Evidence map›Paper›PMID 32466775›Full record

ArticleRadiation oncology (London, England)2020

A multi-center analysis of single-fraction versus hypofractionated stereotactic radiosurgery for the treatment of brain metastasis.

Jill S Remick, Emily Kowalski, Rahul Khairnar, Kai Sun, Emily Morse, Hua-Ren R Cherng, Yannick Poirier, Narottam Lamichhane, Stewart J Becker, Shifeng Chen and 7 more

Open access · goldAbstract readComparative StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Radiation oncology (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 2 pooled it
4.8field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 2 syntheses or guidelines pooled it, 64 citations in OpenAlex.

  1. Pooled it
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  6. Chinese Society of Clinical Oncology breast cancer expert consensus on the diagnosis and treatment of breast cancer brain metastasis (2025).Translational breast cancer research : a journal focusing on translational research in breast cancer · 2026
    Review
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  20. CSCO expert consensus on the diagnosis and treatment of breast cancer brain metastasis.Translational breast cancer research : a journal focusing on translational research in breast cancer · 2022
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 3 institutions in 1 country.

Jill S RemickDepartment of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA.
Emily KowalskiDepartment of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA.
Rahul KhairnarDepartment of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
Kai SunDepartment of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
Emily MorseDepartment of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
Hua-Ren R CherngDepartment of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
Yannick PoirierDepartment of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
Narottam LamichhaneDepartment of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
Stewart J BeckerDepartment of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
Shifeng ChenDepartment of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
Akshar N PatelChesapeake Oncology Hematology Associates, Glen Bernie, MD, USA.
Young KwokDepartment of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
Elizabeth NicholsDepartment of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
Pranshu MohindraDepartment of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
Graeme F WoodworthDepartment of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA.
William F RegineDepartment of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
Mark V MishraDepartment of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA. mmishra@umm.edu.
University of Maryland, Baltimore · USUniversity of Maryland Medical Center · USChesapeake Urology Associates · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHypofractionated-SRS (HF-SRS) may allow for improved local control and a reduced risk of radiation necrosis compared to single-fraction-SRS (SF-SRS). However, data comparing these two treatment approaches are limited. The purpose of this study was to compare clinical outcomes between SF-SRS versus HF-SRS across our multi-center academic network.

methodsPatients treated with SF-SRS or HF-SRS for brain metastasis from 2013 to 2018 across 5 radiation oncology centers were retrospectively reviewed. SF-SRS dosing was standardized, whereas HF-SRS dosing regimens were variable. The co-primary endpoints of local control and radiation necrosis were estimated using the Kaplan Meier method. Multivariate analysis using Cox proportional hazards modeling was performed to evaluate the impact of select independent variables on the outcomes of interest. Propensity score adjustments were used to reduce the effects confounding variables. To assess dose response for HF-SRS, Biologic Effective Dose (BED) assuming an α/β of 10 (BED

resultsOne-hundred and fifty six patients with 335 brain metastasis treated with SF-SRS (n = 222 lesions) or HF-SRS (n = 113 lesions) were included. Prior whole brain radiation was given in 33% (n = 74) and 34% (n = 38) of lesions treated with SF-SRS and HF-SRS, respectively (p = 0.30). After a median follow up time of 12 months in each cohort, the adjusted 1-year rate of local control and incidence of radiation necrosis was 91% (95% CI 86-96%) and 85% (95% CI 75-95%) (p = 0.26) and 10% (95% CI 5-15%) and 7% (95% CI 0.1-14%) (p = 0.73) for SF-SRS and HF-SRS, respectively. For lesions > 2 cm, the adjusted 1 year local control was 97% (95% CI 84-100%) for SF-SRS and 64% (95% CI 43-85%) for HF-SRS (p = 0.06). On multivariate analysis, SRS fractionation was not associated with local control and only size ≤2 cm was associated with a decreased risk of developing radiation necrosis (HR 0.21; 95% CI 0.07-0.58, p < 0.01). For HF-SRS, 1 year local control was 100% for lesions treated with a BED

conclusionsIn this comparison study of dose fractionation for the treatment of brain metastases, there was no difference in local control or radiation necrosis between HF-SRS and SF-SRS. For HF-SRS, a BED

Indexed as

Radiation Dose HypofractionationRadiosurgeryBrain NeoplasmsHumansRadiation InjuriesRadiotherapy Planning, Computer-AssistedRetrospective StudiesBiologic effective doseBrain metastasisGammaKnifeHypofractionated stereotactic radiosurgeryNormal tissue injuryStereotactic radiosurgery

Identifiers

PMID32466775
PMCPMC7257186
OpenAlexW3031763437

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.