Single Versus Multiple Fraction Stereotactic Radiosurgery for Medium-Sized Brain Metastases (4-14 Cc in Volume): Reducing or Fractionating the Radiosurgery Dose?

Philipp Reinhardt,Uzeyir Ahmadli,Emre Uysal, Binaya Kumar Shrestha,Philippe Schucht,Arsany Hakim,Ekin Ermis

Frontiers in Oncology（2024）

Bern Univ Hosp | Univ Bern | Prof Dr Cemil Tascioglu City Hosp

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Abstract

Background and purposeStereotactic 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 and 12-months RN rate of this specific patient population.Materials and methodsThis 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.ResultsThe 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).ConclusionPatients 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.

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Key words

brain metastases,stereotactic radiosurgery,multiple fraction SRS,single fraction SRS,radionecrosis,MRI,response assessment,recurrence

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