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Outcomes Following Hypofractionated Stereotactic Radiotherapy in the Management of Brain Metastases

Ahmed, Kamran A. MD; Sarangkasiri, Siriporn MS; Chinnaiyan, Prakash MD; Sahebjam, Solmaz MD; Yu, Hsiang-Hsuan Michael MD, ScM; Etame, Arnold B. MD, PhD; Rao, Nikhil G. MD

American Journal of Clinical Oncology: August 2016 - Volume 39 - Issue 4 - p 379–383
doi: 10.1097/COC.0000000000000076
Original Articles: Central Nervous System

Objective: To evaluate the outcomes of patients treated with hypofractionated stereotactic radiotherapy (HSRT) for radiosensitive and radioresistant brain metastases.

Methods: Between August 2006 and July 2013, a total of 56 lesions in 44 patients with brain metastases were treated with HSRT. Twenty-three (41.1%) lesions were radioresistant. Patients were treated to a total dose of 24 to 30 Gy in 3 to 5 fractions. Median planning target volume was 6.18 cm3. The primary endpoint for this study was local control with secondary endpoints of overall survival, distant failure, performance status, and treatment toxicity.

Results: The median follow-up for all patients was 5 months (range, 0.4 to 58.3 mo). Six- and 12-month Kaplan-Meier estimates of local control for all lesions were 85.6% and 79.4%, respectively. Radioresistant tumors had a 6- and 12-month local control rate of 87.0%, whereas radiosensitive tumors had a 6- and 12-month local control rate of 82.5% and 72.2%, respectively (P=0.41). Six- and 12-month distant brain control rates were 56.8% and 46.9%, respectively. Overall survival was significantly associated with recursive partitioning analysis classes I, II, and III (P=0.0003) and graded prognostic assessment classes 2 to 3 and 1 to 1.5 (P=0.041).

Conclusions: HSRT is a safe and feasible alternative to single-session stereotactic radiosurgery for brain metastases. No difference was observed in local control rates between radioresistant and radiosensitive tumors.

Departments of *Radiation Oncology

Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL

LifeBridge Health, Baltimore, MD

The authors declare no conflicts of interest.

Reprints: Nikhil G. Rao, MD, Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL 33612. E-mail:

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