title: Efficacy and Safety of Fractionated Stereotactic Radiosurgery for Large Brain Metastases.
abstract: OBJECTIVE
  To investigate the efficacy and safety of fractionated stereotactic radiosurgery for large brain metastases (BMs).
  
  
  METHODS
  Between June 2011 and December 2013, a total of 38 large BMs >3.0 cm in 37 patients were treated with fractionated Cyberknife radiosurgery. These patients comprised 16 men (43.2%) and 21 women, with a median age of 60 years (range, 38-75 years). BMs originated from the lung (n=19, 51.4%), the gastrointestinal tract (n=10, 27.0%), the breast (n=5, 13.5%), and other tissues (n=3, 8.1%). The median tumor volume was 17.6 cc (range, 9.4-49.6 cc). For Cyberknife treatment, a median peripheral dose of 35 Gy (range, 30-41 Gy) was delivered in 3 to 5 fractions.
  
  
  RESULTS
  With a median follow-up of 10 months (range, 1-37 months), the crude local tumor control (LTC) rate was 86.8% and the estimated LTC rates at 12 and 24 months were 87.0% and 65.2%, respectively. The median overall survival (OS) and progression-free survival (PFS) rates were 16 and 11 months, respectively. The estimated OS and PFS rates at 6, 12, and 18 months were 81.1% and 65.5%, 56.8% and 44.9%, and 40.7% and 25.7%, respectively. Patient performance status and preoperative focal neurologic deficits improved in 20 of 35 (57.1%) and 12 of 17 patients (70.6%), respectively. Radiation necrosis with a toxicity grade of 2 or 3 occurred in 6 lesions (15.8%).
  
  
  CONCLUSIONS
  These results suggest a promising role of fractionated stereotactic radiosurgery in treating large BMs in terms of both efficacy and safety.
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Won Joo
authors.initials: WJ
authors.lastname: Jeong
authors.affiliation: Radiosurgery Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jae Hong
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Chang Jin
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Young Hyun
authors.initials: YH
authors.lastname: Cho
keywords: Brain metastases; Cyberknife; Fractionated stereotactic radiosurgery