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Background: Glioblastoma (GBM) is a dismal disease. Recurrence is inevitable despite initial surgery and postoperative temozolomide (TMZ) and radiotherapy. Salvage surgery is the standard treatment in selected patients. Chemotherapy, biological agents, and re-irradiation are other treatment approaches available. Stereotactic radiotherapy (SRT) is nowadays a common treatment as a salvage treatment option., Materials and Methods: We reviewed the files of 132 GBM cases treated between 2010 and 2018. All patients received TMZ and radiotherapy after surgery or biopsy. Among the patients who had recurrence, we identified 42 cases treated with salvage SRT. The CyberKnife robotic system was used to administer SRT., Results: While the median follow-up time for all patients was 16 months (range 1-123), the median follow-up time for patients treated with SRT after initial diagnosis was 26.5 months (range 9-123). The median follow-up time after SRT was 10 months (range 2-107). SRT was performed in a median of 3 fractions (range 2-5). The median prescription dose was 20 Gy (range 18-30). While the median actuarial survival after initial diagnosis for patients treated with salvage SRT was 30 months (range 9-123), it was only 14 months (range 1-111) for patients who could not be treated with salvage SRT (p = 0.001). The median survival time after SRT was 12 months, and 1- and 2-year survival rates were 48 and 9%, respectively. The time to progression after SRT was 5 months (range 1-62), and 6-month and 1-year progression-free survival rates were 50 and 22%, respectively. Patients with longer time to recurrence >12 months had longer overall survival with respect to the ones having recurrence <12 months (p < 0.001). Salvage surgery had been performed in 7 out of 42 patients before SRT. These reoperated patients had significantly worse survival after SRT when compared to the patients who underwent SRT alone (p = 0.02). SRT was well tolerated and there was no grade III/IV toxicity., Conclusions: SRT is a viable salvage treatment option for recurrent GBM. SRT provides acceptable local control and survival benefit for recurrent GBM cases. SRT can be considered especially in patients with long time to recurrence., (© 2020 S. Karger AG, Basel.)

Stereotactic radiosurgery is frequently used, either alone or together with whole-brain radiation therapy to treat brain metastases from solid tumors. Certain experts and radiation oncology groups have proposed replacing whole-brain radiation therapy with stereotactic radiosurgery alone for the management of brain metastases. Although randomized trials have favored adding whole-brain radiation therapy to stereotactic radiosurgery for most end points, a recent meta-analysis demonstrated a survival disadvantage for patients treated with whole-brain radiation therapy and stereotactic radiosurgery compared with patients treated with stereotactic radiosurgery alone. However the apparent detrimental effect of adding whole-brain radiation therapy to stereotactic radiosurgery reported in this meta-analysis may be the result of inhomogeneous distribution of the patients with respect to tumor histologies, molecular histologic subtypes, and extracranial tumor stages between the groups rather than a real effect. Unfortunately, soon after this meta-analysis was published, even as an abstract, use of whole-brain radiation therapy in managing brain metastases has become controversial among radiation oncologists. The American Society of Radiation Oncology recently recommended, in their "Choose Wisely" campaign, against routinely adding whole-brain radiation therapy to stereotactic radiosurgery to treat brain metastases. However, this situation creates conflict for radiation oncologists who believe that there are enough high level of evidence for the effectiveness of whole-brain radiation therapy in the treatment of brain metastases.

OBJECTIVE Brain metastasis can be seen in small cell lung cancer patients despite cranial radiotherapy. In case of intracranial recurrence after cranial radiotherapy, treatment choices are restricted. Cranial reirradiation may be an option. In our study, the role of stereotactic radiotherapy after relapse in patients undergoing whole-brain radiotherapy for prophylaxis or metastasis was investigated. METHODS Thirty-six small cell lung cancer patients who had intracranial recurrence after total cranial irradiation and who were treated with salvage SRT in our clinic between June 2010 and January 2019 were evaluated retrospectively in this study. The patients were treated using a frameless robotic radiosurgery system (CyberKnife-Accuray, CA, USA). Median 20 Gy (10-24 Gy) was administered in one to four fractions depending on the volume and relation of the tumor with critical structures. RESULTS Whole-brain radiotherapy was performed with cranial prophylaxis in 16 patients (44.5%) and brain metastasis in 20 patients (55.5%), in which patients underwent stereotactic radiotherapy (SRT) with recurrence/metastasis. Median follow-up time after SRT was 5.5 months. Median one and two years survival after SRT were %33 and %6,6, and median survival was 4,1 months. After SRT, one and twoyear cranial control rates were 57% and 15%, and the median cranial control duration was 12.8 months. In multivariate analysis, the only time interval between WBRT and SRT was found to be significant for survival after SRT p=0.014 (HR: 2.66 95% CI:1.21-5.82). CONCLUSION SRT should be considered as a treatment alternative, especially in patients with long time intracranial control after whole-brain radiotherapy and in patients with systemic disease control. [ABSTRACT FROM AUTHOR]

OBJECTIVE In this study, we aimed to analyze the results of stereotactic body radiotherapy (SBRT) in patients with adrenal gland metastasis due to different primary tumors. METHODS 26 patients with 29 adrenal gland metastases who were treated between 2011-2018 with Cyberknife Robotic System were evaluated retrospectively. RESULTS The origin of adrenal gland metastasis was lung in 22 patients, breast in 1 patient, parotid gland in 1 patient, and sarcoma in 2 patients. Fifteen patients (58%) had other organ metastasis in addition to the adrenal metastases. Six patients were treated for synchronous metastasis and 20 patients for metachronous metastasis. SBRT was performed in median 3 fractions (3-5 fractions), and the median prescription dose to PTV was 30 Gy (18- 45 Gy), with a BED10 (Biological Equivalent Dose) value of 60 Gy (28.8-112,5 Gy). The median follow-up time was 11 months (1-34 months), and median overall survival was 12 months after SBRT, 1,2-years survival rates were 49,7%, 21% respectively. Median time to local failure was not reached, and the 6-months, 1 and 2-years local failure free survival rates were 78,6%, 66,5% and 66,5% respectively. The presence of metastatic disease outside the adrenal gland was found to be a significant prognostic factor on survival after SBRT in both univariate and multivariate analyzes, (HR:3; 95% CI 1,06-8,55 p:0,04). In general treatment was well tolerated and no major acute toxicities were observed. CONCLUSION SBRT provides high local control rates and a well tolerated treatment in patients with adrenal gland metastases. Survival is particularly encouraging for patients with solitary adrenal metastasis. [ABSTRACT FROM AUTHOR]

Purpose: In our study, rates of and factors affecting survival obtained by frameless robotic stereotactic radiosurgery are investigated retrospectively in progressive brain metastases previously treated with total cranial radiotherapy. Materials and Methods: SRS was given as salvage therapy to 60 patients with brain metastases after WBRT. CyberKnife® radiosurgical system (Accuray, Sunnyvale, CA) was used for SRS. Median 1800 (800- 2400) cGy dosage of SRS was used in 44 cases (68%) in one fraction, and in 21 cases (32%) in two fractions. Result: For 12 patients, progression occurred within the SRS field, and overall local control was 80%. Survival rate was 85% at sixth months, and 52% in 12th months (median 12.5 months). Significantly better survival rates were achieved in the patients who breast carcinoma was the primary tumor site. Survival rates significantly decreased if the systemic disease showed progression. A significant change in survival was not observed in different Recursive Partitioning Analysis (RPA) groups, however for Score Index for Radiosurgery (SIR) survival, there was a significant relation. In the multivariance analysis, younger age and smaller tumor size were significantly related with better survival. Conclusion: In the progressive brain metastases, patients with relatively limited life expectancy, SRS is a preferable alternative with 12 months median survival. [ABSTRACT FROM AUTHOR]