PMID- 29874299 OWN - NLM STAT- MEDLINE DCOM- 20190114 LR - 20190114 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 13 IP - 6 DP - 2018 TI - Repeated in-field radiosurgery for locally recurrent brain metastases: Feasibility, results and survival in a heavily treated patient cohort. PG - e0198692 LID - 10.1371/journal.pone.0198692 [doi] LID - e0198692 AB - PURPOSE: Stereotactic radiosurgery (SRS) is an established primary treatment for newly diagnosed brain metastases with high local control rates. However, data about local re-irradiation in case of local failure after SRS (re-SRS) are rare. We evaluated the feasibility, efficacy and patient selection characteristics in treating locally recurrent metastases with a second course of SRS. METHODS: We retrospectively evaluated patients with brain metastases treated with re-SRS for local tumor progression between 2011 and 2017. Patient and treatment characteristics as well as rates of tumor control, survival and toxicity were analyzed. RESULTS: Overall, 32 locally recurrent brain metastases in 31 patients were irradiated with re-SRS. Median age at re-SRS was 64.9 years. The primary histology was breast cancer and non-small-cellular lung cancer (NSCLC) in respectively 10 cases (31.3%), in 5 cases malignant melanoma (15.6%). In the first SRS-course 19 metastases (59.4%) and in the re-SRS-course 29 metastases (90.6%) were treated with CyberKnife(R) and the others with Gamma Knife. Median planning target volume (PTV) for re-SRS was 2.5 cm3 (range, 0.1-37.5 cm3) and median dose prescribed to the PTV was 19 Gy (range, 12-28 Gy) in 1-5 fractions to the median 69% isodose (range, 53-80%). The 1-year overall survival rate was 61.7% and the 1-year local control rate was 79.5%. The overall rate of radiological radio-necrosis was 16.1% and four patients (12.9%) experienced grade >/= 3 toxicities. CONCLUSIONS: A second course of SRS for locally recurrent brain metastases after prior local SRS appears to be feasible with acceptable toxicity and can be considered as salvage treatment option for selected patients with high performance status. Furthermore, this is the first study utilizing robotic radiosurgery for this indication, as an additional option for frameless fractionated treatment. FAU - Balermpas, Panagiotis AU - Balermpas P AUID- ORCID: 0000-0001-5261-6446 AD - Department of Radiation Oncology, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany. AD - Saphir Radiosurgery Center, Frankfurt, Germany. AD - German Cancer Research Center (DKFZ), Heidelberg, Germany. AD - German Cancer Consortium (DKTK) partner site: Frankfurt am Main, Germany. FAU - Stera, Susanne AU - Stera S AD - Department of Radiation Oncology, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany. FAU - Muller von der Grun, Jens AU - Muller von der Grun J AD - Department of Radiation Oncology, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany. FAU - Loutfi-Krauss, Britta AU - Loutfi-Krauss B AD - Department of Radiation Oncology, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany. FAU - Forster, Marie-Therese AU - Forster MT AD - Department of Neurosurgery, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany. FAU - Wagner, Marlies AU - Wagner M AD - Institute for Neuroradiology, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany. FAU - Keller, Christian AU - Keller C AD - Department of Radiation Oncology, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany. AD - Saphir Radiosurgery Center, Frankfurt, Germany. FAU - Rodel, Claus AU - Rodel C AD - Department of Radiation Oncology, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany. AD - German Cancer Research Center (DKFZ), Heidelberg, Germany. AD - German Cancer Consortium (DKTK) partner site: Frankfurt am Main, Germany. FAU - Seifert, Volker AU - Seifert V AD - Department of Neurosurgery, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany. FAU - Blanck, Oliver AU - Blanck O AD - Saphir Radiosurgery Center, Frankfurt, Germany. AD - Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany. FAU - Wolff, Robert AU - Wolff R AD - Saphir Radiosurgery Center, Frankfurt, Germany. AD - Department of Neurosurgery, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany. LA - eng PT - Journal Article DEP - 20180606 PL - United States TA - PLoS One JT - PloS one JID - 101285081 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Brain/diagnostic imaging/pathology/radiation effects MH - Brain Neoplasms/mortality/pathology/*radiotherapy/secondary MH - Breast Neoplasms/pathology MH - Carcinoma, Non-Small-Cell Lung/mortality/pathology/radiotherapy/secondary MH - Feasibility Studies MH - Female MH - Follow-Up Studies MH - Humans MH - Lung Neoplasms/pathology MH - Magnetic Resonance Imaging MH - Male MH - Melanoma/mortality/pathology/radiotherapy/secondary MH - Middle Aged MH - Neoplasm Recurrence, Local/mortality/pathology/*radiotherapy/secondary MH - Patient Selection MH - Radiation Injuries/*epidemiology/etiology MH - Radiosurgery/adverse effects/instrumentation/*methods MH - Retreatment/adverse effects/methods MH - Retrospective Studies MH - Robotic Surgical Procedures/adverse effects/instrumentation/*methods MH - Survival Analysis MH - Treatment Outcome PMC - PMC5991396 COIS- The authors have declared that no competing interests exist. EDAT- 2018/06/07 06:00 MHDA- 2019/01/15 06:00 PMCR- 2018/06/06 CRDT- 2018/06/07 06:00 PHST- 2018/02/17 00:00 [received] PHST- 2018/05/23 00:00 [accepted] PHST- 2018/06/07 06:00 [entrez] PHST- 2018/06/07 06:00 [pubmed] PHST- 2019/01/15 06:00 [medline] PHST- 2018/06/06 00:00 [pmc-release] AID - PONE-D-18-05292 [pii] AID - 10.1371/journal.pone.0198692 [doi] PST - epublish SO - PLoS One. 2018 Jun 6;13(6):e0198692. doi: 10.1371/journal.pone.0198692. eCollection 2018.