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Fractionated stereotactic radiosurgery for patients with brain metastases

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Abstract

Stereotactic radiosurgery (SRS) delivered in 2–5 fractions (multi-fraction SRS) has been employed in patients with brain metastases as an alternative to single-fraction SRS with the aim to reduce late radiation-induced toxicity while maintaining high local control rate. In the present study we have evaluated the efficacy and toxicity of multi-fraction SRS in patients with 1–3 brain metastases. Between March 2006 and October 2012, 135 patients (63 men and 72 women) with 171 brain metastases have been treated with multi-fraction SRS (3 × 9 Gy or 3 × 12 Gy). At a median follow-up of 11.4 months, 16 lesions recurred locally. The 1- and 2-year local control rates were 88 and 72 %, respectively. The 1- and 2-year survival rates were 57 and 25 %, and respective distant failure rates were 52 and 73 %. Seventy-eight percent of patients succumbed to their extracranial disease and 22 % died of progressive intracranial disease. Multivariate analysis showed that melanoma histology was predictive of local failure (p = 0.02; HR 6.1, 95 % CI 1.5–24). Specifically, the 1-year local control rates were 68 % for melanoma, 92 % for breast carcinoma, and 88 % for NSCLC, respectively. Stable extracranial disease (p = 0.004) and Karnofsky performance status (p = 0.01) were predictive of longer survival. Radiologic changes suggestive of radionecrosis occurred in 12 (7 %) out of 171 lesions, with an actuarial risk of 9 % at 1 year and 17 % at 2 years, respectively. In conclusion, multi-fraction SRS appears to be an effective and safe treatment modality for brain metastases. It may represent an alternative to single-dose SRS for patients with large lesions or lesions located near critical structures.

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Acknowledgments

We thank Professor Alessandro Bozzao, dr Andrea Romano and dr Guido Trasimeni, neuroradiologists, at Sant’Andrea Hospital, Neuroradiology Unit, for reviewing all MRI scans.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Radiation Oncology Unit, Sant’ Andrea Hospital, University “Sapienza”, Via di Grottarossa 1035, 00189, Rome, Italy

    Giuseppe Minniti, Claudia Scaringi, Enrico Clarke, Mattia Falchetto Osti & Riccardo Maurizi Enrici

  2. IRCCS Neuromed, 86077, Pozzilli, IS, Italy

    Giuseppe Minniti

  3. Radiotherapy and Oncology Department, Campus Bio-Medico University, 00128, Rome, Italy

    Rolando M. D’Angelillo, Luca E. Trodella, Paolo Matteucci, Sara Ramella & Lucio Trodella

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  1. Giuseppe Minniti
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  2. Rolando M. D’Angelillo
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Correspondence to Giuseppe Minniti.

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Minniti, G., D’Angelillo, R.M., Scaringi, C. et al. Fractionated stereotactic radiosurgery for patients with brain metastases. J Neurooncol 117, 295–301 (2014). https://doi.org/10.1007/s11060-014-1388-3

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  • DOI: https://doi.org/10.1007/s11060-014-1388-3

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