ArticleRadiation oncology (London, England)2018
Radiosurgery or hypofractionated stereotactic radiotherapy for brain metastases from radioresistant primaries (melanoma and renal cancer).
Article in Radiation oncology (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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32 citing papers in PubMed, 1 synthesis or guideline pooled it, 40 citations in OpenAlex.
- Bibliometric and visualization analysis of radiation brain injury from 2003 to 2023.Frontiers in neurology · 2023Pooled it
- Radionecrosis risk and local control after CyberKnifeRadiation oncology (London, England) · 2026Article
- Efficacy and safety of hypofractionated radiotherapy for melanoma brain metastases: a retrospective study.Frontiers in oncology · 2026Article
- Management of critically located brain metastases in patients with precluded survival using customised double-dose prescription-based, adaptive accelerated staged radiosurgery: a long-term retrospective analysis.Radiation oncology (London, England) · 2025Article
- Precision radiotherapy with molecular-profiling of CNS tumours.Journal of neuro-oncology · 2025Review
- Transcriptome analysis of novel B16 melanoma metastatic variants generated by serial intracarotid artery injection.Acta neuropathologica communications · 2025Article
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- Fractionated stereotactic radiotherapy of brain metastases: results of a retrospective study.Radiation oncology (London, England) · 2023Article
- Stereotactic radiosurgery and combined immune checkpoint therapy with ipilimumab and nivolumab in patients with melanoma brain metastases: A retrospective monocentric toxicity analysis.Clinical and translational radiation oncology · 2023Article
- Multimodal Treatments for Brain Metastases from Renal Cell Carcinoma: Results of a Multicentric Retrospective Study.Cancers · 2023Article
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- Dose-Response Effect and Dose-Toxicity in Stereotactic Radiotherapy for Brain Metastases: A Review.Cancers · 2021Review
- Focal Radiotherapy of Brain Metastases in Combination With Immunotherapy and Targeted Drug Therapy.Deutsches Arzteblatt international · 2021Article
- CyberknifeJournal of cancer research and clinical oncology · 2021Article
- Interfractional target changes in brain metastases during 13-fraction stereotactic radiotherapy.Radiation oncology (London, England) · 2021Article
- Quality of Automated Stereotactic Radiosurgery Plans in Patients with 4 to 10 Brain Metastases.Cancers · 2021Article
- Single-fraction versus hypofractionated gamma knife radiosurgery for small metastatic brain tumors.Clinical & experimental metastasis · 2021Article
- Synchronous brain metastases as a poor prognosis factor in clear cell renal carcinoma: a strong argument for systematic brain screening.Journal of neuro-oncology · 2021Article
- Metastatic renal cell carcinoma to the brain: optimizing patient selection for gamma knife radiosurgery.Acta neurochirurgica · 2021Article
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Authors and funding
11 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUntil 50% of patients with renal cancer or melanoma, develop brain metastases during the course of their disease. Stereotactic radiotherapy has become a standard of care for patients with a limited number of brain metastases. Given the radioresistant nature of melanoma and renal cancer, optimization of the fractionation of stereotactic radiotherapy is needed. The purpose of this retrospective study was to elucidate if hypofractionated stereotactic radiotherapy (HFSRT) impacts local control of brain metastases from radioresistant tumors such as melanoma and renal cancer, in comparison with radiosurgery (SRS).
methodsBetween 2012 and 2016, 193 metastases, smaller than 3 cm, from patients suffering from radioresistant primaries (melanoma and renal cancer) were treated with HFSRT or SRS. The primary outcome was local progression free survival (LPFS) at 6, 12 and 18 months. Overall survival (OS) and cerebral progression free survival (CPFS) were secondary outcomes, and were evaluated per patient. Objective response rate and radionecrosis incidence were also reported. The statistical analysis included a supplementary propensity score analysis to deal with bias induced by non-randomized data.
resultsAfter a median follow-up of 7.4 months, LPFS rates at 6, 12 and 18 months for the whole population were 83, 74 and 70%, respectively. With respect to fractionation, LPFS rates at 6, 12 and 18 months were 89, 79 and 73% for the SRS group and 80, 72 and 68% for the HFSRT group. The fractionation schedule was not statistically associated with LPFS (HR = 1.39, CI95% [0.65-2.96], p = 0.38). Time from planning MRI to first irradiation session longer than 14 days was associated with a poorer local control rate. Over this time, LPFS at 12 months was reduced from 86 to 70% (p = 0.009). Radionecrosis occurred in 7.1% for HFSRT treated metastases to 9.6% to SRS treated metastases, without any difference according to fractionation (p = 0.55). The median OS was 9.6 months. Six, 12 and 18 months CPFS rates were 54, 24 and 17%, respectively.
conclusionFractionation does not decrease LPFS. Even for small radioresistant brain metastases (< 3 cm), HFSRT, with 3 or 6 fractions, leads to an excellent local control rate of 72% at 1 year with a rate of 7.1% of radionecrosis. HFSRT is a safe and efficient alternative treatment to SRS.
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