Skip to main content

Advertisement

SpringerLink
Log in

Hypofractionated stereotactic radiotherapy for oligometastases in the brain: a single-institution experience

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

The treatment of brain metastases is changing. Many different radiotherapy options are now available and under clinical evaluation. As part of this effort, we retrospectively evaluated the efficacy and toxicity of hypofractionated stereotactic radiotherapy (HSRT) in patients with up to three brain metastases. Sixty-five patients with 81 lesions were treated with hypofractionated radiotherapy. Median dose was 24 Gy in three fractions. Median follow-up was 24.6 months. Actuarial tumour control was 75 and 45% at 9 months and 24 months after treatment, respectively. Median survival time was 7.5 months, and 32% of the patients died from brain tumour progression. Actuarial overall survival was 75% at 3 months and 25% at 12 months. Recursive partitioning analysis class was the only significant prognostic factor. Neoadjuvant whole-brain radiotherapy (in 29 patients) had no impact on survival or local control. Neurological status improved in 42 patients (65%). Adverse events were rare and usually mild. This experience suggests HSRT should be considered as an alternative approach in the treatment of one to three metastatic lesions in selected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Posner JB, Chernik NL (1978) Intracranial metastases from systemic cancer. Adv Neurol 19:579–592

    PubMed  CAS  Google Scholar 

  2. Khuntia D, Brown P, Li J, Mehta MP (2006) Whole-brain radiotherapy in the management of brain metastasis. J Clin Oncol 24:1295–1304

    Article  PubMed  CAS  Google Scholar 

  3. DeAngelis LM, Delattre JY, Posner JB (1989) Radiation induced dementia in patients cured of brain metastases. Neurology 39:789–796

    PubMed  CAS  Google Scholar 

  4. Soffietti R, Rudà R, Trevisan E (2008) Brain metastases: current management and new developments. Curr Opin Oncol 20(6):676–684

    Article  PubMed  Google Scholar 

  5. Lindsey ME, Andrews DW, Asher AL, Burris SH, Kondziolka D, Robinson PD, Ammirati M, Cobbs CS, Gaspar LE, Loeffler JS, McDermott M, Mehta MP, Mikkelsen T, Olson JJ, Paleologos NA, Patchell RA, Ryken TC, Kalkanis SN (2010) The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96(1):45–68

    Article  Google Scholar 

  6. Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, Kenjyo M, Oya N, Hirota S, Shioura H, Kunieda E, Inomata T, Hayakawa K, Katoh N, Kobashi (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs. stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 295:2483–2491

  7. Gaudy-Marqueste C, Regis JM, Muracciole X, Laurans R, Richard MA, Bonerandi JJ, Grob JJ (2006) Gamma-Knife radiosurgery in the management of melanoma patients with brain metastases: a series of 106 patients without whole-brain radiotherapy. Int J Radiat Oncol Biol Phys 809–816

  8. Hasegawa T, Kondziolka D, Flickinger JC, Germanwala A, Lunsford LD (2003) Brain metastases treated with radiosurgery alone: an alternative to whole brain radiotherapy? Neurosurgery 52:1318–1326

    Article  PubMed  Google Scholar 

  9. Shirato H, Takamura A, Tomita M, Suzuki K, Nishioka T, Isu T, Kato T, Sawamura Y, Miyamachi K, Abe H, Miyasaka K (1997) Stereotactic irradiation without whole-brain irradiation for single brain metastasis. Int J Radiat Oncol Biol Phys 37:385–391

    Article  PubMed  CAS  Google Scholar 

  10. Sneed PK, Suh JH, Goetsch SJ, Sanghavi SN, Chappell R, Buatti JM, Regine WF, Weltman E, King VJ, Breneman JC, Sperduto PW, Mehta MP (2002) A multi-institutional review of radiosurgery alone vs. radiosurgery with whole brain radiotherapy as the initial management of brain metastases. Int J Radiat Oncol Biol Phys 53:519–526

    Article  PubMed  Google Scholar 

  11. Aoyama H, Shirato H, Onimaru R, Kagei K, Ikeda J, Ishii N, Sawamura Y, Miyasaka K (2003) Hypofractionated stereotactic radiotherapy alone without whole-brain irradiation for patients with solitary and oligo brain metastasis using noninvasive fixation of the skull. Int J Radiat Oncol Biol Phys 56:793–800

    Article  PubMed  Google Scholar 

  12. Lederman G, Wronski M, Fine M (2001) Fractionated radiosurgery for brain metastases in 43 patients with breast carcinoma. Breast Cancer Res Treat 65:145–154

    Article  PubMed  CAS  Google Scholar 

  13. Muacevic A, Kreth FW, Mack A Tonn JC, B Wowra (2004) Stereotactic radiosurgery without radiation therapy providing high local tumor control of multiple brain metastases from renal cell carcinoma. Minim Invasive Neurosurg 47:203–208

    Article  PubMed  CAS  Google Scholar 

  14. Schoeggl A, Kitz K, Reddy M (2002) Stereotactic radiosurgery for brain metastases from colorectal cancer. Int J Colorectal Dis 17:150–155

    Article  PubMed  CAS  Google Scholar 

  15. Schomas DA, Roeske JC, MacDonald RL, Sweeney PJ, Mehta N, Mundt AJ (2005) Predictors of tumor control in patients treated with linac-based stereotactic radiosurgery for metastatic disease to the brain. Am J Clin Oncol 28:180–187

    Article  PubMed  Google Scholar 

  16. Selek U, Chang EL, Hassenbusch SJ 3rd, Shiu AS, Lang FF, Allen P, Weinberg J, Sawaya R, Maor MH (2004) Stereotactic radiosurgical treatment in 103 patients for 153 cerebral melanoma metastases. Int J Radiat Oncol Biol Phys 59:1097–1106

    Article  PubMed  Google Scholar 

  17. Serizawa T, Saeki N, Higuchi Y, Ono J, Iuchi T, Nagano O, Yamaura A (2005) Gamma knife surgery for brain metastases: indications for and limitations of a local treatment protocol. Acta Neurochir (Wien) 147:721–726

    Article  CAS  Google Scholar 

  18. Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, Werner-Wasik M, Demas W, Ryu J, Bahary JP, Souhami L, Rotman M, Mehta MP, Curran WJ Jr (2004) Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 363:1665–1672

    Article  PubMed  Google Scholar 

  19. Kocher M, Maarouf M, Bendel M, Voges J, Müller RP, Sturm V (2004) Linac radiosurgery versus whole brain radiotherapy for brain metastases: a survival comparison based on the RTOG recursive partitioning analysis. Strahlenther Onkol 180:263–267

    Article  PubMed  Google Scholar 

  20. Kondziolka D, Niranjan A, Flickinger JC, Lunsford LD (2005) Radiosurgery with or without whole-brain radiotherapy for brain metastases: the patients’ perspective regarding complications. Am J Clin Oncol 28:173–179

    Article  PubMed  Google Scholar 

  21. Kondziolka D, Patel A, Lunsford LD, Kassam A, Flickinger JC (1999) Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases. Int J Radiat Oncol Biol Phys 45:427–434

    PubMed  CAS  Google Scholar 

  22. Lindvall P, Bergstrom P, Lofroth PO (2005) Hypofractionated conformal stereotactic radiotherapy alone or in combination with whole-brain radiotherapy in patients with cerebral metastases. Int J Radiat Oncol Biol Phys 61:1460–1466

    Article  PubMed  Google Scholar 

  23. Pirzkall A, Debus J, Lohr F, Fuss M, Rhein B, Engenhart-Cabillic R, Wannenmacher M (1998) Radiosurgery alone or in combination with whole-brain radiotherapy for brain metastases. J Clin Oncol 16:3563–3569

    PubMed  CAS  Google Scholar 

  24. Murray KJ, Scott C, Zachariah B, Michalski JM, Demas W, Vora NL, Whitton A, Movsas B (2000) Importance of the mini-mental status examination in the treatment of patients with brain metastases: a report from the Radiation Therapy Oncology Group protocol 91–04. Int J Radiat Oncol Biol Phys 48:59–64

    Article  PubMed  CAS  Google Scholar 

  25. Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751

    Article  PubMed  CAS  Google Scholar 

  26. Gaspar LE, Scott C, Murray K, Curran W (2000) Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys 47:1001–1006

    Article  PubMed  CAS  Google Scholar 

  27. Yuan J, Wang JZ, Lo S, Grecula JC, Ammirati M, Montebello JF, Zhang H, Gupta N, Yuh WT, Mayr NA (2008) Hypofractionation regimens for stereotactic radiotherapy for large brain tumors. Int J Radiat Oncol Biol Phys 1:72(2): 390–397

    Google Scholar 

  28. Paddick I. (2000) A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg 93(Suppl 3):219–222

    Google Scholar 

  29. Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280

    PubMed  CAS  Google Scholar 

  30. Radiation Therapy Oncology Group (1999) RTOG/EORTC Late radiation morbidity scoring schema. http://www.rtog.org/members/toxicity/late.html. Accessed June 15

  31. Rades D, Bohlen G, Pluemer A, Veninga T, Hanssens P, Dunst J, Schild SE (2007) Stereotactic radiosurgery alone versus resection plus whole-brain radiotherapy for 1 or 2 brain metastases in recursive partitioning analysis class 1 and 2 patients. Cancer 15:109(12):2515–2521

    Google Scholar 

  32. Schlienger M, Nataf F, Huguet F, Pene F, Foulquier JN, Orthuon A, Roux FX, Touboul E (2010) Hypofractionated stereotactic radiotherapy for brain metastases. Cancer Radiother 14(2):119–127

    Google Scholar 

  33. Chidel MA, Suh JH, Reddy CA, Chao ST, Lundbeck MF, Barnett GH (2000) Application of recursive partitioning analysis and evaluation of the use of whole brain radiation among patients treated with stereotactic radiosurgery for newly diagnosed brain metastases. Int J Radiat Oncol Biol Phys 47:993–999

    Article  PubMed  CAS  Google Scholar 

  34. Kwon AK, Dibiase SJ, Wang B, Hughes SL, Milcarek B, Zhu Y (2009) Hypofractionated stereotactic radiotherapy for the treatment of brain metastases. Cancer 15:115(4):890–898

    Google Scholar 

  35. Giubilei C, Ingrosso G, D’Andrea M, Benassi M, Santoni R (2009) Hypofractionated stereotactic radiotherapy in combination with whole brain radiotherapy for brain metastases. J Neurooncol 91(2):207–212

    Article  PubMed  Google Scholar 

  36. Hara W, Tran P, Li G, Su Z, Puataweepong P, Adler JR Jr, Soltys SG, Chang SD, Gibbs IC (2009) Cyberknife for brain metastases of malignant melanoma and renal cell carcinoma. Neurosurgery 64(2 Suppl):A26–A32

    Article  PubMed  Google Scholar 

  37. Manning MA, Cardinale RM, Benedict SH, Kavanagh BD, Zwicker RD, Amir C, Broaddus WC (2000) Hypofractionated stereotactic radiotherapy as an alternative to radiosurgery for the treatment of patients with brain metastases. Int J Radiat Oncol Biol Phys 47:603–608

    Article  PubMed  CAS  Google Scholar 

  38. Scorsetti M, Facoetti A, Navarria P, Bignardi M, De Santis M, Ninone SA, Lattuada P, Urso G, Vigorito S, Mancosu P, Del Vecchio M (2009) Hypofractionated stereotactic radiotherapy and radiosurgery for the treatment of patients with radioresistant brain metastases. Anticancer Res 29(10):4259–4263

    PubMed  Google Scholar 

Download references

Acknowledgment

The authors wish to thank Dr. David W. Schaal and Dr. Mikail Gezginci, Accuray Incorporated, for technical and editorial assistance.

Conflict of interest

The authors have no financial interest in the instruments presented in this manuscript.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Division of Radiotherapy, Fondazione IRCCS Istituto Neurologico “C.Besta”, Via Celoria 11, 20133, Milan, Italy

    Marcello Marchetti, Ida Milanesi, Chiara Falcone, Michela De Santis, Luisa Fumagalli & Laura Fariselli

  2. CyberKnife Center CDI, Milan, Italy

    Lorenzo Brait & Livia Bianchi

Authors
  1. Marcello Marchetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ida Milanesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chiara Falcone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michela De Santis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luisa Fumagalli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lorenzo Brait
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Livia Bianchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Laura Fariselli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcello Marchetti.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marchetti, M., Milanesi, I., Falcone, C. et al. Hypofractionated stereotactic radiotherapy for oligometastases in the brain: a single-institution experience. Neurol Sci 32, 393–399 (2011). https://doi.org/10.1007/s10072-010-0473-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-010-0473-4

Keywords

Search

Navigation