Journal of Cancer Research and Clinical Oncology

, Volume 145, Issue 1, pp 193–200 | Cite as

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 GregucciEmail author
  • Stefanie Corradini
  • Niccolo Giaj-Levra
  • Luigi Romano
  • Michele Rigo
  • Francesco Ricchetti
  • Alberto Beltramello
  • Gianluigi Lunardi
  • Rosario Mazzola
  • Ruggero Ruggieri
Original Article – Cancer Research



Radiosurgery (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).


BMs 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.


From 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.


The 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.


Brain metastases Radiotherapy Radiosurgery Stereotactic fractionated radiotherapy Linac-based VMAT HyperArc 



No funding or financial interests for this study.

Compliance with ethical standards

Ethical approval

For this type of study formal consent is not required. However, all procedures were in accordance with the ethical standards and the Helsinki declaration.

Informed consent

A specific informed consent was obtained from all individual participants included in the study.

Conflict of interest

FA acts as Varian Consultant and he had Speacker Onoraria. Remaining authors (AF, FG, SC, NGL, LR, MR, FR, AB, GL, RM, RR) declare no conflict of interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Filippo Alongi
    • 1
    • 2
  • Alba Fiorentino
    • 1
  • Fabiana Gregucci
    • 1
    Email author
  • Stefanie Corradini
    • 3
  • Niccolo Giaj-Levra
    • 1
  • Luigi Romano
    • 4
  • Michele Rigo
    • 1
  • Francesco Ricchetti
    • 1
  • Alberto Beltramello
    • 4
  • Gianluigi Lunardi
    • 5
  • Rosario Mazzola
    • 1
  • Ruggero Ruggieri
    • 1
  1. 1.Department of Radiation OncologyIRCCS, Ospedale Sacro Cuore Don CalabriaNegrarItaly
  2. 2.University of BresciaBresciaItaly
  3. 3.Department of Radiation OncologyLMU University HospitalMunichGermany
  4. 4.Department of RadiologyIRCCS, Ospedale Sacro Cuore Don CalabriaNegrarItaly
  5. 5.Department of Medical OncologyIRCCS, Ospedale Sacro Cuore Don CalabriaNegrarItaly

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