title: Multidose stereotactic radiosurgery (9 Gy × 3) of the postoperative resection cavity for treatment of large brain metastases.
abstract: OBJECTIVE
  To evaluate the clinical outcomes with linear accelerator-based multidose stereotactic radiosurgery (SRS) to large postoperative resection cavities in patients with large brain metastases.
  
  
  METHODS
  Between March 2005 to May 2012, 101 patients with a single brain metastasis were treated with surgery and multidose SRS (9 Gy × 3) for large resection cavities (>3 cm). The target volume was the resection cavity with the inclusion of a 2-mm margin. The median cavity volume was 17.5 cm(3) (range, 12.6-35.7 cm(3)). The primary endpoint was local control. Secondary endpoints were survival and distant failure rates, cause of death, performance measurements, and toxicity of treatment.
  
  
  RESULTS
  With a median follow-up of 16 months (range, 6-44 months), the 1-year and 2-year actuarial survival rates were 69% and 34%, respectively. The 1-year and 2-year local control rates were 93% and 84%, with respective incidences of new distant brain metastases of 50% and 66%. Local control was similar for radiosensitive (non-small cell lung cancer and breast cancer) and radioresistant (melanoma and renal cell cancer) brain metastases. On multivariate Cox analysis stable extracranial disease, breast cancer histology, and Karnofsky performance status >70 were associated with significant survival benefit. Brain radionecrosis occurred in 9 patients (9%), being symptomatic in 5 patients (5%).
  
  
  CONCLUSIONS
  Adjuvant multidose SRS to resection cavity represents an effective treatment option that achieves excellent local control and defers the use of whole-brain radiation therapy in selected patients with large brain metastases.
authors.affiliation: Radiation Oncology Unit, Sant' Andrea Hospital, University Sapienza, Rome, Italy. gminniti@ospedalesantandrea.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Minniti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Esposito
authors.forename: Enrico
authors.initials: E
authors.lastname: Clarke
authors.forename: Claudia
authors.initials: C
authors.lastname: Scaringi
authors.forename: Gaetano
authors.initials: G
authors.lastname: Lanzetta
authors.forename: Maurizio
authors.initials: M
authors.lastname: Salvati
authors.forename: Antonino
authors.initials: A
authors.lastname: Raco
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bozzao
authors.forename: Riccardo
authors.initials: R
authors.lastname: Maurizi Enrici
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology / Q000528:radiation effects; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D003110:Colonic Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011182:Postoperative Care; D011832:Radiation Injuries / Q000473:pathology; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods; D047368:Tumor Burden