found an article on avoiding WBR (whole brain radiation therapy)

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Clinical Investigation

Three-Staged Stereotactic Radiotherapy Without Whole Brain Irradiation for Large Metastatic Brain Tumors

Yoshinori Higuchi M.D.*, §, , , Toru Serizawa M.D.*, Osamu Nagano M.D.*, Shinji Matsuda M.D.â€*, Junichi Ono M.D.*, Makoto Sato R.T.‡, Yasuo Iwadate M.D.§ and Naokatsu Saeki M.D.§

â€*Department of Neurology, Chiba Cardiovascular Center, Ichihara, Japan

‡Department of Radiological Technology, Chiba Cardiovascular Center, Ichihara, Japan

*Department of Neurosurgery, Chiba Cardiovascular Center, Ichihara, Japan

§Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan


Received 27 November 2007; revised 14 September 2008; accepted 13 October 2008. Available online 8 January 2009.
Purpose

To evaluate the efficacy and toxicity of staged stereotactic radiotherapy with a 2-week interfraction interval for unresectable brain metastases more than 10 cm3 in volume.

Patients and Methods

Subjects included 43 patients (24 men and 19 women), ranging in age from 41 to 84 years, who had large brain metastases (> 10 cc in volume). Primary tumors were in the colon in 14 patients, lung in 12, breast in 11, and other in 6. The peripheral dose was 10 Gy in three fractions. The interval between fractions was 2 weeks. The mean tumor volume before treatment was 17.6 ± 6.3 cm3 (mean ± SD). Mean follow-up interval was 7.8 months. The local tumor control rate, as well as overall, neurological, and qualitative survivals, were calculated using the Kaplan-Meier method.

Results

At the time of the second and third fractions, mean tumor volumes were 14.3 ± 6.5 (18.8% reduction) and 10.6 ± 6.1 cm3 (39.8% reduction), respectively, showing significant reductions. The median overall survival period was 8.8 months. Neurological and qualitative survivals at 12 months were 81.8% and 76.2%, respectively. Local tumor control rates were 89.8% and 75.9% at 6 and 12 months, respectively. Tumor recurrence-free and symptomatic edema-free rates at 12 months were 80.7% and 84.4%, respectively.

Conclusions

The 2-week interval allowed significant reduction of the treatment volume. Our results suggest staged stereotactic radiotherapy using our protocol to be a possible alternative for treating large brain metastases.

Author Keywords: Brain metastasis; Interfraction interval; Staged radiotherapy; Stereotactic radiosurgery; Stereotactic radiotherapy

Article Outline

Introduction
Methods and Materials
Patient characteristics
Radiotherapy technique
Assessment of the control rate of brain metastases
Assessment of survival
Results
Changes in tumor volume during treatment protocol
Local tumor control
Patient status following treatment and overall survival
Neurological and qualitative survivals
New lesion-free survival
Complications
Discussion
Efficacy of staged stereotactic radiotherapy for large brain metastases
Dose fractionation and effect of 2-week interval
Survival data
Conclusions
Acknowledgements
References


Reprint requests to: Yoshinori Higuchi, M.D., Ph.D., Department of Neurological Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. Tel: (+81) 43-226-2158; Fax: (+81) 43-226-2159

International Journal of Radiation Oncology*Biology*Physics
Volume 74, Issue 5, 1 August 2009, Pages 1543-1548