title: Single-Fraction Versus Multifraction (3 × 9 Gy) Stereotactic Radiosurgery for Large (>2 cm) Brain Metastases: A Comparative Analysis of Local Control and Risk of Radiation-Induced Brain Necrosis.
abstract: To investigate the local control and radiation-induced brain necrosis in patients with brain metastases >2 cm in size who received single-fraction or multifraction stereotactic radiosurgery (SRS); factors associated with clinical outcomes and the development of brain radionecrosis were assessed.
  
  
  
  Two hundred eighty-nine consecutive patients with brain metastases >2.0 cm who received SRS as primary treatment at Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy, were analyzed. Cumulative incidence analysis was used to compare local control and radiation-induced brain necrosis between groups from the time of SRS. To achieve a balanced distribution of baseline covariates between treatment groups, a propensity score analysis was used.
  
  
  
  The 1-year cumulative local control rates were 77% in the single-fraction SRS (SF-SRS) group and 91% in the multifraction SRS (MF-SRS) group (P=.01). Recurrences occurred in 25 and 11 patients who received SF-SRS or MF-SRS (P=.03), respectively. Thirty-one patients (20%) undergoing SF-SRS and 11 (8%) subjected to MF-SRS experienced brain radionecrosis (P=.004); the 1-year cumulative incidence rate of radionecrosis was 18% and 9% (P=.01), respectively. Significant differences between the 2 groups in terms of local control and risk of radionecrosis were maintained after propensity score adjustment.
  
  
  
  Multifraction SRS at a dose of 27 Gy in 3 daily fractions seems to be an effective treatment modality for large brain metastases, associated with better local control and a reduced risk of radiation-induced radionecrosis as compared with SF-SRS.
authors.affiliation: Unit of Radiation Oncology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy. Electronic address: gminniti@ospedalesantandrea.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Minniti
authors.affiliation: Unit of Radiation Oncology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Scaringi
authors.affiliation: IRCCS Neuromed, Pozzilli, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Paolini
authors.affiliation: IRCCS Neuromed, Pozzilli, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Lanzetta
authors.affiliation: Unit of Neuroradiology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Romano
authors.affiliation: Unit of Nuclear Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cicone
authors.affiliation: Unit of Radiation Oncology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Osti
authors.affiliation: Unit of Radiation Oncology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Riccardo Maurizi
authors.initials: RM
authors.lastname: Enrici
authors.affiliation: IRCCS Neuromed, Pozzilli, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Esposito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D057216:Propensity Score; D011832:Radiation Injuries / Q000209:etiology*; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012306:Risk