Journal of Neuro-Oncology

, Volume 126, Issue 1, pp 91–97 | Cite as

Repeated stereotactic radiosurgery for patients with progressive brain metastases

  • Giuseppe Minniti
  • Claudia Scaringi
  • Sergio Paolini
  • Enrico Clarke
  • Francesco Cicone
  • Vincenzo Esposito
  • Andrea Romano
  • Mattia Osti
  • Riccardo Maurizi Enrici
Clinical Study


In the present study we have evaluated the efficacy and toxicity of repeated stereotactic radiosurgery (SRS) in patients with recurrent/progressive brain metastases. Between March 2006 and October 2014, 43 patients (21 men and 22 women) with 47 lesions received a second course of SRS given in three daily fractions of 7–8 Gy. With a follow-up study of 19 months, the 1- and 2-year survival rates from repeated SRS were 37 and 20 %, respectively, and the 1- and 2-year local control rates were 70 and 60 %, respectively. Actuarial local control was significantly better for breast and lung metastases as compared with melanoma metastases; specifically, 1-year local control rates were 38 % for melanoma, 78 % for breast carcinoma and 73 % for non-small cell lung cancer (NSCLC) metastases (p = 0.01). The cause of death was progressive systemic disease in 25 patients and progressive brain disease in 11 patients. Stable extracranial disease (p = 0.01) and Karnofsky performance status (KPS; p = 0.03) were predictive of longer survival. Radiologic changes suggestive of brain radionecrosis were observed in 9 (19 %) out of 47 lesions, with an actuarial risk of 34 % at 12 months. Neurological deficits (RTOG Grade 2 or 3) associated with brain necrosis occurred in 14 % of patients. In conclusion, a second course of SRS given in three daily fractions is a feasible treatment for selected patients with recurrent/progressive brain metastases. Further studies are needed to explore the efficacy and safety of different dose-fractionation schedules, especially in patients with melanoma or large metastases.


Stereotactic radiosurgery Brain metastases Fractionated stereotactic radiotherapy Reirradiation Brain radionecrosis 



We thank Professor Alessandro Bozzao, dr Andrea Romano and dr Guido Trasimeni, neuroradiologists, at Sant’Andrea Hospital, Neuroradiology Unit, for reviewing all MRI scans.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Giuseppe Minniti
    • 1
    • 2
  • Claudia Scaringi
    • 2
  • Sergio Paolini
    • 1
  • Enrico Clarke
    • 2
  • Francesco Cicone
    • 3
  • Vincenzo Esposito
    • 2
  • Andrea Romano
    • 4
  • Mattia Osti
    • 2
  • Riccardo Maurizi Enrici
    • 2
  1. 1.IRCCS NeuromedPozzilliItaly
  2. 2.Radiation Oncology Unit, Sant’ Andrea HospitalUniversity SapienzaRomeItaly
  3. 3.Nuclear Medicine Unit, Sant’ Andrea HospitalUniversity SapienzaRomeItaly
  4. 4.Neuroradiology Unit, Sant’ Andrea HospitalUniversity SapienzaRomeItaly

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