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Purpose: This multicenter randomized trial would assess whether surgery plus radiosurgery on surgical cavity in solitary brain metastasis give better results in term of local control respect to surgery plus WBRT. Methods: Patients with solitary brain metastasis of solid tumors (small-cell lung cancer excluded) with stable systemic disease or asymptomatic primary tumors and WHO performance status (PS) of 0 to 2 were treated with complete surgery and randomly assigned to adjuvant WBRT (30 Gy in 10 fractions) or SRS (17-20 Gy single fraction) on surgical cavity (max diameter 3.5 cm). The primary end point is local control, secondary end points survival, quality of life and toxicity. Results: From December 2009 to September 2012, sixty-five patients have been treated with adjuvant radiotherapy after radical surgery: 42 were randomised to receive SRS treatment and 23 WBRT treatment. Twenty-seven patients are alive at last follow-up, 27 died. Eleven patients were lost to the follow-up. Median overall survival was 19.0 months: 17.7 months in WBRT arm and 20.1 months in SRS arm. Local tumor control rate at 1 year is not statistically significant: 93,9% for SRS group and 82,4% for WBRT group (p = 0.7750). Only 2 patients developed intracranial progression. This patients were located in WBRT group and intracranial progression caused death. Salvage therapies were used more frequently after SRS than after WBRT. On multivariate analysis, KPS, age at diagnosis and RPA classes was not statistically significant in survival from diagnosis. Conclusions: In our study WBRT and SRS treatment post-surgical resection in solitary brain metastases are equivalent in terms of local control, survival and toxicity. Radiosurgery can substitute whole brain radiotherapy in solitary brain metastases. Disclosure: No significant relationships. [ABSTRACT FROM AUTHOR]

Objective: Because of their particular location the treatment of the petroclival meningiomas remains a clinical challenge. In fact the proximity of the hindbrain and of multiple cranial nerves made actual the concern about neuro-toxicity. The aim of the present study was to evaluate both single-session and multisession radiosurgery safety and effectiveness. Method. In the period between June 2004 and December 2009, at our Institution, 28 patients underwent a radiosurgical treatment due to a petroclival meningioma. Radiosurgery was used as either primary and adjuvant therapy. Inclusion criteria were residual or recurrent tumors after previous resection and newly diagnosed symptomatic tumors. All patients treated with radiosurgery had radiological evidence of tumor growth, before the treatment. Contraindications included larger tumor volumes associated with symptomatic mass effect on the brainstem. The treatment plan was always designed both on CT and MR images. Local control and neurological outcome were regularly assessed. Results: The treatment was well tolerated by all the patients. Ten patients underwent a single-session radiosurgery (sSRS) with a mean dose of 12,5 Gy (range11,5-14Gy). Eighteen underwent a multisession radiosurgery (mSRS) with a mean dose of 23 Gy (range12-25 Gy) in 3 to 5 fractions. The reference dose line, which usually included the 95% of the tumor volume, ranged from the 65% to the 80%. The mean target volume was 7,3 cc (median 8,3) and 17,6 cc (median 14,8 cc) in case of sSRS and mSRS respectively. After a mean follow up period of 40 months the 90% of the lesions were radiologically (MRI) stable or had a partial response. Under a neurological point of view most of the patients were stable. In this sense the main problem was the tumor related trigeminal neuralgia. If present, the trigeminal pain rarely satisfactory responded to the treatment. Early and late toxicity rates were quite low. Nobody had a toxicity > grade 2 RTOG. Conclusion: Although larger series and longer follow-up are required, these preliminary results suggest that both single and multisession radiosurgery are safe and effective. Local control rate is promising and toxicity is low. This is also supported by the reported gamma knife long term studies. Finally, multi and single-session radiosurgery seem to be equally safe and effective, anyway, in order to establish the real impact of hypofractionated regimens both in term of local control and toxicity, further studies are mandatory. Disclosure: No significant relationships. [ABSTRACT FROM AUTHOR]

Purpose: patient-(age, performance status, psychological distress), disease-(type, localization) and treatment (neurosurgery, radiotherapy, chemotherapy)-related factors may impact on cognitive functioning of metastasis patients. Neuropsychological involvement may be an important factor, reducing quality of daily life (QoL). This study aimed to evaluate difference between whole brain radiotherapy (WBRT) and radiosurgery (SRS) on neurocognitive functioning accordingly on QoL of brain metastasis patients.We did a randomized controlled trial to test our prediction. Methods and Materials: Patients with solitary brain metastasis of solid tumors with stable systemic disease tumors and KPS >/= 70 were treated with complete surgery and randomly assigned to adjuvant WBRT (30 Gy in 10 fractions) or SRS (17-20 Gy single fraction) on surgical cavity (max diameter 3.5 cm). The primary end point was local control, secondary end points survival, quality of life and toxicity. 65 patients, fulfilling the study inclusion criteria, were treated since December 2009 to September 2012. After randomization 42 subjects were assigned to SRS group, 23 to WBRT. All subjects were tested to assessed global cognitive functioning using the Mini Mental State Examination (MMSE): at baseline (T1) before radiotherapy treatment, after one year (T2) and after 2 years (T3). Preliminary results were available for 55 subjects at T1, for 25 subjects at T2, for 6 at T3. Results: The pretreatment MMSE was available for 37 patients randomized for SRS, and 18 for WBRT. The sample did not present cognitive deficit post surgery and no statistically significant difference were found between the baseline MMSE of two groups (P = 0,064). Of the 25 patients underwent the follow-up MMSE at one year, 10 (40%) had improved their scores and 5 (20%) worsened in SRS group; all subjects (100%) obtained lower scores in WBRT group. From preliminary evaluations it was found a statistically significant difference between the neurocognitive performance of WBRT group and the SRS one (P = 0,039). Currently, there's no sufficient data at 2 years. Conclusion: The results of this study have revealed that the long-term adverse effect of WBRT on neurocognitive functioning might not be negligible also for the quality of life of brain metastases patients. Disclosure: No significant relationships. [ABSTRACT FROM AUTHOR]

Objectives: Aim of this study is to compare the planning performance of two collimators (fixed and dynamic aperture IRIS) mounted on the cyberknife system. Methods: Three treatment plans for each petroclival meningioma patient (average target volume 13.9cc) were optimized for different collimator setups: up to three fixed, free variable aperture IRIS (fIRIS) and IRIS apertures constrained to the fixed plan ones (cIRIS). The prescription dose was 25 Gy in 5 fractions and the reference isodose for each patient was chosen to produced equivalent target coverage for the three plans. The comparison among different collimator setups was performed in terms of OARs sparing (brain stem, cochlea and omolateral acoustic nerve), CI (van't Riet et al.), total MU, treatment time and body volumes receiving 70%, 50%, 30% and 10% of the prescription dose. Results: Plans for all patients had a mean target coverage of 96.1%, and the mean prescription isodose was 81%. The three collimator setups did not produce significant differences in terms of OARs sparing and CI values. Compared to fixed collimators, both IRIS plans showed improvements in low dose regions, with a reduction of 4.9% and 6.7% for the total volume enclosed respectively by the 30% and 10% of the prescription dose isodoses; no relevant differences were appreciated when 70% and 50% isodoses were considered. Treatment time was reduced by 16.6% when the IRIS collimator setup was used, with a minimal difference between free variable aperture and constrained IRIS (~2 min less for fIRIS). The fIRIS setup also allowed a reduction of the 5.6% and 8.7% of the total MU number, if compared to fixed and cIRIS plans respectively. Conclusions: The different collimator setups analysed showed nonsignificant differences in terms of OARs sparing for radiosurgery treatment of petroclival miningiomas. Using the IRIS collimator with free variable aperture can reduce the total volume enclosed by medium and low dose isodoses. Moreover, it can also reduce treatment time and total MU number. Finally, using IRIS constrained apertures instead of free ones could be advantageous in terms of treatment planning computation time. Disclosure: No significant relationships. [ABSTRACT FROM AUTHOR]

Objective: Traditional treatment options for optic nerve sheath meningiomas (ONSMs) include observation, surgery and radiotherapy, but to date none of these has become the clear treatment of choice. The aim of this study is to evaluate the effectiveness and safety of multisession radiosurgery for ONSM. Method: From May 2004 to date, 35 patients affected by ONSMs underwent a radiosurgical treatment by using the frameless CyberKnife system. Patient age ranged from 16-73 years (mean, 51 years; median 52 years). All patients were treated using multisession radiosurgery, with 5 fractions of 5 Gy each to a total dose of 25 Gy prescribed to the 75-85% isodose line. Patients were evaluated both for tumor growth control and visual function. Results: The median pre-treatment tumor volume was 3.7 cc (range, 0.2 - 23 cc). The mean follow-up was 26 months (range, 5-68 months). Thirteen patients had a follow-up period longer than 36 months. No patients showed ONSM progression on follow-up MRI. Two patients (10%) had a partial response. At the moment of the present analysis the visual function was stable in the 74 % of the patients, improved in the 20 % and worsened in the 6 %. Unexpectedly, in this experience the optic neuropathy always occurred during the first 6 months after the treatment. Moreover, the analysis of these two cases revealed that the dose to the chiasm, optic nerve, retina, ocular bulb and lacrimal gland as well as the involved volumes were not at the higher level of the present series Conclusion. Multisession radiosurgery for ONSMs was found to be safe and effective. The preliminary results from the present study, in terms of both growth control and visual function improvement are at least promising. Further studies are required not only to define the long term results, but also to better understand the real mechanism underlying the treatment related optic neuropathy. Disclosure: No significant relationships. [ABSTRACT FROM AUTHOR]

Objective: Surgery represents the first-choice treatment for spinal, intradural tumors. Whether surgery is most appropriate in the setting of recurrences, residual or multiple lesions, or for patients who are not amenable to surgery remains an open question. In this study we report about our own radiosurgery experience in treatment of benign intradural, extramedullary tumours of the spine. Method. In this study we analyzed outcomes for 20 patients (24 lesions) treated for benign intradural, extramedullary lesions with a minimum follow-up period of 32 months. The lesions included 14 meningiomas, 9 schwannomas and 1 neurofibroma. Results: The mean follow-up was 43 months (32-73 months). The median tumour volume was 2.6 cc (0.2-138 cc). Eleven lesions underwent single-fraction treatment (dose to the target 10 to 15 Gy). The others received a multisession radiosurgery treatment (4 to 6 fractions) with a mean prescription dose ranging from 16.8 to 30 Gy. The maximum dose to the spinal cord ranged from 9 to 26 Gy. During the follow-up period no lesion showed radiological evidence of progression. Neurological status was preserved or improved and no permanent sequelae were observed. Significant and durable pain relief was observed. Conclusion. Although surgical excision remains the primary treatment option for most intradural tumours, radiosurgery offers a true alternative therapeutic modality for such lesions, especially in case of recurrent and residual lesions or when surgery is contraindicated. Disclosure: No significant relationships. [ABSTRACT FROM AUTHOR]