Clinical Trial Finder

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

Arms

Experimental: FSRT Stereotactic radiation therapy

Each cerebral metastasis (hemorrhagic or otherwise) will be treated by radiation

Interventions

Radiation: - FSRT Stereotactic radiation therapy

For each metastasis, dose of 30 Gy in 3 fractions at 10 Gy / fraction over 7 days