Skip to main content

ORIGINAL RESEARCH article

Front. Oncol.
Sec. Radiation Oncology
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1333245
This article is part of the Research Topic Radiotherapy for Brain Metastases View all 10 articles

Single versus multiple fraction stereotactic radiosurgery for medium-sized brain metastases (4-14 cc in volume): reducing or fractionating the radiosurgery dose?

Provisionally accepted
Philipp Reinhardt Philipp Reinhardt 1*Uzeyir Ahmadli Uzeyir Ahmadli 2Emre Uysal Emre Uysal 3Binaya K. Shrestha Binaya K. Shrestha 1Philippe Schucht Philippe Schucht 4Arsany Hakim Arsany Hakim 2Ekin Ermis Ekin Ermis 1
  • 1 Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
  • 2 University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Bern, Switzerland
  • 3 Department of Radiation Oncology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
  • 4 Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

The final, formatted version of the article will be published soon.

    Background and purpose Stereotactic radiosurgery (SRS) of brain metastases (BM) and resection cavities is a widely used and effective treatment modality. Based on target lesion size and anatomical location, single fraction SRS (SF-SRS) or multiple fraction SRS (MF-SRS) are applied. Current clinical recommendations conditionally recommend either reduced dose SF-SRS or MF-SRS for medium-sized BM (2-2.9 cm in diameter). Despite excellent local control rates, SRS carries the risk of radionecrosis (RN). The purpose of this study was to assess the 12-months local control (LC) rate rate and 12-months RN rate of this specific patient population.This single-center retrospective study included 54 patients with medium-sized intact BM (n=28) or resection cavities (n=30) treated with either SF-SRS or MF-SRS. Follow-up MRI was used to determine LC and RN using a modification of the "Brain Tumor Reporting and Data System" (BT-RADS) scoring system.The 12-month LC rate following treatment of intact BM was 66.7% for SF-SRS and 60.0% for MF-SRS (p=1.000). For resection cavities, the 12-month LC rate was 92.9%% after SF-SRS and 46.2% after MF-SRS (p=0.013). For intact BM, RN rate was 17.6% for SF-SRS and 20.0% for MF-SRS (p=1.000). For resection cavities, RN rate was 28.6% for SF-SRS and 20.0% for MF-SRS (p=1.000).Patients with intact BM showed no statistically significant differences in 12-months LC and RN rate following SF-SRS or MF-SRS. In patients with resection cavities the 12-months LC rate was significantly better following SF-SRS, with no increase in the RNFS.

    Keywords: brain metastases, Stereotactic radiosurgery, multiple fraction SRS, single fraction SRS, radionecrosis, MRI, response assessment, Recurrence

    Received: 04 Nov 2023; Accepted: 24 Jul 2024.

    Copyright: © 2024 Reinhardt, Ahmadli, Uysal, Shrestha, Schucht, Hakim and Ermis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Philipp Reinhardt, Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.