title: Hypofractionated stereotactic radiotherapy for brain metastases--results from three different dose concepts.
abstract: OBJECTIVE
  To evaluate efficacy and toxicity of hypofractionated stereotactic radiotherapy (hfSRT) with three different dose concepts for irresectable brain metastases not amenable to radiosurgery (SRS) using non-invasive fixation of the skull.
  
  
  METHODS
  From 6/2000 to 6/2005, 150 patients with 228 brain metastases were treated at the dedicated stereotactic radiosurgery system Novalis (BrainLAB, Feldkirchen, Germany) in two German treatment centers. Three different dose concepts were applied: 5 x 6-7 Gy (A: 72 brain metastases), 10 x 4 Gy (B: 59 brain metastases) and 7 x 5 Gy (C: 97 brain metastases). Median planning target volume (PTV) was 6.1 cm(3) (range, 0.02-95.97).
  
  
  RESULTS
  Rates of complete remission (CR), partial remission (PR), no change (NC) and progressive disease (PD) were 42%, 30%, 21% and 7%, respectively (median follow-up 28 months). Median survival was 16 months. Survival at 6 and 12 months was 83% and 66%, respectively. Side effects were dependent on the PTV and on dose concept (median PTV in case of increasing edema or necrosis: 17 cm3, A: 22%, C: 7%). HfSRT with 10 x 4 Gy (B) was well tolerated without side effects.
  
  
  CONCLUSIONS
  Hypofractionated stereotactic radiotherapy is an effective and safe treatment. In case of brain metastases >15 cm(3) (diameter >3 cm) and concerning toxicity, 10 x 4 Gy seem to be more advantageous than shorter fractionation with higher doses while 5 x 6-7 Gy and 7 x 5 Gy were followed by higher response rates. Further specification of tolerance doses and tolerance according to the different brain regions has to be done.
authors.affiliation: Department of Radiation Therapy and Novalis Shaped Beam Surgery Center of the University of Erlangen, Erlangen, Germany. antje.fahrig@strahlen.imed.uni-erlangen.de
authors.forename: Antje
authors.initials: A
authors.lastname: Fahrig
authors.forename: Oliver
authors.initials: O
authors.lastname: Ganslandt
authors.forename: Ulrike
authors.initials: U
authors.lastname: Lambrecht
authors.forename: Gerhard
authors.initials: G
authors.lastname: Grabenbauer
authors.forename: Gabriele
authors.initials: G
authors.lastname: Kleinert
authors.forename: Rolf
authors.initials: R
authors.lastname: Sauer
authors.forename: Klaus
authors.initials: K
authors.lastname: Hamm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D016371:Cranial Irradiation; D003627:Data Interpretation, Statistical; D018450:Disease Progression; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012074:Remission Induction; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome