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Invited Commentary
October 15, 2020

Stereotactic Radiotherapy and Resection of Brain Metastases: The Role of Hypofractionation

Author Affiliations
  • 1Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
  • 2Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
  • 3Department of Radiation Oncology, Stanford School of Medicine, Palo Alto, California
JAMA Oncol. Published online October 15, 2020. doi:10.1001/jamaoncol.2020.4400

Management of brain metastases has notably evolved since the original study by Patchell et al1 established the role of adjuvant radiation therapy after surgical resection with the use of whole brain radiotherapy. Because of longer overall survival (OS) of patients with cancer and increased availability of magnetic resonance imaging brain surveillance, stereotactic therapy has emerged as an important alternative to minimize the morbidity of whole brain radiotherapy. Despite expected lower distant intracranial control, the gains in preserving neurocognition and options for distal salvage have established a clinical preference for stereotactic therapy in patients with limited brain metastases and good performance status. Stereotactic therapy may be delivered as single-fraction stereotactic radiosurgery (SRS) or multifraction/hypofractionated stereotactic radiotherapy (SRT). The article by Eitz et al2 represents 1 of the largest cohorts of patients treated with hypofractionated SRT by combining data from 6 high-volume centers of 558 patients and 581 cavities. The 1-year local control (LC) rate was 84%, and the median OS was 21.2 months. The overall rate of leptomeningeal disease (LMD) was 13.1%. Of importance, the clinical radionecrosis rate was 8.6%, with a median time to occurrence of 13.1 months.

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