title: Repeated stereotactic radiosurgery for patients with progressive brain metastases.
abstract: In the present study we have evaluated the efficacy and toxicity of repeated stereotactic radiosurgery (SRS) in patients with recurrent/progressive brain metastases. Between March 2006 and October 2014, 43 patients (21 men and 22 women) with 47 lesions received a second course of SRS given in three daily fractions of 7-8 Gy. With a follow-up study of 19 months, the 1- and 2-year survival rates from repeated SRS were 37 and 20%, respectively, and the 1- and 2-year local control rates were 70 and 60%, respectively. Actuarial local control was significantly better for breast and lung metastases as compared with melanoma metastases; specifically, 1-year local control rates were 38% for melanoma, 78% for breast carcinoma and 73% for non-small cell lung cancer (NSCLC) metastases (p = 0.01). The cause of death was progressive systemic disease in 25 patients and progressive brain disease in 11 patients. Stable extracranial disease (p = 0.01) and Karnofsky performance status (KPS; p = 0.03) were predictive of longer survival. Radiologic changes suggestive of brain radionecrosis were observed in 9 (19%) out of 47 lesions, with an actuarial risk of 34% at 12 months. Neurological deficits (RTOG Grade 2 or 3) associated with brain necrosis occurred in 14% of patients. In conclusion, a second course of SRS given in three daily fractions is a feasible treatment for selected patients with recurrent/progressive brain metastases. Further studies are needed to explore the efficacy and safety of different dose-fractionation schedules, especially in patients with melanoma or large metastases.
authors.affiliation: IRCCS Neuromed, 86077, Pozzilli, IS, Italy. gminniti@ospedalesantandrea.it.|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.affiliation: Radiation Oncology Unit, Sant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189, Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Scaringi
authors.affiliation: IRCCS Neuromed, 86077, Pozzilli, IS, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Paolini
authors.affiliation: Radiation Oncology Unit, Sant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Clarke
authors.affiliation: Nuclear Medicine Unit, Sant' Andrea Hospital, University Sapienza, 00189, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cicone
authors.affiliation: Radiation Oncology Unit, Sant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Esposito
authors.affiliation: Neuroradiology Unit, Sant' Andrea Hospital, University Sapienza, 00189, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Romano
authors.affiliation: Radiation Oncology Unit, Sant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189, Rome, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Osti
authors.affiliation: Radiation Oncology Unit, Sant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189, Rome, Italy.
authors.forename: Riccardo Maurizi
authors.initials: RM
authors.lastname: Enrici
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D018450:Disease Progression; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D016634:Radiosurgery / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Brain metastases; Brain radionecrosis; Fractionated stereotactic radiotherapy; Reirradiation; Stereotactic radiosurgery