OBJECT: Linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) is a treatment option for @entity1 with @entity320 in whom brain @entity3 have developed. Very limited data are available on treating @entity1 with >= 5 lesions. The authors sought to determine the effectiveness of SRS in @entity1 with >= 5 @entity320 brain @entity3 . METHODS: A retrospective analysis of @entity320 treated with SRS in a single treatment session for >= 5 lesions was performed. Magnetic resonance imaging studies were reviewed post-SRS to evaluate local control (LC). Disease progression on imaging was defined using the 2009 Response Evaluation Criteria in @entity5 (RECIST). Survival curves were calculated from the date of brain @entity3 diagnosis or the date of SRS by using the Kaplan-Meier (KM) method. Univariate and multivariate analysis (UVA and MVA, respectively) were performed using the Cox proportional-hazards model. RESULTS: The authors identified 149 metastatic @entity75 treated in 28 @entity1 . The median @entity1 age was 60.5 years (range 38-83 years), and the majority of @entity1 (24 [85.7%]) had extracranial @entity3 . Four @entity1 (14.3%) had received previous whole-brain radiotherapy (WBRT), and 11 (39.3%) had undergone previous SRS. The median planning target volume ( @entity343 ) was 0.34 cm3 (range 0.01-12.5 cm3). Median follow-up was 6.3 months (range 1-46 months). At the time of treatment, 7% of @entity1 were categorized as recursive partitioning analysis (RPA) Class I, 89% as RPA Class II, and 4% as RPA Class III. The rate of local failure was 11.4%. Kaplan-Meier LC estimates at 6 and 12 months were 91.3% and 82.2%, respectively. A @entity343 volume>= 0.34 cm3 was a significant predictor of local failure on UVA (HR 16.1, 95% CI 3.2-292.6, p<0.0001) and MVA (HR 14.8, 95% CI 3.0-268.5, p=0.0002). Sixteen @entity1 (57.1%) were noted to have distant failure in the brain with a median time to failure of 3 months (range 1-15 months). Nine @entity1 with distant failures received WBRT, and 7 received additional SRS. Median overall survival (OS) was 9.4 and 7.6 months from the date of brain @entity3 diagnosis and the date of SRS, respectively. The KM OS estimates at 6 and 12 months were 57.8% and 28.2%, respectively, from the time of SRS treatment. The RPA class was a significant predictor of KM OS estimates from the date of treatment (p=0.02). @entity1 who did not receive WBRT after SRS treatment had decreased OS on MVA (HR 3.5, 95% CI 1.1-12.0, p=0.03), and @entity1 who did not receive WBRT prior to SRS had improved OS (HR 0.11, 95% CI 0.02-0.53, p=0.007). CONCLUSIONS: Stereotactic radiosurgery for >= 5 lesions appears to be effective for selected @entity1 with @entity320 , offering excellent LC. This is particularly important for @entity1 as new targeted systemic agents are improving outcomes but still have limited efficacy within the central nervous system.

Potential role for LINAC-based stereotactic radiosurgery for the treatment of 5 or more radioresistant XXXX brain @entity3 .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity5 :: ('MESH:D009369', 'Disease') :: ['Solid Tumors'] @entity75 :: ('MESH:D001927', 'Disease') :: ['brain lesions'] @entity343 :: ('187978', 'Species') :: ['PTV'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastases'] @entity320 :: ('MESH:D008545', 'Disease') :: ['melanoma', 'metastatic melanoma']
@entity320 :: (MESH:D008545,Disease) :: ['melanoma']
