Comparison Between Radiosurgery and Stereotactic Fractionated Radiation for the Treatment of Brain Metastases

Salles, Antonio A. F. De; Mi, Hariz; Bajada, Cl; Goetsch, Steven J.; Selch, Michael T.; Holly, F. Eugene; Solberg, T.D.; Becker, Donald P.

doi:10.1007/978-3-7091-9297-9_27

Cited by 19 publications

(18 citation statements)

References 8 publications

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“…We know that patients with multiple metastases may have a survival of 7 to 13 months with radiosurgery alone [3][4][5][6][7][8][9][10][11]. Limiting factors of efficacy after radiosurgical treatment are a volume of metastases above 3 cm 3 and doses lower than 18 Gy to the PTV, which are often applied due to high volume metastases [23,25].…”

Section: Discussionmentioning

confidence: 99%

“…Our study revealed a median survival time of 16 months which is comparable to the radiosurgery data. Table 4 summarizes all data on hypofractionated stereotactic radiotherapy of brain metastases [2,6,17,20,26]. In most of the studies, exact response rates for complete and partial response are not mentioned separately and actually, patient numbers treated by hypofractionated schemes for brain metastases are not comparably large to radiosurgery data yet.…”

Section: Discussionmentioning

confidence: 99%

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Hypofractionated Stereotactic Radiotherapy for Brain Metastases

et al. 2007

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hypofractionated Stereotactic Radiotherapy for Brain Metastases

et al. 2007

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“…While many have proposed that larger radiation dose per fraction may confer improved therapeutic efficacy [21,22], clinical data substantiating these proposals remain elusive. A review of the literature suggests that clinical data for HSRS remain limited in the treatment of cerebral metastases [23][24][25][26][27][28]. In this context, we reviewed our institutional experience of HSRS in patients with cerebral metastases.…”

Section: Rationale For Hsrsmentioning

confidence: 98%

“…Despite these theoretical considerations, clinical data on the efficacy and toxicity profiles of HSRS remained limited. For cerebral lesions, cumulative doses ranging from 1800 to 3500 cGy delivered in three to five fractions have been reported for the treatment of both benign and malignant tumors [23][24][25][26][27][28][29]. Here we review our experience with HSRS in the treatment of cerebral metastases with regard to fractionation schedule, efficacy, and toxicity.…”

Section: Introductionmentioning

confidence: 96%

Cyberknife hypofractionated stereotactic radiosurgery (HSRS) of resection cavity after excision of large cerebral metastasis: efficacy and safety of an 800 cGy × 3 daily fractions regimen

et al. 2011

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Development of hypofractionated stereotactic radiosurgery (HSRS) has expanded the size of lesion that can be safely treated by focused radiation in a limited number of treatment sessions. However, clinical data regarding the efficacy and morbidity of HSRS in the treatment of cerebral metastasis is lacking. Here, we review our experience with CyberKnife(®) HSRS for this indication. From 2005 to 2010, we identified 37 patients with large (>3 cm in diameter) cerebral metastases resection cavity that was treated with HSRS. This constituted approximately 8% of all treated resection cavities. We reviewed dose regimens, local control, distal control, and treatment associated morbidities. Primary sites for the metastatic lesions included: lung (n = 10), melanoma (n = 12), breast (n = 9), kidney (n = 4), and colon (n = 2). All patients underwent resection of the cerebral metastasis and received 800 cGy × 3 daily fractions to the resection cavity. Of the 37 patients treated, one-year follow-up data was available for 35 patients. The median survival was 5.5 months. Actuarial local control rate at 6 months was 80%. Local failures did not correlate with prior WBRT, or tumor histology. Distant recurrence occurred in 7 of the 35 patients. Morbidities associated with HSRS totaled 9%, including radiation necrosis (n = 1, 2.9%), prolonged steroid use (n = 1, 2.9%), and new-onset seizures (n = 1, 2.9%). This study demonstrates the safety and efficacy of an 800 cGy × 3 daily fractions CyberKnife(®) HSRS regimen for irradiation of large resection cavity. The efficacy compares favorably to historical data derived from patients undergoing WBRT, SRS, or brachytherapy.

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“…However, a significant increase of neuroradiologic changes and clinical side effects occurs, if > 10 cm 3 of normal brain are treated with > 10-12 Gy [14,27,28]. Recently, several clinical trials have shown the benefit of hypofractionated stereotactic radiotherapy (hfSRT) as an alternative to SRS for higher-volume targets applying lower doses to normal tissue and profiting from fractionation effects [1,2,4,5,7,15,17,26]. Nevertheless, histopathologic effects of hfSRT on healthy brain tissue have not yet been investigated.…”

Section: Introductionmentioning

confidence: 99%

Hypofractionated Stereotactic Radiotherapy to the Rat Hippocampus

et al. 2007

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Partial-brain irradiation with hfSRT (Novalis System) was successfully adopted for small animals and histopathologic analysis confirmed its repositioning accuracy. The neuropathologic effects correlated with dose and observation time. The approach will be further developed for quality assurance in hfSRT of normal brain tissue, as well as novel treatment modalities in epileptic rats and orthotopic tumor models.

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Comparison Between Radiosurgery and Stereotactic Fractionated Radiation for the Treatment of Brain Metastases

Cited by 19 publications

References 8 publications

Hypofractionated Stereotactic Radiotherapy for Brain Metastases

Hypofractionated Stereotactic Radiotherapy for Brain Metastases

Cyberknife hypofractionated stereotactic radiosurgery (HSRS) of resection cavity after excision of large cerebral metastasis: efficacy and safety of an 800 cGy × 3 daily fractions regimen

Hypofractionated Stereotactic Radiotherapy to the Rat Hippocampus

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