• J. Cancer Res. Clin. Oncol. · Jan 2019

    First experience and clinical results using a new non-coplanar mono-isocenter technique (HyperArc™) for Linac-based VMAT radiosurgery in brain metastases.

    • Filippo Alongi, Alba Fiorentino, Fabiana Gregucci, Stefanie Corradini, Niccolo Giaj-Levra, Luigi Romano, Michele Rigo, Francesco Ricchetti, Alberto Beltramello, Gianluigi Lunardi, Rosario Mazzola, and Ruggero Ruggieri.
    • Department of Radiation Oncology, IRCCS, Ospedale Sacro Cuore Don Calabria, Via don A. Sempreboni 5, 37024, Negrar, Verona, Italy.
    • J. Cancer Res. Clin. Oncol. 2019 Jan 1; 145 (1): 193-200.

    IntroductionRadiosurgery (SRS) or stereotactic fractionated radiotherapy (SFRT) is increasing in the treatment of brain metastases (BMs). Aim of the present study was to evaluate the safety and effectiveness of SRS/SFRT for BMs, using a new mono-isocenter non-coplanar solution (HyperArc™ Varian Medical System).MethodsBMs patients with a diameter inferior to 3 cm, a life expectancy of more than 3 months and a good performance status, were eligible for Linac-based volumetric modulated arc therapy (VMAT) SFRT/SRS with HyperArc™. A retrospective analysis of patients and BMs was performed.ResultsFrom August 2017 to May 2018, 381 BMs in 64 patients were treated and 246 BMs (43 patients, median number of BMs: 5) of them were suitable for analysis. With a median FU time of 6 months, 244 out 246 (99%) BMs were controlled (18% complete response; 41% partial response, 40% stable disease), 2 BMs showed a progression, at the first control. No acute or late toxicities were reported. Median overall survival (OS) has not yet been achieved, while median time to progression was 5 months. In univariate analysis, statistically negative prognostic factors for OS were histology of primary tumor (p = 0.009): lung/breast cancer had better survival rates as compared to others. Cumulative intracranial volume disease ≥ 15 cc and systemic progression disease were independent prognostic factors for OS at univariate (p = 0.04; p = 0.005) and multivariate (p = 0.04; p = 0.009) analysis, respectively.ConclusionThe present first clinical data show that SFRT/SRS with HyperArc™ is safe and effective for BMs patients. The utilization of SFRT/SRS for BMs is promising and should be further explored in randomized trials.

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