title: Fractionated stereotactic radiosurgery for patients with skull base metastases from systemic cancer involving the anterior visual pathway.
abstract: BACKGROUND
  To analyze the tumor control, survival outcomes, and toxicity after stereotactic radiosurgery (SRS) for skull base metastases from systemic cancer involving the anterior visual pathway.
  
  
  METHODS
  We have analyzed 34 patients (23 females and 11 males, median age 59 years) who underwent multi-fraction SRS for a skull base metastasis compressing or in close proximity of optic nerves and chiasm. All metastases were treated with frameless LINAC-based multi-fraction SRS in 5 daily fractions of 5 Gy each. Local control, distant failure, and overall survival were estimated using the Kaplan-Meier method calculated from the time of SRS. Prognostic variables were assessed using log-rank and Cox regression analyses.
  
  
  RESULTS
  At a median follow-up of 13 months (range, 2-36.5 months), twenty-five patients had died and 9 were alive. The 1-year and 2-year local control rates were 89% and 72%, and respective actuarial survival rates were 63% and 30%. Four patients recurred with a median time to progression of 12 months (range, 6-27 months), and 17 patients had new brain metastases at distant brain sites. The 1-year and 2-year distant failure rates were 50% and 77%, respectively. On multivariate analysis, a Karnofsky performance status (KPS) >70 and the absence of extracranial metastases were prognostic factors associated with lower distant failure rates and longer survival. After multi-fraction SRS, 15 (51%) out of 29 patients had a clinical improvement of their preexisting cranial deficits. No patients developed radiation-induced optic neuropathy during the follow-up.
  
  
  CONCLUSIONS
  Multi-fraction SRS (5 x 5 Gy) is a safe treatment option associated with good local control and improved cranial nerve symptoms for patients with a skull base metastasis involving the anterior visual pathway.
authors.affiliation: Radiation Oncology Unit, Sant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 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: Alessandro
authors.initials: A
authors.lastname: Bozzao
authors.forename: Teresa
authors.initials: T
authors.lastname: Falco
authors.forename: Vitaliana
authors.initials: V
authors.lastname: De Sanctis
authors.forename: Maurizio Maurizi
authors.initials: MM
authors.lastname: Enrici
authors.forename: Maurizio
authors.initials: M
authors.lastname: Valeriani
authors.forename: Mattia Falchetto
authors.initials: MF
authors.lastname: Osti
authors.forename: Riccardo Maurizi
authors.initials: RM
authors.lastname: Enrici
mesh_terms: D000368:Aged; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009369:Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D016634:Radiosurgery; D019292:Skull Base Neoplasms / Q000556:secondary / Q000601:surgery*; D015996:Survival Rate; D014795:Visual Pathways / Q000473:pathology / Q000601:surgery*