Fractionated stereotactic radiosurgery for patients with brain metastases.
Stereotactic radiosurgery (SRS) delivered in 2-5 fractions (multi-fraction SRS) has been employed in patients with brain metastases as an alternative to single-fraction SRS with the aim to reduce late radiation-induced toxicity while maintaining high local control rate. In the present study we have evaluated the efficacy and toxicity of multi-fraction SRS in patients with 1-3 brain metastases. Between March 2006 and October 2012, 135 patients (63 men and 72 women) with 171 brain metastases have been treated with multi-fraction SRS (3 × 9 Gy or 3 × 12 Gy). At a median follow-up of 11.4 months, 16 lesions recurred locally. The 1- and 2-year local control rates were 88 and 72 %, respectively. The 1- and 2-year survival rates were 57 and 25 %, and respective distant failure rates were 52 and 73 %. Seventy-eight percent of patients succumbed to their extracranial disease and 22 % died of progressive intracranial disease. Multivariate analysis showed that melanoma histology was predictive of local failure (p = 0.02; HR 6.1, 95 % CI 1.5-24). Specifically, the 1-year local control rates were 68 % for melanoma, 92 % for breast carcinoma, and 88 % for NSCLC, respectively. Stable extracranial disease (p = 0.004) and Karnofsky performance status (p = 0.01) were predictive of longer survival. Radiologic changes suggestive of radionecrosis occurred in 12 (7 %) out of 171 lesions, with an actuarial risk of 9 % at 1 year and 17 % at 2 years, respectively. In conclusion, multi-fraction SRS appears to be an effective and safe treatment modality for brain metastases. It may represent an alternative to single-dose SRS for patients with large lesions or lesions located near critical structures.
Radiation Oncology Unit, Sant' Andrea Hospital, University "Sapienza", Via di Grottarossa 1035, 00189, Rome, Italy, gminniti@ospedalesantandrea.it.
Giuseppe
G
Minniti
Rolando M
RM
D'Angelillo
Claudia
C
Scaringi
Luca E
LE
Trodella
Enrico
E
Clarke
Paolo
P
Matteucci
Mattia Falchetto
MF
Osti
Sara
S
Ramella
Riccardo Maurizi
RM
Enrici
Lucio
L
Trodella
D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*