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Title: Single-Fraction Versus Multifraction (3 × 9 Gy) Stereotactic Radiosurgery for Large (>2 cm) Brain Metastases: A Comparative Analysis of Local Control and Risk of Radiation-Induced Brain Necrosis

Abstract

Purpose: To investigate the local control and radiation-induced brain necrosis in patients with brain metastases >2 cm in size who received single-fraction or multifraction stereotactic radiosurgery (SRS); factors associated with clinical outcomes and the development of brain radionecrosis were assessed. Methods and Materials: Two hundred eighty-nine consecutive patients with brain metastases >2.0 cm who received SRS as primary treatment at Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy, were analyzed. Cumulative incidence analysis was used to compare local control and radiation-induced brain necrosis between groups from the time of SRS. To achieve a balanced distribution of baseline covariates between treatment groups, a propensity score analysis was used. Results: The 1-year cumulative local control rates were 77% in the single-fraction SRS (SF-SRS) group and 91% in the multifraction SRS (MF-SRS) group (P=.01). Recurrences occurred in 25 and 11 patients who received SF-SRS or MF-SRS (P=.03), respectively. Thirty-one patients (20%) undergoing SF-SRS and 11 (8%) subjected to MF-SRS experienced brain radionecrosis (P=.004); the 1-year cumulative incidence rate of radionecrosis was 18% and 9% (P=.01), respectively. Significant differences between the 2 groups in terms of local control and risk of radionecrosis were maintained after propensity score adjustment. Conclusions: Multifraction SRS at a dose of 27 Gymore » in 3 daily fractions seems to be an effective treatment modality for large brain metastases, associated with better local control and a reduced risk of radiation-induced radionecrosis as compared with SF-SRS.« less

Authors:
 [1];  [2];  [1]; ;  [3];  [4];  [5]; ;  [1];  [3]
  1. Unit of Radiation Oncology, Sant'Andrea Hospital, Sapienza University of Rome, Rome (Italy)
  2. (Italy)
  3. IRCCS Neuromed, Pozzilli (Italy)
  4. Unit of Neuroradiology, Sant'Andrea Hospital, Sapienza University of Rome, Rome (Italy)
  5. Unit of Nuclear Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome (Italy)
Publication Date:
OSTI Identifier:
22648729
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 95; Journal Issue: 4; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRAIN; GY RANGE 01-10; GY RANGE 10-100; ITALY; NECROSIS; PATIENTS; RADIATION HAZARDS; RADIOTHERAPY; SURGERY

Citation Formats

Minniti, Giuseppe, E-mail: gminniti@ospedalesantandrea.it, IRCCS Neuromed, Pozzilli, Scaringi, Claudia, Paolini, Sergio, Lanzetta, Gaetano, Romano, Andrea, Cicone, Francesco, Osti, Mattia, Enrici, Riccardo Maurizi, and Esposito, Vincenzo. Single-Fraction Versus Multifraction (3 × 9 Gy) Stereotactic Radiosurgery for Large (>2 cm) Brain Metastases: A Comparative Analysis of Local Control and Risk of Radiation-Induced Brain Necrosis. United States: N. p., 2016. Web. doi:10.1016/J.IJROBP.2016.03.013.
Minniti, Giuseppe, E-mail: gminniti@ospedalesantandrea.it, IRCCS Neuromed, Pozzilli, Scaringi, Claudia, Paolini, Sergio, Lanzetta, Gaetano, Romano, Andrea, Cicone, Francesco, Osti, Mattia, Enrici, Riccardo Maurizi, & Esposito, Vincenzo. Single-Fraction Versus Multifraction (3 × 9 Gy) Stereotactic Radiosurgery for Large (>2 cm) Brain Metastases: A Comparative Analysis of Local Control and Risk of Radiation-Induced Brain Necrosis. United States. doi:10.1016/J.IJROBP.2016.03.013.
Minniti, Giuseppe, E-mail: gminniti@ospedalesantandrea.it, IRCCS Neuromed, Pozzilli, Scaringi, Claudia, Paolini, Sergio, Lanzetta, Gaetano, Romano, Andrea, Cicone, Francesco, Osti, Mattia, Enrici, Riccardo Maurizi, and Esposito, Vincenzo. Fri . "Single-Fraction Versus Multifraction (3 × 9 Gy) Stereotactic Radiosurgery for Large (>2 cm) Brain Metastases: A Comparative Analysis of Local Control and Risk of Radiation-Induced Brain Necrosis". United States. doi:10.1016/J.IJROBP.2016.03.013.
@article{osti_22648729,
title = {Single-Fraction Versus Multifraction (3 × 9 Gy) Stereotactic Radiosurgery for Large (>2 cm) Brain Metastases: A Comparative Analysis of Local Control and Risk of Radiation-Induced Brain Necrosis},
author = {Minniti, Giuseppe, E-mail: gminniti@ospedalesantandrea.it and IRCCS Neuromed, Pozzilli and Scaringi, Claudia and Paolini, Sergio and Lanzetta, Gaetano and Romano, Andrea and Cicone, Francesco and Osti, Mattia and Enrici, Riccardo Maurizi and Esposito, Vincenzo},
abstractNote = {Purpose: To investigate the local control and radiation-induced brain necrosis in patients with brain metastases >2 cm in size who received single-fraction or multifraction stereotactic radiosurgery (SRS); factors associated with clinical outcomes and the development of brain radionecrosis were assessed. Methods and Materials: Two hundred eighty-nine consecutive patients with brain metastases >2.0 cm who received SRS as primary treatment at Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy, were analyzed. Cumulative incidence analysis was used to compare local control and radiation-induced brain necrosis between groups from the time of SRS. To achieve a balanced distribution of baseline covariates between treatment groups, a propensity score analysis was used. Results: The 1-year cumulative local control rates were 77% in the single-fraction SRS (SF-SRS) group and 91% in the multifraction SRS (MF-SRS) group (P=.01). Recurrences occurred in 25 and 11 patients who received SF-SRS or MF-SRS (P=.03), respectively. Thirty-one patients (20%) undergoing SF-SRS and 11 (8%) subjected to MF-SRS experienced brain radionecrosis (P=.004); the 1-year cumulative incidence rate of radionecrosis was 18% and 9% (P=.01), respectively. Significant differences between the 2 groups in terms of local control and risk of radionecrosis were maintained after propensity score adjustment. Conclusions: Multifraction SRS at a dose of 27 Gy in 3 daily fractions seems to be an effective treatment modality for large brain metastases, associated with better local control and a reduced risk of radiation-induced radionecrosis as compared with SF-SRS.},
doi = {10.1016/J.IJROBP.2016.03.013},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 95,
place = {United States},
year = {Fri Jul 15 00:00:00 EDT 2016},
month = {Fri Jul 15 00:00:00 EDT 2016}
}