Repeated stereotactic radiosurgery (SRS) using a non-coplanar mono-isocenter (HyperArc™) technique versus upfront whole-brain radiotherapy (WBRT): a matched-pair analysis

  • Luca NicosiaEmail author
  • Vanessa Figlia
  • Rosario Mazzola
  • Giuseppe Napoli
  • Niccolò Giaj-Levra
  • Francesco Ricchetti
  • Michele Rigo
  • Gianluigi Lunardi
  • Davide Tomasini
  • Marco L. Bonù
  • Stefanie Corradini
  • Ruggero Ruggieri
  • Filippo Alongi
Research Paper


Stereotactic radiosurgery (SRS) is an effective treatment option for multiple brain metastases (BMs). Modern mono-isocentric techniques allow the delivery of multiple stereotactic courses, in the event of intracranial failure. Nevertheless, limited data on effectiveness and toxicity have been reported in comparison to WBRT. Aim of this retrospective matched-pair analysis was to compare patients affected by limited BMs treated with multiple SRS courses using a mono-isocentric, non-coplanar technique (HyperArc™, Varian Medical System) to upfront WBRT. One hundred and two patients accounting for 677 BMs were treated with HyperArc™. In case of further intracranial progression, 44 treatment courses of 201 metastases in 19 patients, were treated by subsequent HyperArc™ courses. This population was matched with 38 patients treated with WBRT. The median BMs number was 4 (range 2–10) for HyperArc™ and 5 (range 2–10) for WBRT. Overall survival (OS) and toxicity were evaluated. The median follow-up was 9 months (range 3–40 months). The median OS was not reached (range 5–22 months) for HyperArc™ patients and 8 months (range 3–40 months) for WBRT patients, while the 1-year OS was 77% and 34.6% for HyperArc™ and WBRT, respectively (p = 0.001; HR 4.77, 95% CI 1.62–14.00). There was one case of radionecrosis. HyperArc™ is an effective and safe technique for the treatment of multiple BMs. In selected cases of intracranial oligorecurrence, further subsequent courses can be safely delivered with the same technical approach. Moreover, in patients with a limited number of BMs, SRS showed an improved survival outcome when compared to WBRT.


Brain metastases Radiosurgery Radiotherapy HyperArc Linac-based VMAT Whole-brain radiotherapy 



Not applicable.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Luca Nicosia
    • 1
    Email author
  • Vanessa Figlia
    • 1
  • Rosario Mazzola
    • 1
  • Giuseppe Napoli
    • 1
  • Niccolò Giaj-Levra
    • 1
  • Francesco Ricchetti
    • 1
  • Michele Rigo
    • 1
  • Gianluigi Lunardi
    • 2
  • Davide Tomasini
    • 1
    • 3
  • Marco L. Bonù
    • 1
    • 3
  • Stefanie Corradini
    • 4
  • Ruggero Ruggieri
    • 1
  • Filippo Alongi
    • 1
    • 3
  1. 1.Advanced Radiation Oncology DepartmentIRCCS Sacro Cuore Don Calabria Hospital, Cancer Care CenterNegrarItaly
  2. 2.Medical Analysis LaboratoryIRCCS Sacro Cuore Don Calabria Hospital, Cancer Care CenterNegrarItaly
  3. 3.University of BresciaBresciaItaly
  4. 4.Radiation Oncology DepartmentUniversity Hospital, LMU MunichMunichGermany

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