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Retrospective analysis of hypofractionated stereotactic radiotherapy for tumors larger than 2 cm

Stereotactic radiosurgery for large brain metastases (BM) not amenable to surgical resection is associated with limited local control and neurotoxicity, while hypofractionated stereotactic radiotherapy (HFSRT) has emerged as a promising option. We retrospectively evaluated 61 patients with BM larger...

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Autores principales: Koide, Yutaro, Tomita, Natsuo, Adachi, Sou, Tanaka, Hiroshi, Tachibana, Hiroyuki, Kodaira, Takeshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nagoya University 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728199/
https://www.ncbi.nlm.nih.gov/pubmed/31579330
http://dx.doi.org/10.18999/nagjms.81.3.397
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author Koide, Yutaro
Tomita, Natsuo
Adachi, Sou
Tanaka, Hiroshi
Tachibana, Hiroyuki
Kodaira, Takeshi
author_facet Koide, Yutaro
Tomita, Natsuo
Adachi, Sou
Tanaka, Hiroshi
Tachibana, Hiroyuki
Kodaira, Takeshi
author_sort Koide, Yutaro
collection PubMed
description Stereotactic radiosurgery for large brain metastases (BM) not amenable to surgical resection is associated with limited local control and neurotoxicity, while hypofractionated stereotactic radiotherapy (HFSRT) has emerged as a promising option. We retrospectively evaluated 61 patients with BM larger than 2 cm in the maximum diameter, who were treated with HFSRT (mainly 35 Gy/5 fractions) in our center between 2006–2016, focusing on the effect of BM size on outcomes. Eligible patients were divided according to the maximum BM diameter (group A [23 patients]: ≥3 cm, group B [22 patients]: <3 cm) to assess the relationship between tumor size and prognosis or safety. The primary outcome was the local control rate (LCR), and secondary outcomes were the response rate (RR), brain progression-free survival (BPFS), median survival time (MST), and radionecrosis (RN). Univariate and multivariate analyses for LCR were conducted using Cox’s proportional hazards model. In the 45 eligible patients (58 lesions) enrolled in this study, the RR was 86.4% with an overall LCR of 64.7% at 12 months (67.1% for group A and 61.5% for group B [p = 0.45]). The median BPFS and MST were 11.6 and 14.2 months, respectively. Univariate analyses revealed that female patients and gynecological cancer patients had poorer LCR, but they were not significantly independent prognostic factors (p = 0.06, 0.09, respectively). Two patients (4.4%) experienced RN that was detected more than 4 years after HFSRT. We conclude that HFSRT is safe for large BM but further studies are needed to determine optimal doses and fractions.
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spelling pubmed-67281992019-10-02 Retrospective analysis of hypofractionated stereotactic radiotherapy for tumors larger than 2 cm Koide, Yutaro Tomita, Natsuo Adachi, Sou Tanaka, Hiroshi Tachibana, Hiroyuki Kodaira, Takeshi Nagoya J Med Sci Original Paper Stereotactic radiosurgery for large brain metastases (BM) not amenable to surgical resection is associated with limited local control and neurotoxicity, while hypofractionated stereotactic radiotherapy (HFSRT) has emerged as a promising option. We retrospectively evaluated 61 patients with BM larger than 2 cm in the maximum diameter, who were treated with HFSRT (mainly 35 Gy/5 fractions) in our center between 2006–2016, focusing on the effect of BM size on outcomes. Eligible patients were divided according to the maximum BM diameter (group A [23 patients]: ≥3 cm, group B [22 patients]: <3 cm) to assess the relationship between tumor size and prognosis or safety. The primary outcome was the local control rate (LCR), and secondary outcomes were the response rate (RR), brain progression-free survival (BPFS), median survival time (MST), and radionecrosis (RN). Univariate and multivariate analyses for LCR were conducted using Cox’s proportional hazards model. In the 45 eligible patients (58 lesions) enrolled in this study, the RR was 86.4% with an overall LCR of 64.7% at 12 months (67.1% for group A and 61.5% for group B [p = 0.45]). The median BPFS and MST were 11.6 and 14.2 months, respectively. Univariate analyses revealed that female patients and gynecological cancer patients had poorer LCR, but they were not significantly independent prognostic factors (p = 0.06, 0.09, respectively). Two patients (4.4%) experienced RN that was detected more than 4 years after HFSRT. We conclude that HFSRT is safe for large BM but further studies are needed to determine optimal doses and fractions. Nagoya University 2019-08 /pmc/articles/PMC6728199/ /pubmed/31579330 http://dx.doi.org/10.18999/nagjms.81.3.397 Text en http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Paper
Koide, Yutaro
Tomita, Natsuo
Adachi, Sou
Tanaka, Hiroshi
Tachibana, Hiroyuki
Kodaira, Takeshi
Retrospective analysis of hypofractionated stereotactic radiotherapy for tumors larger than 2 cm
title Retrospective analysis of hypofractionated stereotactic radiotherapy for tumors larger than 2 cm
title_full Retrospective analysis of hypofractionated stereotactic radiotherapy for tumors larger than 2 cm
title_fullStr Retrospective analysis of hypofractionated stereotactic radiotherapy for tumors larger than 2 cm
title_full_unstemmed Retrospective analysis of hypofractionated stereotactic radiotherapy for tumors larger than 2 cm
title_short Retrospective analysis of hypofractionated stereotactic radiotherapy for tumors larger than 2 cm
title_sort retrospective analysis of hypofractionated stereotactic radiotherapy for tumors larger than 2 cm
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728199/
https://www.ncbi.nlm.nih.gov/pubmed/31579330
http://dx.doi.org/10.18999/nagjms.81.3.397
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