PURPOSE: To evaluate efficacy and toxicity of hypofractionated stereotactic radiotherapy (hfSRT) with three different dose concepts for irresectable brain metastases not amenable to radiosurgery (SRS) using non-invasive fixation of the skull. PATIENTS AND METHODS: From 6/2000 to 6/2005, 150 patients with 228 brain metastases were treated at the dedicated stereotactic radiosurgery system Novalis (BrainLAB, Feldkirchen, Germany) in two German treatment centers. Three different dose concepts were applied: 5 x 6-7 Gy (A: 72 brain metastases), 10 x 4 Gy (B: 59 brain metastases) and 7 x 5 Gy (C: 97 brain metastases). Median planning target volume (PTV) was 6.1 cm(3) (range, 0.02-95.97). RESULTS: Rates of complete remission (CR), partial remission (PR), no change (NC) and progressive disease (PD) were 42%, 30%, 21% and 7%, respectively (median follow-up 28 months). Median survival was 16 months. Survival at 6 and 12 months was 83% and 66%, respectively. Side effects were dependent on the PTV and on dose concept (median PTV in case of increasing edema or necrosis: 17 cm3, A: 22%, C: 7%). HfSRT with 10 x 4 Gy (B) was well tolerated without side effects. CONCLUSION: Hypofractionated stereotactic radiotherapy is an effective and safe treatment. In case of brain metastases >15 cm(3) (diameter >3 cm) and concerning toxicity, 10 x 4 Gy seem to be more advantageous than shorter fractionation with higher doses while 5 x 6-7 Gy and 7 x 5 Gy were followed by higher response rates. Further specification of tolerance doses and tolerance according to the different brain regions has to be done.
PURPOSE: To evaluate efficacy and toxicity of hypofractionated stereotactic radiotherapy (hfSRT) with three different dose concepts for irresectable brain metastases not amenable to radiosurgery (SRS) using non-invasive fixation of the skull. PATIENTS AND METHODS: From 6/2000 to 6/2005, 150 patients with 228 brain metastases were treated at the dedicated stereotactic radiosurgery system Novalis (BrainLAB, Feldkirchen, Germany) in two German treatment centers. Three different dose concepts were applied: 5 x 6-7 Gy (A: 72 brain metastases), 10 x 4 Gy (B: 59 brain metastases) and 7 x 5 Gy (C: 97 brain metastases). Median planning target volume (PTV) was 6.1 cm(3) (range, 0.02-95.97). RESULTS: Rates of complete remission (CR), partial remission (PR), no change (NC) and progressive disease (PD) were 42%, 30%, 21% and 7%, respectively (median follow-up 28 months). Median survival was 16 months. Survival at 6 and 12 months was 83% and 66%, respectively. Side effects were dependent on the PTV and on dose concept (median PTV in case of increasing edema or necrosis: 17 cm3, A: 22%, C: 7%). HfSRT with 10 x 4 Gy (B) was well tolerated without side effects. CONCLUSION: Hypofractionated stereotactic radiotherapy is an effective and safe treatment. In case of brain metastases >15 cm(3) (diameter >3 cm) and concerning toxicity, 10 x 4 Gy seem to be more advantageous than shorter fractionation with higher doses while 5 x 6-7 Gy and 7 x 5 Gy were followed by higher response rates. Further specification of tolerance doses and tolerance according to the different brain regions has to be done.
Authors: R Wiggenraad; A Verbeek-de Kanter; M Mast; R Molenaar; H B Kal; G Lycklama à Nijeholt; C Vecht; H Struikmans Journal: Strahlenther Onkol Date: 2012-06-23 Impact factor: 3.621
Authors: Jürgen Wilbert; Matthias Guckenberger; Bülent Polat; Otto Sauer; Michael Vogele; Michael Flentje; Reinhart A Sweeney Journal: Radiat Oncol Date: 2010-05-26 Impact factor: 3.481
Authors: Selvan Rajakesari; Nils D Arvold; Rachel B Jimenez; Laura W Christianson; Margaret C Horvath; Elizabeth B Claus; Alexandra J Golby; Mark D Johnson; Ian F Dunn; Eudocia Q Lee; Nancy U Lin; Scott Friesen; Edward G Mannarino; Matthew Wagar; Fred L Hacker; Stephanie E Weiss; Brian M Alexander Journal: J Neurooncol Date: 2014-07-25 Impact factor: 4.130