title: Fractionated stereotactic radiosurgery for large brain metastases.
abstract: OBJECTIVE
  Large brain metastases (>3 cm) present a therapeutic dilemma, as the dose delivered by stereotactic radiosurgery (SRS) in a single fraction is limited by toxicity to adjacent tissues, resulting in suboptimal local control. This study assessed the efficacy and safety of fractionated SRS for the treatment of large brain metastases.
  
  
  METHODS
  We identified 36 patients with 37 brain metastases treated with fractionated SRS. The median SRS dose was 24 Gy (range, 12 to 27 Gy) in 2 to 5 fractions and the median treatment volume was 15.6 mL (range, 10 to 82.7 mL). Kaplan-Meier analysis was used to estimate local control and overall survival rates.
  
  
  RESULTS
  Of the 21 lesions with available radiographic follow-up, 6 lesions (29%) had a documented local failure, yielding an actuarial progression-free survival at 6 and 12 months of 73% and 63%, respectively. The actuarial 6-month and 1-year overall survival rates were 22% and 13%, respectively. No patients in this cohort experienced acute or late complications secondary to SRS.
  
  
  CONCLUSIONS
  Fractionated SRS is feasible and safe in patients with large brain metastases. Local control rates appear to be improved when compared with that of single fraction SRS with a relative paucity of treatment-related toxicity.
authors.affiliation: *Department of Radiation Oncology, University of Pittsburgh Cancer Institute †Department of Neurological Surgery, University of Pittsburgh Cancer Institute, Pittsburgh, PA.
authors.forename: Rodney E
authors.initials: RE
authors.lastname: Wegner
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Leeman
authors.forename: Peyman
authors.initials: P
authors.lastname: Kabolizadeh
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Rwigema
authors.forename: Arlan H
authors.initials: AH
authors.lastname: Mintz
authors.forename: Steven A
authors.initials: SA
authors.lastname: Burton
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016634:Radiosurgery / Q000379:methods*