Cyberknife radiosurgery in brain metastases

Italian experience

I. Milanese, L. Fariselli, M. De Santis, F. Ghielmetti, L. Fumagalli, L. Bianchi, L. Brait, A. Merlotti, C. Falcone, G. Broggi, F. Colombo, L. Casentini

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: We evaluate local control after Cyberknife Radiosurgery in 142 patients treated in 2 institutions: Istituto Nazionale Neurologico "C. Besta" Milan and San Bortolo Hospital Vicenza. METHODS: From January 2003 to August 2005 74 patients (110 lesions) in Vicenza and 68 patients (94 lesions) in Milan underwent Radiosurgery. In 56 patients Whole Brain Radiotherapy was also performed. 56.8% were RPA class 1, 41.7% were RPA class 2 and 1.4 class 3. We did clinical and neuroradiological evaluation 3 months interval up to 1 year. We defined: complete response as total radiographic disappearance of the lesion; partial response as greater than a 25% decrease in size of the lesion; stable disease as a 0-25% decrease in size of the lesion; progressive disease as an increase in the size of the lesion. RESULTS: After 3 months of follow up local control was: 49.4% stable disease, 22.2% partial response, 20.1% complete response and 7.4% progressive disease; ten patients were died and 4 patients were lost at follow up. After 6 months our results were: 48.1% stable disease, 11.5% partial response, 26.9% complete response and 13.5% progressive disease; twenty-one patients were died and 7 patients were lost at follow up. Regarding 65 patients treated at National Neurological Institute, 31 died at 18 months: 9 for local progressive disease, 16 for systemic disease and 6 for intra and extra cerebral progressive disease. After 12 months of follow up 75% of our patients had stable disease (stable disease, complete response, partial response). Three patients had a acute toxicity consistent in two transitory edema and 1 partial seizure in regression with steroid drugs. Only a patient had late complications (occurring ≥ 3 months after treatment), consistent in radiation necrosis, histologically confirmed. CONCLUSIONS: Our data suggest that Radiosurgery with Cyberknife achieved a good local control and could be an alternative for solitary brain metastatic patients with less invasiveness compared to stereotactic head-frame SRS. Furthermore this treatment improve quality of life and symptom control and is associated with a small risk of early or late toxicity.

Original languageEnglish
Pages (from-to)143-146
Number of pages4
JournalRivista Medica
Volume13
Issue number1
Publication statusPublished - Mar 2007

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Radiosurgery
Neoplasm Metastasis
Brain
Edema
Seizures
Necrosis
Radiotherapy

Keywords

  • Brain metastases
  • Cyberknife
  • Radiosurgery

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Milanese, I., Fariselli, L., De Santis, M., Ghielmetti, F., Fumagalli, L., Bianchi, L., ... Casentini, L. (2007). Cyberknife radiosurgery in brain metastases: Italian experience. Rivista Medica, 13(1), 143-146.

Cyberknife radiosurgery in brain metastases : Italian experience. / Milanese, I.; Fariselli, L.; De Santis, M.; Ghielmetti, F.; Fumagalli, L.; Bianchi, L.; Brait, L.; Merlotti, A.; Falcone, C.; Broggi, G.; Colombo, F.; Casentini, L.

In: Rivista Medica, Vol. 13, No. 1, 03.2007, p. 143-146.

Research output: Contribution to journalArticle

Milanese, I, Fariselli, L, De Santis, M, Ghielmetti, F, Fumagalli, L, Bianchi, L, Brait, L, Merlotti, A, Falcone, C, Broggi, G, Colombo, F & Casentini, L 2007, 'Cyberknife radiosurgery in brain metastases: Italian experience', Rivista Medica, vol. 13, no. 1, pp. 143-146.
Milanese, I. ; Fariselli, L. ; De Santis, M. ; Ghielmetti, F. ; Fumagalli, L. ; Bianchi, L. ; Brait, L. ; Merlotti, A. ; Falcone, C. ; Broggi, G. ; Colombo, F. ; Casentini, L. / Cyberknife radiosurgery in brain metastases : Italian experience. In: Rivista Medica. 2007 ; Vol. 13, No. 1. pp. 143-146.
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AU - Fumagalli, L.

AU - Bianchi, L.

AU - Brait, L.

AU - Merlotti, A.

AU - Falcone, C.

AU - Broggi, G.

AU - Colombo, F.

AU - Casentini, L.

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N2 - INTRODUCTION: We evaluate local control after Cyberknife Radiosurgery in 142 patients treated in 2 institutions: Istituto Nazionale Neurologico "C. Besta" Milan and San Bortolo Hospital Vicenza. METHODS: From January 2003 to August 2005 74 patients (110 lesions) in Vicenza and 68 patients (94 lesions) in Milan underwent Radiosurgery. In 56 patients Whole Brain Radiotherapy was also performed. 56.8% were RPA class 1, 41.7% were RPA class 2 and 1.4 class 3. We did clinical and neuroradiological evaluation 3 months interval up to 1 year. We defined: complete response as total radiographic disappearance of the lesion; partial response as greater than a 25% decrease in size of the lesion; stable disease as a 0-25% decrease in size of the lesion; progressive disease as an increase in the size of the lesion. RESULTS: After 3 months of follow up local control was: 49.4% stable disease, 22.2% partial response, 20.1% complete response and 7.4% progressive disease; ten patients were died and 4 patients were lost at follow up. After 6 months our results were: 48.1% stable disease, 11.5% partial response, 26.9% complete response and 13.5% progressive disease; twenty-one patients were died and 7 patients were lost at follow up. Regarding 65 patients treated at National Neurological Institute, 31 died at 18 months: 9 for local progressive disease, 16 for systemic disease and 6 for intra and extra cerebral progressive disease. After 12 months of follow up 75% of our patients had stable disease (stable disease, complete response, partial response). Three patients had a acute toxicity consistent in two transitory edema and 1 partial seizure in regression with steroid drugs. Only a patient had late complications (occurring ≥ 3 months after treatment), consistent in radiation necrosis, histologically confirmed. CONCLUSIONS: Our data suggest that Radiosurgery with Cyberknife achieved a good local control and could be an alternative for solitary brain metastatic patients with less invasiveness compared to stereotactic head-frame SRS. Furthermore this treatment improve quality of life and symptom control and is associated with a small risk of early or late toxicity.

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