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Background: Resection followed by local radiation therapy (RT) is the standard of care for symptomatic brain metastases. However, the optimal technique, fractionation scheme and dose are still being debated. Lately, low-energy X-ray intraoperative RT (lex-IORT) has been of increasing interest. Method: Eighteen consecutive patients undergoing BM resection followed by immediate lex-IORT with 16–30 Gy applied to the spherical applicator were retrospectively analyzed. Demographic, RT-specific, radiographic and clinical data were reviewed to evaluate the effectiveness and safety of IORT for BM. Descriptive statistics and Kaplan–Meyer analysis were applied. Results: The mean follow-up time was 10.8 months (range, 0–39 months). The estimated local control (LC), distant brain control (DBC) and overall survival (OS) at 12 months post IORT were 92.9% (95%-CI 79.3–100%), 71.4% (95%-CI 50.2–92.6%) and 58.0% (95%-CI 34.1–81.9%), respectively. Two patients developed radiation necrosis (11.1%) and wound infection (CTCAE grade III); both had additional adjuvant treatment after IORT. For five patients (27.8%), the time to the start or continuation of systemic treatment was ≤15 days and hence shorter than wound healing and adjuvant RT would have required. Conclusion: In accordance with previous series, this study demonstrates the effectiveness and safety of IORT in the management of brain metastases despite the small cohort and the retrospective characteristic of this analysis.

Introduction: The tumor growth delay assay is a well-accepted technique in experimental animal tumor models for the measurement of the response to treatments. Tumor growth delay assays were mostly performed with subcutaneous xenograft tumors in the hind leg of small animals. However, some radiation qualities with low energy and/or very small irradiation fields cannot use this method. This study was performed to test a new irradiation setup at the Small Animal Radiation Research Platform (SARRP, Xtrahl Ltd.) which can be especially used to irradiate very small tumors with low energy X-rays. Methods: This study was performed with a human head and neck cancer cell line (FaDu). 100 000 FaDu cells were suspended in Matrigel® and subcutaneously injected at the right ear of immunocompromised NMRI nu/nu mice. Tumors with a size of 2x2 mm2 were irradiated with 3 Gy and 6 Gy operating the SARRP at 70 kVp X-rays. Tumor growth was determined over a follow-up of 20 days with a caliper. The tumor growth delay was compared between homogeneously and non-irradiated mice. 20 days after irradiation tumor cells were transferred in cell culture. Results: In this pilot study using 70 kVp X-rays, six tumor-bearing mice were irradiated with either 3 or 6 Gy. Three tumor-bearing mice served as a control. The tumor volume doubling time of unirradiated tumors was 2.75 ± 0.4 days. Out of three, one mouse showed an obvious tumor growth delay at 3 Gy. However, all tumors irradiated with 6 Gy were controlled. The tumor cells which were transferred into cell culture medium showed normal growth characteristics. Conclusion and Outlook: We successfully implemented a xenograft tumor system in mouse ears and irradiations of 2x2 mm2 tumors at the SARRP. The mouse ear tumor model allows an accurate and simple method to determine the tumor volume. In future, this tumor-bearing mouse ear model will enable irradiations which are limited due to small irradiation fields and/or low X-ray energies. Moreover, it is possible to isolate tumor cells out of the mouse ear for future in-vitro analysis. This new method could be used at the first brilliant and compact synchrotron X-ray source (Munich Compact Light Source) where the dose can be deposited by spatially fractionated X-ray beamlets like microbeam radiation therapy (MRT). Acknowledgements: This work was supported by the DFG-Cluster of Excellence ‘‘Munich-Centre for Advanced Photonics’’.