title: Clinical outcomes of patients with limited brain metastases treated with hypofractionated (5×6Gy) conformal radiotherapy.
abstract: Hypofractionated conformal radiotherapy (hfCRT) is used for larger brain metastases or metastases near critical structures. We investigated hfCRT outcomes for newly diagnosed brain metastases.
  
  
  
  We identified 195 patients with 1-3 brain metastases who underwent 5×6Gy hfCRT for 231 lesions from 2007 to 2013. Associations among clinical factors, local control (LC), distant brain control (DC) and overall survival (OS) were tested using univariate and multivariate (MVA) Cox regression analysis and Kaplan-Meier method.
  
  
  
  Median follow-up was 12.8months. One hundred forty-three (62%) lesions were treated with hfCRT post-operatively, and 88 (38%) with definitive hfCRT. LC for all lesions was 83% at 1year. For lesions treated with post-operative hfCRT, tumor size (HR=4.7, p=0.04) and subtotal resection (HR=2.7, p=0.02) were predictive of local failure on MVA. For lesions ≥2.8cm in size, LC was 61% at 12months for lesions status-post subtotal resection, compared to 84% status-post gross total resection (p=0.004). Extracranial disease presence was associated with worse DC (HR=1.8, p=0.008) and OS (HR=3.1, p<0.001).
  
  
  
  We showed 5×6Gy hfCRT provides acceptable LC at 1year for limited brain metastases. For large lesions not grossly resected, more aggressive strategies can be considered to improve LC.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Natalie A
authors.initials: NA
authors.lastname: Lockney
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Diana G
authors.initials: DG
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Philip H
authors.initials: PH
authors.lastname: Gutin
authors.affiliation: Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Cameron
authors.initials: C
authors.lastname: Brennan
authors.affiliation: Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Viviane
authors.initials: V
authors.lastname: Tabar
authors.affiliation: Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Ase
authors.initials: A
authors.lastname: Ballangrud
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Xin
authors.initials: X
authors.lastname: Pei
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Chan
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: T Jonathan
authors.initials: TJ
authors.lastname: Yang
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA. Electronic address: bealk@mskcc.org.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Beal
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D000069473:Radiation Dose Hypofractionation; D020266:Radiotherapy, Conformal / Q000379:methods*; D012189:Retrospective Studies
keywords: Brain metastases; Hypofractionated conformal radiation; Local control