Repeated Hyperarc Radiosurgery for Recurrent Intracranial Metastases and Dosimetric Analysis of Recurrence Pattern to Account for Diffuse Dose Effect on Microscopical Disease

Repeated Hyperarc Radiosurgery for Recurrent Intracranial Metastases and Dosimetric Analysis of Recurrence Pattern to Account for Diffuse Dose Effect on Microscopical Disease Publisher

Nicosia L¹ ; Allegra AG¹ ; Giajlevra N¹ ; Bayani R^{2, 3} ; Darzikolaee NM³ ; Mazzola R¹ ; Pastorello E¹ ; Ravelli P¹ ; Ricchetti F¹ ; Rigo M¹ ; Ruggieri R¹ ; Gurrera D¹ ; Borgese RF¹ ; Gaito S^{4, 5} Show All Authors

Nicosia L¹
Allegra AG¹
Giajlevra N¹
Bayani R^{2, 3}
Darzikolaee NM³
Mazzola R¹
Pastorello E¹
Ravelli P¹
Ricchetti F¹
Rigo M¹
Ruggieri R¹
Gurrera D¹
Borgese RF¹
Gaito S^{4, 5}
Minniti G^{6, 7}
Navarria P^{8, 9}
Scorsetti M^{8, 9}
Alongi F^{1, 10}

Source: Clinical and Translational Radiation Oncology Published:2024

Abstract

Aims: Evaluate effectiveness and safety of multiple HyperArc courses and patterns of progression in patients affected by BMs with intracranial progression. Methods: 56 patients were treated for 702 BMs with 197 (range 2–8) HyperArc courses in case of exclusive intracranial progression. Primary end-point was the overall survival (OS), secondary end-points were intracranial progression-free survival (iPFS), toxicity, local control (LC), neurological death (ND), and whole-brain RT (WBRT)-free survival. Site of progression was evaluated against isodoses levels (0, 1, 2, 3, 5, 7, 8, 10, 13, 15, 20, and 24 Gy.). Results: The 1-year OS was 70 %, and the median was 20.8 months (17–36). At the univariate analysis (UVA) biological equivalent dose (BED) > 51.3 Gy and non-melanoma histology significantly correlated with OS. The median time to iPFS was 4.9 months, and the 1-year iPFS was 15 %. Globally, 538 new BMs occurred after the first HA cycle in patients with extracranial disease controlled. 96.4 % of them occurred within the isodoses range 0–7 Gy as follows: 26.6 % (0 Gy), 16.5 % (1 Gy), 16.5 % (2 Gy), 20.1 % (3 Gy), 13.1 % (5 Gy), 3.4 % (7 Gy) (p = 0.00). Radionecrosis occurred in 2 metastases (0.28 %). No clinical toxicity of grade 3 or higher occurred during follow-up. One- and 2-year LC was 90 % and 79 %, respectively. At the UVA BED > 70 Gy and non-melanoma histology were significant predictors of higher LC. The 2-year WBRT-free survival was 70 %. After a median follow-up of 17.4 months, 12 patients deceased by ND. Conclusion: Intracranical relapses can be safely and effectively treated with repeated HyperArc, with the aim to postpone or avoid WBRT. Diffuse dose by volumetric RT might reduce microscopic disease also at relatively low levels, potentially acting as a virtual CTV. Neurological death is not the most common cause of death in this population, which highlights the impact of extracranial disease on overall survival. © 2024 The Author(s)

2. State of the Art in Combination Immuno/Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis, Current Oncology (2022)

3. Frameless Stereotactic Radiosurgery for Brain Metastasis: A Systematic Review and Meta-Analysis, Neurosurgical Review (2024)

Style	Citing Format
MLA	Nicosia L, et al.. "Repeated Hyperarc Radiosurgery for Recurrent Intracranial Metastases and Dosimetric Analysis of Recurrence Pattern to Account for Diffuse Dose Effect on Microscopical Disease." Clinical and Translational Radiation Oncology, vol. 48, no. , 2024, pp. -.
APA	Nicosia L, Allegra AG, Giajlevra N, Bayani R, Darzikolaee NM, Mazzola R, Pastorello E, Ravelli P, Ricchetti F, Rigo M, Ruggieri R, Gurrera D, Borgese RF, Gaito S, Minniti G, Navarria P, Scorsetti M, Alongi F (2024). Repeated Hyperarc Radiosurgery for Recurrent Intracranial Metastases and Dosimetric Analysis of Recurrence Pattern to Account for Diffuse Dose Effect on Microscopical Disease. Clinical and Translational Radiation Oncology, 48(), -.
Chicago	Nicosia L, Allegra AG, Giajlevra N, Bayani R, Darzikolaee NM, Mazzola R, Pastorello E, et al.. "Repeated Hyperarc Radiosurgery for Recurrent Intracranial Metastases and Dosimetric Analysis of Recurrence Pattern to Account for Diffuse Dose Effect on Microscopical Disease." Clinical and Translational Radiation Oncology 48, no. (2024): -.
Harvard	Nicosia L et al. (2024) 'Repeated Hyperarc Radiosurgery for Recurrent Intracranial Metastases and Dosimetric Analysis of Recurrence Pattern to Account for Diffuse Dose Effect on Microscopical Disease', Clinical and Translational Radiation Oncology, 48(), pp. -.
Vancouver	Nicosia L, Allegra AG, Giajlevra N, Bayani R, Darzikolaee NM, Mazzola R, et al.. Repeated Hyperarc Radiosurgery for Recurrent Intracranial Metastases and Dosimetric Analysis of Recurrence Pattern to Account for Diffuse Dose Effect on Microscopical Disease. Clinical and Translational Radiation Oncology. 2024;48():-.
BibTex	@article{ author = {Nicosia L and Allegra AG and Giajlevra N and Bayani R and Darzikolaee NM and Mazzola R and Pastorello E and Ravelli P and Ricchetti F and Rigo M and Ruggieri R and Gurrera D and Borgese RF and Gaito S and Minniti G and Navarria P and Scorsetti M and Alongi F}, title = {Repeated Hyperarc Radiosurgery for Recurrent Intracranial Metastases and Dosimetric Analysis of Recurrence Pattern to Account for Diffuse Dose Effect on Microscopical Disease}, journal = {Clinical and Translational Radiation Oncology}, volume = {48}, number = {}, pages = {-}, year = {2024} }
RIS	TY - JOUR AU - Nicosia L AU - Allegra AG AU - Giajlevra N AU - Bayani R AU - Darzikolaee NM AU - Mazzola R AU - Pastorello E AU - Ravelli P AU - Ricchetti F AU - Rigo M AU - Ruggieri R AU - Gurrera D AU - Borgese RF AU - Gaito S AU - Minniti G AU - Navarria P AU - Scorsetti M AU - Alongi F TI - Repeated Hyperarc Radiosurgery for Recurrent Intracranial Metastases and Dosimetric Analysis of Recurrence Pattern to Account for Diffuse Dose Effect on Microscopical Disease JO - Clinical and Translational Radiation Oncology VL - 48 IS - SP - EP - PY - 2024 ER -

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