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
| Autor: | Minniti, Giuseppe, Scaringi, Claudia, Paolini, Sergio, Lanzetta, Gaetano, Romano, Andrea, Cicone, Francesco, Osti, Mattia Falchetto, Enrici, Riccardo Maurizi, Esposito, Vincenzo, MAURIZI ENRICI, Riccardo |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Risk Cancer Research medicine.medical_treatment Radiation induced Brain necrosis Radiosurgery 03 medical and health sciences Necrosis 0302 clinical medicine Nuclear Medicine and Imaging parasitic diseases Medicine Humans Radiology Nuclear Medicine and imaging Cumulative incidence In patient Propensity Score Radiation Injuries Aged Aged 80 and over Radiation Medicine (all) Oncology Radiology Nuclear Medicine and Imaging business.industry Brain Neoplasms Dose fractionation Brain Middle Aged Single fraction 3. Good health 030220 oncology & carcinogenesis Propensity score matching Female Dose Fractionation Radiation business Nuclear medicine Radiology 030217 neurology & neurosurgery |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics |
| ISSN: | 1879-355X |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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