We retrospectively evaluated and compared the efficacy and the toxicity profile of stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) for the treatment of patients with brain metastases (BM). Between 2000 and 2009, 260 patients with 1-3 BM were treated using either SRS (median dose 20 Gy; n = 138) or two different FSRT dose concepts: 7 × 5 Gy (n = 61) or 10 × 4 Gy (n = 61). The median survival for SRS, 7 × 5 Gy and 10 × 4 Gy was 8, 7 and 10 months (p = 0.575), respectively, and the overall survival (OS) was 9 months. Follow-up imaging data were available in 214 of the 260 patients. The 1-year local progression-free survival (LPFS) was 73, 75 and 71 %, respectively (p = 0.191). After a mean follow-up of 28 months (range: 2.1-77 months), the rate of complete remission, partial remission, stable disease and progressive disease were 29, 40, 21 and 10 %, respectively. On multivariate analysis, RPA class I was associated with better OS and regional progression-free survival (both p < 0.001). SRS was associated with a higher toxicity rate (grade I-III) compared to the 7 × 5 Gy and 10 × 4 Gy groups (14 vs. 6 vs. 2 %, respectively; p = 0.01). Although FSRT was used for large lesions and/or lesions near critical structures, the LPFS was comparable to SRS. Importantly, FSRT presented low toxicity and appears to be an effective and safe treatment for BM not amenable to SRS. The 10 × 4 Gy fractionation scheme warrants further investigation due to its efficacy and safe toxicity profile.

hFSRT as a secondary treatment of recurrent GBM is a feasible and effective treatment option. Only minor side effects were observed with prolonged life expectancy of 9 months.

Meningiomas shrink significantly after SRT. TV shrinkage declines towards a steady state, which is not yet defined. Younger age and smaller TV are determining factors. Previous operations, sex, prescribed dose, or histological subtypes do not affect TV shrinkage. Eighteen to 24 months after irradiation, when symptoms are clinically stable, is the best time for the first magnetic resonance imaging scans evaluating tumor control and shrinkage.

This retrospective study aimed to investigate long-term outcome in patients with arteriovenous malformations (AVM) treated with stereotactic radiosurgery (SRS). Between 1998 and 2008, 164 patients with AVM received SRS. Median age was 36 years (range 7-69 years). Before SRS, 39 % of the patients experienced haemorrhage and 27 % suffered from epileptic seizures, whereas 43 % received previously embolization, 7.9 % neurosurgery and 1.8 % proton radiotherapy. Primary SRS was applied in 51.2 % of the patients. Median single dose was 19 Gy (80 % isodose; range 18-20 Gy) and median target volume was 4 cc (range 0.1-24.4). Median follow-up was 93 months (range 12-140). Complete obliteration (CO) was observed in 100 (61 %) patients at a median time of 29 months (range 6.1-88.5). The 3 and 5-year CO rates were 61 and 88 %, respectively. In multivariate analysis, radiation dose ≥ 19 Gy (p = 0.044) and target volume <4 cc (p = 0.015) were associated with significantly higher rates of CO. Intracranial haemorrhage was seen in nine patients (5.5 %) after SRS, whereas three patients (1.8 %) died as a consequence of bleeding. The annual bleeding risk was 1.3 % after 1 year and 1.3 % after 2 years, respectively. In multivariate analysis, only target volume >4 cm(3) (p = 0.031) and Spetzler-Martin grade III-V (p = 0.046) retained significance for increased risk of intracranial bleeding. After SRS an improvement in epileptic episodes, headaches and motor-sensory deficits was found in 8.5, 14 and 15 % of patients, respectively. Our long-term follow-up data show that SRS is an effective treatment option in AVM with low toxicity and bleeding risk, depending on AVM size and Spetzler-Martin grade. An improvement of neurologic symptoms is achievable.