title: Hypo-fractionated stereotactic radiotherapy alone using volumetric modulated arc therapy for patients with single, large brain metastases unsuitable for surgical resection.
abstract: BACKGROUND
  Hypo-fractionated stereotactic radiotherapy (HSRT) is emerging as a valid treatment option for patients with single, large brain metastases (BMs). We analyzed a set of our patients treated with HSRT. The aim of this study was to evaluate local control (LC), brain distant progression (BDP), toxicity and overall survival (OS).
  
  
  METHODS
  From July 2011 to May 2015, 102 patients underwent HSRT consisting of 27Gy/3fractions for lesions 2.1-3 cm and 32Gy/4 fractions for lesions 3.1-5 cm. Local progression was defined as increase of the enhancing abnormality on MRI, and distant progression as new brain metastases outside the irradiated volume. Toxicity in terms of radio-necrosis was assessed using contrast enhanced T1MRI, T2 weighted-MRI and perfusion- MRI.
  
  
  RESULTS
  The median maximum diameter of BM was 2.9 cm (range 2.1-5 cm), the median gross target volume (GTV) was 16.3 cm(3) and the median planning target volume (PTV) was 33.7 cm(3) The median,1,2-year local control rate was 30 months, 96, 96 %; the median, 1-2-year rate of BDP was 24 months, 12, 24 %; the median,1,2-year OS was 14 months, 69, 33 %. KPS and controlled extracranial disease were associated with significant survival benefit (p <0.01). Brain radio-necrosis occurred in six patients (5.8 %).
  
  
  CONCLUSIONS
  In patients with single, large BMs unsuitable for surgical resection, HSRT is a safe and feasible treatment, with good brain local control and limited toxicity.
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
authors.forename: Pierina
authors.initials: P
authors.lastname: Navarria
authors.affiliation: Neuro Surgery Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pessina
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy. Luca.cozzi@humanitas.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ascolese
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
authors.forename: Fiorenza
authors.initials: F
authors.lastname: De Rose
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Fogliata
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Franzese
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Franceschini
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Tozzi
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Agostino
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Comito
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Iftode
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Maggi
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Reggiori
authors.affiliation: Neuro Surgery Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bello
authors.affiliation: Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D016371:Cranial Irradiation; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011379:Prognosis; D016634:Radiosurgery; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies
keywords: Brain metastases; HSRT; RapidArc; Volumetric modulated arc therapy