title: Hypofractionated stereotactic radiotherapy (hfSRT) after tumour resection of a single brain metastasis: report of a single-centre individualized treatment approach.
abstract: OBJECTIVE
  Standard treatment of single brain metastases so far is tumour resection in combination with postoperative whole-brain radiotherapy or stereotactic radiosurgery. Here, we report retrospectively our first experience with postoperative hypofractionated stereotactic radiotherapy (hfSRT) to the resection cavity in order to replace upfront WBRT with respect to treatment efficacy and safety.
  
  
  METHODS
  Between March 2006 and October 2011, 33 patients with a single newly diagnosed intracranial metastasis were treated with hfSRT following microsurgical resection. Fractionation concepts were 10 × 4 Gy (n = 22), 7 × 5 Gy (n = 7) and 5 × 6 Gy (n = 4). Planning target volume enclosed the tumour resection cavity with a safety margin of 4 mm.
  
  
  RESULTS
  No patient demonstrated toxicity grade 2 or higher. Actuarial median overall survival summed up to 20.2 months, and 12-month survival was 64 %. Actuarial mean local brain control was 30.6 months, median distant brain control 12.4 months and intracranial control 8.8 months, respectively. Actuarial 1-year rates of local, distant brain and intracranial control were 71, 57 and 43 %. Salvage whole-brain radiotherapy due to recurrent brain metastases was performed in 13 patients (39 %).
  
  
  CONCLUSIONS
  Postoperative hfSRT appears to be a feasible treatment option in patients with a single newly diagnosed brain metastasis. Replacing the standard postoperative whole-brain radiotherapy necessitates compliant patients and regular MRI follow-up analysis.
authors.affiliation: Department of Radiation Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. steinmann.diana@mh-hannover.de
authors.forename: Diana
authors.initials: D
authors.lastname: Steinmann
authors.forename: Bettina
authors.initials: B
authors.lastname: Maertens
authors.forename: Stefan
authors.initials: S
authors.lastname: Janssen
authors.forename: Martin
authors.initials: M
authors.lastname: Werner
authors.forename: Jörg
authors.initials: J
authors.lastname: Frühauf
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakamura
authors.forename: Hans
authors.initials: H
authors.lastname: Christiansen
authors.forename: Michael
authors.initials: M
authors.lastname: Bremer
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology / Q000528:radiation effects / Q000601:surgery*; D001932:Brain Neoplasms / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome