X线立体定向放射治疗脑转移瘤疗效分析

目的分析Ｘ线立体定向放射治疗（ＳｔｅｒｅｏｔａｃｔｉｃＲａｄｉｏｔｈｅｒａｐｙ，ＳＲＴ）加全脑放疗降低脑转移瘤局部复发的意义。材料与方法１９９６年５月至１９９７年１０月间对６５例脑转移瘤患者行ＳＲＴ加全脑放疗３０例，单纯ＳＲＴ治疗３５例。全脑放疗３８～４０Ｇｙ／４～４．５周。ＳＲＴ周边剂量１５～３２Ｇｙ。结果ＳＲＴ加全脑放疗组中位复发时间９．５个月，局部复发率３．３％，显著优于单纯ＳＲＴ治疗组的３个月和２８．６％（Ｐ＜０．０５）；ＳＲＴ加全脑放疗组局部控制率９３．６％，中位生存时间１０个月，１年生存率８３．３％和死亡率１６．７％与对照组９２．９％，７个月，７１．４％和２８．６％比较差异无显著意义（Ｐ＞０．０５）。结论ＳＲＴ加全脑放疗治疗脑转移瘤在控制局部复发，延长复发时间方面优于单纯ＳＲＴ治疗     

立体定向放射手术结合全脑照射治疗脑转移瘤

目的探讨立体定向放射手术（ＳＲＳ）结合全脑照射治疗脑转移瘤的疗效和影响预后的因素。方法回顾性分析了１９９４年７月～１９９６年６月间应用ＳＲＳ治疗脑转移患者１８例（２８个病灶）。中位随诊时间为１４个月。所有患者的Ｋａｒｎｏｆｓｋｙ评分≥４０分。肿瘤直径为１２ｍｍ～４０ｍｍ（平均２７ｍｍ）。ＳＲＳ治疗采用１０ＭＶ的直线加速器，肿瘤剂量（８０％剂量线）为２０Ｇｙ～３０Ｇｙ（平均２２１Ｇｙ）。ＳＲＳ后１５例进行了全脑分次照射，脑中间平均剂量为３０Ｇｙ～４０Ｇｙ，ＳＲＳ前后均行ＣＴ和（或）磁共振成像（ＭＲＩ）检查。结果中位生存期为８个月，肿瘤控制率为８３３％（２０／２４），肿瘤消失为５０％（１２／２４），肿瘤明显缩小（＞５０％）为３３３％（８／２４），肿瘤稍缩小（≤５０％）或无变化１６７％（４／２４），ＣＴ显示肿瘤坏死２例，无肿瘤复发。原发肿瘤已控制、无脑外转移患者的生存期较长（Ｐ＜００５），单发和多发脑转移者生存期无明显差异（Ｐ＞００５）。结论ＳＲＳ结合全脑照射治疗脑转移瘤是安全和有效的。     

X线立体定向放射治疗脑转移瘤疗效分析

为了探讨X线立体定向放射治疗加全脑放疗的疗效,在四种预后因素(年龄、疗前KPS评分、有无远外转移及转移灶数目)相同或相似的条件下,配对选择两组各43例脑转移瘤患者分成X线立体定向放射治疗(SRT)加全脑放疗组(研究组)和单纯SRT治疗组(对照组)。研究组采用全脑放疗30~40Gy/3·5~4·5周,SRT处方剂量为15~32Gy,SRT前行全脑放疗17例,后行全脑放疗26例。对照组采用单纯SRT处方剂量18~32Gy。结果研究组复发率11·6%(5/43),中位生存时间12·7个月,与对照组的44·2%(19/43)和7·8个月比较差异有统计学意义(χ2=10·03,P<0·01;t=2·26,P<0·05);研究组局部控制率(CR PR)97·7%(42/43),1年生存率67·4%(29/43),1年死亡率32·6%(14/43),与对照组的93%(40/43)、51·1%(22/43)和48·9%(21/43)比较差异无统计学意义(P>0·05)。初步研究结果提示,SRT加全脑放疗在控制肿瘤复发和延长中位生存时间均明显优于单纯SRT。     

X线立体定向放射治疗与全脑放射治疗脑转移瘤的疗效比较

目的 评价X线立体定向放射治疗脑转移瘤的疗效。方法 单纯全脑照射20例（WBI组），单纯X线立体定向放射治疗19例（SRI组），X线立体定向放射加全脑放射治疗39例（SRT＋WBI组）。WBI组和SRT＋WBI组全脑放疗总剂量均为30－40Gy／2－4周。SRT组和SRT＋WBI组立体定向放射治疗，每次剂量为4．5－7．5Gy，每周3次，总剂量21－42Gy。结果 局部控制率、局部复发率和因脑转移所致率，WBI组分别为65．0％、25．0％和52．9％；SRT组分别为94．7％、5．3％和116．7％；SRT＋WBI组分别为89．75、0和8．7％。WBI组与其它2组比较，局部控制率、局部复发率和因脑转移所致死亡率均有显著性差异（P＜0．05）。结论 X线立体定向放射治疗脑转移瘤，在提高局部控制率、降低局复发率方面优于全脑放疗。     

X线立体定向放射治疗在脑转移瘤治疗中的作用

目的探讨Ｘ线立体定向放射治疗在脑转移瘤常规放射治疗中的作用。材料与方法在４种预后因素（年龄、疗前ＫＰＳ评分、有无远处转移及是否单发转移灶）相同或相似的条件下，配对选择两组病例，Ｘ线立体定向放射治疗加常规放疗组４０例，常规放疗组８０例，常规放疗组采用全脑照射３０～４０Ｇｙ／３～４周；在Ｘ线立体定向放射治疗加常规放疗组中，Ｘ线立体定向放射治疗采用单次照射２７例，分次照射１３例，单次靶区平均处方剂量为１３．４Ｇｙ，分次照射方法为５～１０Ｇｙ／次，每周２次，总量达１５～３０Ｇｙ。结果Ｘ线立体定向放射治疗加常规放疗组与单纯常规放疗组比较：１年生存率分别为５０％，２０％；１年局控率分别为７３％，１５％；治疗后ＫＰＳ评分好转的比例分别为８８％，５６％；疗后１～３个月头部ＣＴ、ＭＲＩ示，影像学上有效率分别为８０％，５０％，以上结果经统计学处理均有明显差异（Ｐ＜０．０１）。在死因分析中，发现Ｘ线立体定向放射治疗加常规放疗组死于头部的比例为２２％比单纯放疗组４９％的低（Ｐ＜０．０５）。而两组病例的放射并发症发生率相似。结论Ｘ线立体定向放射治疗与常规放疗结合治疗脑转移瘤，疗效优于单纯常规放疗     

X线立体定向放射治疗在脑转移瘤治疗中的应用

目的 探讨Ｘ线立体定向放射治疗在脑转移瘤常规放射治疗中的作用。材料与方法 在４种预后因素（年龄、疗前ＫＰＳ评分、有无远处转移及是否单发转移灶）相同或相似的条件下，配对选择两组病例，Ｘ线立体定向放射治疗加常规放疗组４０例，常规放疗组８０例，常规放疗采用单次照射２７例，分次照射１３例，单次靶区平均处方剂量为１３．４Ｇｙ３￣４周；在Ｘ线立体定向放射治疗加常规放疗组中，Ｘ线立体定向放射治疗采用单次照射２７     

脑转移瘤的立体定向放射外科治疗24例报道

目的 探讨立体定向放射外科（ＳＲＳ）治疗脑转移瘤的效果。方法 以全脑放疗加ＳＲＳ或单用ＳＲＳ治疗２４例（３０病灶）脑转移瘤。结果 大多数病例在ＳＲＳ后１～２周获不同程度的症状改善,肿瘤反应率为８９％平均存活期为１０月。结论 ＳＲＳ是治疗小而边界清楚的脑转移瘤的有效手段,肿瘤控制率可达８０％以上,ＳＲＳ加全脑放疗可改善肿瘤控制率。ＳＲＳ亦可用以治疗放疗后复发的脑转移瘤。     

脑转移瘤的立体定向放射治疗

单纯立体定向放射外科能取得全脑放疗联合立体定向外科治疗相同的生存率,对于局部控制来说,结果有冲突。全脑放疗较局部治疗（立体定向放射外科和手术）减少颅内新发病灶。单纯立体定向放射外科组颅内治疗病灶外以及颅内总体复发率均增加,而且联合全脑放疗不增加认知功能损伤。对于1-3个脑转移瘤患者,单纯立体定向放射外科生存好于单纯全脑放疗。全脑放疗联合立体定向外科治疗较全脑放疗能改善局部控制,并在不增加并发症的基础上改善KPS评分。对于单发脑转移灶,联合治疗有生存获益。但2个及2个以上的脑转移灶是否有生存优势,尚有争论。对于多发脑转移瘤、KPS〈70分的患者联合治疗能改善生存。全脑放疗联合立体定向外科治疗和手术联合全脑放射治疗两组无生存差异。     

多发性脑转移瘤立体定向放疗的探讨

背景与目的:立体定向放疗(stereotactic radiotherapy,SRT)技术在颅内肿瘤治疗中具有明显优势,但在颅内多发肿瘤治疗中应用的报告较少。本文回顾性分析多发性脑转移瘤患者的治疗结果,评价SRT的治疗作用和应用特点。方法:1996年6月至2002年12月间,136例多发性脑转移瘤患者接受放射治疗。38.2%(52/136)接受单纯常规照射(称常规组),61.8%(84/136)接受SRT(包括单独SRT和全脑照射结合SRT,统称SRT组)。结果:临床有效率分别为常规组86.5%和SRT组96.4%(P=0.02);颅内转移瘤(直径>2cm)消除率分别为常规组36.0%和SRT组70.4%(P=0.007);顽固性脑水肿发生率分别为常规组9.6%和SRT组8.3%(P=0.767);颅内复发率分别为常规组19.4%和SRT组25.0%(P=0.653)。常规组和SRT组的中位生存期和1年生存率分别为6.5个月、10.5个月(P=0.014)和21.2%、40.5%(P=0.023)。结论:合理应用SRT技术可以提高多发性脑转移瘤患者的生存质量和肿瘤疗效、减少颅内复发和放射损伤,从而延长患者生存期。     

X射线立体定向放射治疗配合全脑照射治疗脑转移瘤疗效分析

目的　分析X射线立体定向放射治疗(SRS)配合全脑照射治疗脑转移瘤的作用。方法　对55例脑转移瘤患者进行SRS配合全脑照射,17例行单纯SRS治疗。全脑照射采用8?MVX射线,1.5～2.0 Gy/次,DT30～42 Gy,4～5周;SRS处方剂量为18～30 Gy,SRS前行全脑放射治疗39例,SRS后行全脑放射治疗16例。结果　SRS加全脑照射组病变完全消失(CR)占60.0%,部分消失(PR)占32.7%,无变化(NC)占7.3%,总缓解率(CR+PR)为92.7%;与单纯SRS组的35.0%、41.2%、23.5%、76.2%相比差异无显著性意义（χ2=3.47,P＞0.05）。SRS加全脑照射组复发率为14.5%,中位复发时间为10个月,中位生存时间为13个月;与单纯SRS组的41.2%、4个月、7.5个月相比差异有显著性意义(χ     

Prospective study of stereotactic radiosurgery without whole brain radiotherapy in patients with four or less brain metastases: incidence of intracranial progression and salvage radiotherapy

This prospective study was conducted to evaluate the treatment outcome after stereotactic radiosurgery (SRS) alone with special attention to its influence on intracranial freedom from progression (FFP), local control, time to whole brain radiotherapy (WBRT), and survival. Forty-one patients with brain metastases who met the inclusion criteria were enrolled in this prospective cohort and treated by SRS alone between January 1998 and September 2001. The overall local control rate was 76%. The one year actuarial intracranial FFP was 33%. Ten patients (24%) had relapse at treated site. Twenty-three patients (56%) had intracranial progression with a median time of 4.25 months (1–24.6). Salvage radiotherapy was given in 21 patients (51%). Only 12 (29%) patients required WBRT with the median time to WBRT after SRS of 4.85 months. Nine patients (22%) underwent additional SRS at the median time of 5 months after the first procedure. The median survival was 10 months. At the time of follow up, 16 patients (39%) were still alive with a range of 6–31 months. This prospective study suggests that the omission of WBRT in the initial treatment of patients with SRS for four or less brain metastases may allow up to 70% of patients to avoid WBRT.     

Stereotactic radiosurgery with or without whole-brain radiotherapy for brain metastases: an update

Brain metastases are unfortunately a common occurrence in patients with cancer. Whole-brain radiation therapy (WBRT) is still considered the standard of care in the treatment of brain metastases. Stereotactic radiosurgery (SRS) offers the additional ability to treat tumors with relative sparing of normal brain tissue in a single fraction. While the addition of SRS to WBRT has been shown to improve survival and local tumor control in selected patients, the idea of deferring WBRT in order to avoid its effects on normal tissues and using SRS alone continues to generate significant discussion and interest. Three recent randomized trials from Japan, Europe and the MD Anderson Cancer Center (TX, USA) have attempted to address this issue. In this article, we update a previous review by discussing these trials to compare the outcomes for SRS alone versus SRS plus WBRT for limited metastases. We also discuss recent nonrandomized evidence for the use of SRS alone for oligometastatic disease.     

Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS)

BACKGROUND: Brain metastases are a frequent complication in advanced melanoma. A 3.6 to 4.1-month median survival has been reported after treatment with whole brain radiotherapy. We performed a retrospective analysis of our institutional experience of multimodality treatment utilizing linear accelerator (Linac)-based stereotactic radiosurgery (SRS). METHODS: Forty-four melanoma patients with brain metastases underwent 66 SRS treatments for 156 metastatic foci between 1999 and 2004. Patients were treated with initial SRS if or=70, but 37 patients had active systemic metastases (Recursive Partition Analysis Class 2). Survival was calculated from the time of diagnosis of brain metastases. Minimum follow-up was 1 year after SRS. The potential role of prognostic factors on survival was evaluated including age, sex, interval from initial diagnosis to brain metastases, surgical resection, addition of whole brain radiotherapy (WBRT), number of initial metastases treated, and number of SRS treatments using Cox univariate analysis. RESULTS: The median survival of melanoma patients with brain metastases was 11.1 months (95% confidence interval [CI]: 8.2-14.9 months) from diagnosis. One-year and 2-year survivals were 47.7% and 17.7%, respectively. There was no apparent effect of age or sex. Surgery or multiple stereotactic radiotherapy treatments were associated with prolonged survival. Addition of WBRT to maintain control of brain metastases in a subset of patients did not improve survival. CONCLUSIONS: Our results suggest that aggressive treatment of patients with up to 5 melanoma brain metastases including SRS appears to prolong survival. Subsequent chemotherapy or immunotherapy after SRS may have contributed to the observed outcome.     

Salvage stereotactic radiosurgery for breast cancer brain metastases: outcomes and prognostic factors

BACKGROUND:

Salvage stereotactic radiosurgery (SRS) is often considered in breast cancer patients previously treated for brain metastases. The goal of this study was to analyze clinical outcomes and prognostic factors for survival in the salvage setting.

METHODS:

The authors retrospectively examined 79 consecutive breast cancer patients who received salvage SRS (interval of >3 months after initial therapy), 76 of whom (96%) received prior whole‐brain radiation therapy. Overall survival (OS) and central nervous system (CNS) progression‐free survival rates were calculated from the date of SRS using the Kaplan‐Meier method. Prognostic factors were evaluated using the Cox proportional hazards model.

RESULTS:

Median age was 50.5 years. Fifty‐eight percent of this population was estrogen receptor positive, 62% was HER2 positive, and 10% was triple negative. At the time of SRS, 95% had extracranial metastases, with 81% of extracranial metastases at other visceral sites (lung/pleura/liver). Forty‐eight percent had stable extracranial disease. Median interval from initial brain metastases therapy to SRS was 8.4 months. Median CNS progression‐free survival after SRS was 5.7 months (interquartile range [IQR], 3.6‐11 months), and median OS was 9.8 months (IQR, 3.8‐18 months). Eighty‐two percent of evaluable patients received further systemic therapy after SRS. HER2 status (adjusted hazard ratio [HR], 2.4; P = .008) and extracranial disease status (adjusted HR, 2.7; P = .004) were significant prognostic factors for survival on multivariate analysis.

CONCLUSIONS:

In patients with good Karnofsky performance status, salvage SRS for breast cancer brain metastases is a reasonable treatment option, given an associated median survival in excess of 9 months. Furthermore, patients with HER2‐positive tumors at diagnosis or stable extracranial disease at the time of SRS have an improved clinical course, with median survival of >1 year. Cancer 2012. © 2011 American Cancer Society.     

X线立体定向放射治疗脑恶性胶质细胞瘤的研究

目的　探讨X线立体定向放射治疗在脑恶性胶质细胞瘤 (BMG)治疗中的作用。方法　 1996年 10月～ 1998年 10月 ,112例CT或MRI证实术后病灶残瘤的BMG随机分为单纯常规放射治疗组 (单放组 )和常规放射治疗 +X线立体定向放射治疗 (立体定向放疗组 )。单放组 5 8例 ,男 40例 ,女 18例 ,年龄 16～ 76岁 (中位 40 .5岁 ) ,KPS6 0～ 70者 12例 ,>70者 46例 ;放疗前增强CT或MRI显示 ,肿瘤体积 1.0 0cm3 ～ 2 14 .78cm3 ,中位体积 2 1.0 0cm3 ;常规剂量分割照射 ,5次 /周 ,1.8～ 2Gy/次 ,总剂量 46 .2 0～ 6 5 .95Gy ,中位剂量 5 7.81Gy。立体定向放疗组共 5 4例 ,男 39例 ,女 15例 ,年龄 16～ 78岁 (中位年龄 44.5岁 ) ;KPS6 0～ 70者 8例 ,>70者 76例 ;肿瘤体积 1.76cm3 ～ 132 .0 0cm3 ,中位体积 2 2 .32cm3 ;先行常规照射 ,其照射野设计及其剂量分割与单放组相同 ,总剂量 45 .80～ 6 2 .45Gy ,中位剂量 5 5 .2 6Gy ;于常规放疗结束后 1周行立体定向放疗 ,采用非共面弧形旋转照射 ,PTV边缘剂量 8Gy～ 5 0Gy( 6 0 %～ 90 %等剂量曲线 ) ,中位 2 7.75Gy ;单次治疗 2 2例 ,分两次治疗者 2 8例 ,三次分割治疗者 6例 ,分次治疗的时间间隔为 1周 ;单次剂量 8Gy～ 5 0Gy ,中位单次剂量 15Gy。结果　治疗结束后 3个月CT     

Whole-brain radiotherapy versus stereotactic radiosurgery for patients in recursive partitioning analysis classes 1 and 2 with 1 to 3 brain metastases

BACKGROUND: The authors investigated whether stereotactic radiosurgery (SRS) alone improved outcomes for patients in recursive partitioning analysis (RPA) Classes 1 and 2 who had 1 to 3 brain metastases compared with whole-brain radiotherapy (WBRT). METHODS: Data regarding 186 patients in RPA Classes 1 and 2 who had 1 to 3 brain metastases and who received either 30 to 40 grays (Gy) of WBRT (n = 91 patients) or 18 to 25 Gy SRS (n = 95 patients) were analyzed retrospectively. Eight other potential prognostic factors were evaluated regarding overall survival (OS), entire brain control (BC), local control (LC) of treated metastases, and brain control distant from treated metastases (distant control [DC]): Those 8 factors were age, sex, performance status, tumor type, number of brain metastases, extracranial metastases, RPA class, and interval from tumor diagnosis to radiotherapy. RESULTS: On multivariate analysis of OS, age ( risk ratio [RR], 1.51; P = .024), Karnofsky performance status (KPS) (RR, 1.98; P = .002), and extracranial metastases (RR, 2.26; P < .001) were significant, whereas the radiation regimen was not significant (P = .89). On multivariate analysis of BC, only the radiation regimen (RR, 1.33; P = .003) was found to be significant. On multivariate analysis of LC, radiation regimen (RR, 1.63; P < .001) and sex (RR, 1.62; P = .022) were significant. On multivariate analysis of DC, KPS (RR, 1.85; P = .049) and extracranial metastases (RR, 1.69; P = .047) were significant. The radiation regimen was not found to be significant even on univariate analysis (P = .80). In RPA class subgroup analyses, BC and LC were better after SRS than WBRT for patients in RPA Classes 1 and 2, whereas OS and DC did not differ significantly. CONCLUSIONS: For patients in RPA Classes 1 and 2 who had 1 to 3 brain metastases, SRS alone was associated with improved BC and LC compared with 30 to 40 Gy WBRT, whereas OS and DC were not significantly different. Similar results were observed in separate subgroup analyses of patients in RPA Class 1 and RPA Class 2.     

Extent of perilesional edema differentiates radionecrosis from tumor recurrence following stereotactic radiosurgery for brain metastases

Background

Differentiation of tumor recurrence from radionecrosis is a critical step in the follow-up management of patients treated with stereotactic radiosurgery (SRS) for brain metastases. A method that can reliably differentiate tumor recurrence from radiation necrosis using standard MR sequences would be of significant value.

Methods

We analyzed the records of 49 patients with 52 brain metastases treated with SRS who subsequently underwent surgical resection of the same lesion. Forty-seven of the lesions had preoperative MRI available for review (90%), including T1 postcontrast, T2, and fluid attenuated inversion recovery sequences. Pre-SRS and preoperative lesion and edema volumes were manually contoured and measured in a blinded fashion using radiation treatment planning software. A neuropathologist analyzed samples for the presence of tumor and/or radiation necrosis.

Results

Longer time between SRS and resection (P < .001) and a larger edema/lesion volume ratio (high T2/T1c, P = .002) were found to be predictive of radionecrosis as opposed to tumor recurrence. Using a cutoff value of 10 for the edema/lesion volume ratio, we were able to predict the presence of tumor with a positive predictive value of 92%, which increased to 100% when looking only at patients who underwent resection <18 months following SRS.

Conclusions

On follow-up imaging, lesions with a high edema/lesion volume ratio and lesions that progress later after SRS are more likely to contain radionecrosis. These indices may help guide clinical decision making in the context of evolving lesions after SRS for brain metastases and thereby avoid unnecessary interventions.     

A meta-analysis evaluating stereotactic radiosurgery, whole-brain radiotherapy, or both for patients presenting with a limited number of brain metastases

BACKGROUND:

To perform a meta‐analysis on newly diagnosed brain metastases patients treated with whole‐brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS) boost versus WBRT alone, or in patients treated with SRS alone versus WBRT and SRS boost.

METHODS:

The meta‐analysis primary outcomes were overall survival (OS), local control (LC), and distant brain control (DBC). Secondary outcomes were neurocognition, quality of life (QOL), and toxicity. Using published Kaplan‐Meier curves, results were pooled using hazard ratios (HR).

RESULTS:

Two RCTs reported on WBRT and SRS boost versus WBRT alone. For multiple brain metastases (2‐4 tumors) we conclude no difference in OS, and LC significantly favored WBRT plus SRS boost. Three RCTs reported on SRS alone versus WBRT plus SRS boost (1‐4 tumors). There was no difference in OS despite both LC and DBC significantly favoring WBRT plus SRS boost. Although secondary endpoints could not be pooled for meta‐analysis, those RCTs evaluating SRS alone conclude better neurocognition using the validated Hopkins Verbal Learning Test, no adverse risk in deteriorating Mini‐Mental Status Exam scores or in maintaining performance status, and fewer late toxicities. We conclude insufficient data for QOL outcomes.

CONCLUSIONS:

For selected patients, we conclude no OS benefit for WBRT plus SRS boost compared with SRS alone. Although additional WBRT improves DBC and LC, SRS alone should be considered a routine treatment option due to favorable neurocognitive outcomes, less risk of late side effects, and does not adversely affect the patients performance status. Cancer 2012. © 2011 American Cancer Society.     

Hypofractionated stereotactic radiotherapy for the treatment of brain metastases

BACKGROUND:

This retrospective review evaluated the efficacy and toxicity profiles of various dose fractionations using hypofractionated stereotactic radiotherapy (HSRT) in the treatment of brain metastases.

METHODS:

Between 2004 and 2007, 36 patients with 66 brain metastases were treated with HSRT. Nine of these subjects were excluded because of the absence of post‐treatment magnetic resonance imaging scans, resulting in 27 patients with a total of 52 lesions. Of these 52 lesions, 45 lesions were treated with whole‐brain radiotherapy plus a HSRT boost and 7 lesions were treated with HSRT as the primary treatment. The median prescribed dose was 25 grays (Gy) (range, 20 Gy‐36 Gy) with a median of 5 fractions (range, 4 fractions‐6 fractions) to a median 85% isodose line (range, 50%‐100%). The median follow‐up interval was 6.6 months (range, 0.9 months‐26.8 months).

RESULTS:

The median overall survival time was 10.8 months, and 66.7% of patients died of disease progression. After HSRT treatment of 52 brain lesions, 13 lesions demonstrated complete responses, 12 lesions demonstrated partial responses, 22 lesions demonstrated stable disease, and 5 lesions demonstrated progressive disease. Actuarial local tumor control rates at 6 months and 1 year were 93.9% and 68.2%, respectively. Maximum tumor dimension, concurrent chemotherapy, and a tumor volume <1 cc were found to be statistically significant factors for local tumor control. One patient had a grade 3 toxicity (according to National Cancer Institute Common Terminology Criteria for Adverse Events).

CONCLUSIONS:

HSRT provides a high level of tumor control with minimal toxicity comparable to single‐fraction stereotactic radiosurgery (SRS). The results of the current study warrant a prospective randomized study comparing single‐fraction SRS with HSRT in this patient population. Cancer 2009. © 2009 American Cancer Society.