title: Three-staged stereotactic radiotherapy without whole brain irradiation for large metastatic brain tumors.
abstract: OBJECTIVE
  To evaluate the efficacy and toxicity of staged stereotactic radiotherapy with a 2-week interfraction interval for unresectable brain metastases more than 10 cm(3) in volume.
  
  
  METHODS
  Subjects included 43 patients (24 men and 19 women), ranging in age from 41 to 84 years, who had large brain metastases (> 10 cc in volume). Primary tumors were in the colon in 14 patients, lung in 12, breast in 11, and other in 6. The peripheral dose was 10 Gy in three fractions. The interval between fractions was 2 weeks. The mean tumor volume before treatment was 17.6 +/- 6.3 cm(3) (mean +/- SD). Mean follow-up interval was 7.8 months. The local tumor control rate, as well as overall, neurological, and qualitative survivals, were calculated using the Kaplan-Meier method.
  
  
  RESULTS
  At the time of the second and third fractions, mean tumor volumes were 14.3 +/- 6.5 (18.8% reduction) and 10.6 +/- 6.1 cm(3) (39.8% reduction), respectively, showing significant reductions. The median overall survival period was 8.8 months. Neurological and qualitative survivals at 12 months were 81.8% and 76.2%, respectively. Local tumor control rates were 89.8% and 75.9% at 6 and 12 months, respectively. Tumor recurrence-free and symptomatic edema-free rates at 12 months were 80.7% and 84.4%, respectively.
  
  
  CONCLUSIONS
  The 2-week interval allowed significant reduction of the treatment volume. Our results suggest staged stereotactic radiotherapy using our protocol to be a possible alternative for treating large brain metastases.
authors.affiliation: Department of Neurosurgery, Chiba Cardiovascular Center, Ichihara, Japan. yhiguchi@faculty.chiba-u.jp
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Higuchi
authors.forename: Toru
authors.initials: T
authors.lastname: Serizawa
authors.forename: Osamu
authors.initials: O
authors.lastname: Nagano
authors.forename: Shinji
authors.initials: S
authors.lastname: Matsuda
authors.forename: Junichi
authors.initials: J
authors.lastname: Ono
authors.forename: Makoto
authors.initials: M
authors.lastname: Sato
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Iwadate
authors.forename: Naokatsu
authors.initials: N
authors.lastname: Saeki
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D003110:Colonic Neoplasms / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012074:Remission Induction; D015996:Survival Rate; D047368:Tumor Burden