Background In today’s study factors affecting survival and toxicity in cerebral metastasized patients treated with stereotactic radiosurgery (SRS) were analyzed with special focus on radiation necrosis. survival was found for Karnofsky Performance Status (KPS??70: 122?days; KPS?>?70: 342?days), for RPA (recursive partitioning analysis) class (RPA class I: 1800?days; RPA class II: 281?days; RPA class III: 130?days), irradiated volume (2.5?ml: 354?days; > 2.5?ml: 234?days), prescribed dose (18?Gy: 235?days; > 18?Gy: 351?days), gender (male: 235?days; female: 327?days) and whole brain radiotherapy (+WBRT: 341?days/-WBRT: 231?days). In multivariate analysis significance was confirmed for KPS, RPA class and gender. MRI and clinical symptoms suggested radiation necrosis in 21 patients after SRS +/? whole brain radiotherapy (WBRT). In five patients clinically relevant radiation necrosis was confirmed by PET imaging. Conclusions SRS alone or Epigallocatechin gallate in combination with WBRT represents a feasible option as initial treatment for patients with brain metastases; however a significant subset of patients may develop neurological complications. Performance status, RPA class and gender were identified to predict improved survival in cerebral metastasized patients. Keywords: Stereotactic radiotherapy, Cerebral metastases, Radiosurgery, Radiation necrosis Introduction Cerebral metastases are diagnosed in about 30% of patients with advanced tumors [1,2]. Lung malignancy, breast malignancy and malignant melanoma are the most common causes for brain metastases. Symptoms depend on localization and size including indicators of increased intracranial pressure, headaches, vertigo, nausea and vomiting, paraesthesia and seizures. Patients having more than three brain metastases are generally treated with whole-brain radiotherapy (WBRT). Oligometastatic patients with 1C3 lesions have a better prognosis and are therefore treated more aggressively. Beside neurosurgical resection stereotactic radiosurgery (SRS) is an effective treatment option for patients with 1C3 brain metastases [3,4]. For radiation treatment some studies have shown that SRS alone might be superior to WBRT alone for survival advantage of RPA class I patients [5,6]. It cannot be excluded that this effect Epigallocatechin gallate is usually partially caused by the available salvage options after radiosurgery. In three randomized trials additional WBRT showed even better intracranial tumor control and reduced neurologic causes of death but failed to improve patients overall survival and functional independence [7-9]. The 1-12 months local control rates at the initial tumor site after neurosurgical resection or SRS +/? WBRT were about 80% [3,4,7,8]. Intracranial relapse occurred more frequently in patients having received SRS or resection only. In this context WBRT was used more being a salvage treatment frequently. The deferred WBRT most likely improved the distance from the survival and useful self-reliance in the observation arm. The most recent Cochrane Evaluation of WBRT reported a better local and faraway human brain control but no difference in general success for SRS?+?WBRT in comparison to SRS by itself [10]. SRS aswell as WBRT includes a risk for undesirable events. Rays necrosis shows up 1C2 years after radiotherapy (RT) and cognitive drop develops over a long time. For fractionated RT (<2.5 Gy/d) high cumulative dosages are tolerated. Rays induced necrosis is certainly predicted that occurs in 5% at a biologically effective dosage of 120?Gy [11]. For SRS a relationship between the focus on volume, dosage and the chance of adverse occasions has been confirmed [12,13]. Nevertheless the tolerated dosages for SRS present an excellent range in books. In dosage escalation research RTOG 90C05 optimum tolerated doses were 24?Gy, 18?Gy, and 15?Gy for tumors??20?mm, 21C30?mm, and 31C40?mm [14]. The present study was performed to assess factors that have prognostic relevance on survival in cerebral metastasized patients treated with stereotactic radiosurgery and to assess side effects with a special focus on radiation induced necrosis. Patients and methods Patient data and dose fractionation Between March 2000 and December 2010 340 patients with 1C3 cerebral metastases were treated with stereotactic radiosurgery. Patients with stable systemic disease at the time of SRS or general cerebral progression during follow-up received additional WBRT. The prescribed dose for WBRT usually was 35?Gy/37.5?Gy in 14/15 fractions of 2.5?Gy or 30?Gy in 10 fractions of 3?Gy at midline, 5 fractions per week. Patients showing further single brain metastases during follow-up, but stable systemic disease, again were treated Epigallocatechin gallate with SRS. Head frames For stereotactic radiosurgery a Brown-Robert-Wells (BRW) or Gill-Thomas-Cosman (GTC) stereotactic head frame was used. While the BRW frame is usually fixated to the head with four screws to ensure a Rabbit Polyclonal to B3GALTL definite connection between cranium and head frame the GTC frame is less invasive by using dental fixation. Soon after a preparing computed tomography (CT) with localizer was performed. To guarantee the correct placement of the top body a depth helmet was utilized to measure the length between cranium and surface area from the helmet. This control was done before planning CT and before stereotactic radiosurgery immediately. Rays planning rays picture and setting up fusion Radionics Xknife? was utilized. The gross tumor quantity (GTV) was discovered and delineated in fused picture of the CT as well as the magnetic resonance imaging (MRI). Because of spherical development of human brain metastases the scientific target quantity (CTV) was established equal to the GTV. Relating to risk buildings and anatomical edges.