title: Local control after fractionated stereotactic radiation therapy for brain metastases.
abstract: Stereotactic radiosurgery (SRS) is frequently used in the management of brain metastases, but concerns over potential toxicity limit applications for larger lesions or those in eloquent areas. Fractionated stereotactic radiation therapy (SRT) is often substituted for SRS in these cases. We retrospectively analyzed the efficacy and toxicity outcomes of patients who received SRT at our institution. Seventy patients with brain metastases treated with SRT from 2006-2012 were analyzed. The rates of local and distant intracranial progression, overall survival, acute toxicity, and radionecrosis were determined. The SRT regimen was 25 Gy in 5 fractions among 87 % of patients. The most common tumor histologies were non-small cell lung cancer (37 %), breast cancer (20 %) and melanoma (20 %), and the median tumor diameter was 1.7 cm (range 0.4-6.4 cm). Median survival after SRT was 10.7 months. Median time to local progression was 17 months, with a local control rate of 68 % at 6 months and 56 % at 1 year. Acute toxicity was seen in 11 patients (16 %), mostly grade 1 or 2 with the most common symptom being mild headache. Symptomatic radiation-induced treatment change was seen on follow-up MRIs in three patients (4.3 %). SRT appears to be a safe and reasonably effective technique to treat brain metastases deemed less suitable for SRS, though dose intensification strategies may further improve local control.
authors: Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA.
authors: Selvan
authors: S
authors: Rajakesari
authors: Nils D
authors: ND
authors: Arvold
authors: Rachel B
authors: RB
authors: Jimenez
authors: Laura W
authors: LW
authors: Christianson
authors: Margaret C
authors: MC
authors: Horvath
authors: Elizabeth B
authors: EB
authors: Claus
authors: Alexandra J
authors: AJ
authors: Golby
authors: Mark D
authors: MD
authors: Johnson
authors: Ian F
authors: IF
authors: Dunn
authors: Eudocia Q
authors: EQ
authors: Lee
authors: Nancy U
authors: NU
authors: Lin
authors: Scott
authors: S
authors: Friesen
authors: Edward G
authors: EG
authors: Mannarino
authors: Matthew
authors: M
authors: Wagar
authors: Fred L
authors: FL
authors: Hacker
authors: Stephanie E
authors: SE
authors: Weiss
authors: Brian M
authors: BM
authors: Alexander
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009369:Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D016634:Radiosurgery; D012189:Retrospective Studies; D015996:Survival Rate