stereotactic radiotherapy was performed....( abstract truncated at 250 words).