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Repeated stereotactic radiosurgery for patients with progressive brain metastases

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Abstract

In the present study we have evaluated the efficacy and toxicity of repeated stereotactic radiosurgery (SRS) in patients with recurrent/progressive brain metastases. Between March 2006 and October 2014, 43 patients (21 men and 22 women) with 47 lesions received a second course of SRS given in three daily fractions of 7–8 Gy. With a follow-up study of 19 months, the 1- and 2-year survival rates from repeated SRS were 37 and 20 %, respectively, and the 1- and 2-year local control rates were 70 and 60 %, respectively. Actuarial local control was significantly better for breast and lung metastases as compared with melanoma metastases; specifically, 1-year local control rates were 38 % for melanoma, 78 % for breast carcinoma and 73 % for non-small cell lung cancer (NSCLC) metastases (p = 0.01). The cause of death was progressive systemic disease in 25 patients and progressive brain disease in 11 patients. Stable extracranial disease (p = 0.01) and Karnofsky performance status (KPS; p = 0.03) were predictive of longer survival. Radiologic changes suggestive of brain radionecrosis were observed in 9 (19 %) out of 47 lesions, with an actuarial risk of 34 % at 12 months. Neurological deficits (RTOG Grade 2 or 3) associated with brain necrosis occurred in 14 % of patients. In conclusion, a second course of SRS given in three daily fractions is a feasible treatment for selected patients with recurrent/progressive brain metastases. Further studies are needed to explore the efficacy and safety of different dose-fractionation schedules, especially in patients with melanoma or large metastases.

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Acknowledgments

We thank Professor Alessandro Bozzao, dr Andrea Romano and dr Guido Trasimeni, neuroradiologists, at Sant’Andrea Hospital, Neuroradiology Unit, for reviewing all MRI scans.

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Authors and Affiliations

  1. IRCCS Neuromed, 86077, Pozzilli, IS, Italy

    Giuseppe Minniti & Sergio Paolini

  2. Radiation Oncology Unit, Sant’ Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189, Rome, Italy

    Giuseppe Minniti, Claudia Scaringi, Enrico Clarke, Vincenzo Esposito, Mattia Osti & Riccardo Maurizi Enrici

  3. Nuclear Medicine Unit, Sant’ Andrea Hospital, University Sapienza, 00189, Rome, Italy

    Francesco Cicone

  4. Neuroradiology Unit, Sant’ Andrea Hospital, University Sapienza, 00189, Rome, Italy

    Andrea Romano

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  1. Giuseppe Minniti
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Correspondence to Giuseppe Minniti.

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Minniti, G., Scaringi, C., Paolini, S. et al. Repeated stereotactic radiosurgery for patients with progressive brain metastases. J Neurooncol 126, 91–97 (2016). https://doi.org/10.1007/s11060-015-1937-4

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  • DOI: https://doi.org/10.1007/s11060-015-1937-4

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