title: Hypofractionated stereotactic radiotherapy for brain metastases from lung cancer : Evaluation of indications and predictors of local control.
abstract: OBJECTIVE
  To evaluate the efficacy and toxicity of hypofractionated stereotactic radiotherapy (HSRT) for brain metastases (BMs) from lung cancer, and to explore prognostic factors associated with local control (LC) and indication.
  
  
  METHODS
  We evaluated patients who were treated with linac-based HSRT for BMs from lung cancer. Lesions treated with stereotactic radiosurgery (SRS) in the same patients during the same periods were analysed and compared with HSRT in terms of LC or toxicity. There were 53 patients with 214 lesions selected for this analysis (HSRT: 76 lesions, SRS: 138 lesions). For HSRT, the median prescribed dose was 35 Gy in 5 fractions.
  
  
  RESULTS
  The 1‑year LC rate was 83.6 % in HSRT; on multivariate analysis, a planning target volume (PTV) of <4 cm(3), biologically effective dose (BED10) of ≥51 Gy, and adenocarcinoma were significantly associated with better LC. Moreover, in PTVs ≥ 4 cm(3), there was a significant difference in LC between BED10 < 51 Gy and ≥ 51 Gy (p = 0.024). On the other hand, in PTVs < 4 cm(3), both HSRT and SRS had good LC with no significant difference (p = 0.195). Radiation necrosis emerged in 5 of 76 lesions (6.6 %) treated with HSRT and 21 of 138 (15.2 %) lesions treated with SRS (p = 0.064).
  
  
  CONCLUSIONS
  Linac-based HSRT was safe and effective for BMs from lung cancer, and hence might be particularly useful in or near an eloquent area. PTV, BED10, and pathological type were significant prognostic factors. Furthermore, in BMs ≥ 4 cm(3), a dose of BED ≥ 51 Gy should be considered.
authors.affiliation: Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan. spz694w9@onyx.ocn.ne.jp.|Department of Radiation Oncology, Seirei Mikatahara General Hospital, Shizuoka, Japan. spz694w9@onyx.ocn.ne.jp.
authors.forename: Takeaki
authors.initials: T
authors.lastname: Ishihara
authors.affiliation: Department of Radiation Oncology, Seirei Mikatahara General Hospital, Shizuoka, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Department of Radiation Oncology, Kobe Minimum Invasive Cancer Medical Center, Hyogo, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Harada
authors.affiliation: Department of Radiation Oncology, Seirei Mikatahara General Hospital, Shizuoka, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Isogai
authors.affiliation: Department of Radiation Oncology, Seirei Mikatahara General Hospital, Shizuoka, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tonosaki
authors.affiliation: Department of Radiology, Hyogo Ion Beam Medical Center, Hyogo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Demizu
authors.affiliation: Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Miyawaki
authors.affiliation: Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ejima
authors.affiliation: Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Sasaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000453:epidemiology / Q000532:radiotherapy* / Q000556:secondary*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008175:Lung Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000517:prevention & control*; D015995:Prevalence; D011379:Prognosis; D000069473:Radiation Dose Hypofractionation; D016634:Radiosurgery / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: Control, local; Lung cancer; Metastasis, brain; Prognosis; Stereotactic radiotherapy, linac-based hypofractionated