{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T10:50:44Z","timestamp":1771843844723,"version":"3.50.1"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2017,8,10]],"date-time":"2017-08-10T00:00:00Z","timestamp":1502323200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The treatment of brainstem metastases remains a challenge as the brainstem itself is considered a neurological organ at risk. We aimed to investigate the efficacy and safety of CyberKnife hypofractionated stereotactic radiotherapy (HFSRT) for brainstem metastases, and to examine the balance between efficacy and safety for the management of neurological symptoms. A total of 26 lesions [pons (n = 18), medulla (n = 4) and midbrain (n = 4)] in 20 patients treated with CyberKnife hypofractionated stereotactic radiotherapy were retrospectively analyzed. The total radiation doses (18\u201330 Gy) were delivered in 3 or 5 equal fractions. The median follow-up was 6.5 (range, 0.5\u201338.0) months. The 6- and 12-month local control rates were 100% and 90%, respectively. Symptomatic failures, defined as the worsening and appearance of neurological symptoms due to the brainstem lesion after CyberKnife HFSRT, were observed in 6 patients [local failure (n = 1) and adverse events (n = 5). The symptomatic control and overall survival rates were 90% and 72% (after 6 months), respectively, and 76% and 53% (after 12 months), respectively. Longer symptomatic control was associated with site of lesion origin, and longer overall survival was associated with a graded prognostic assessment score of &amp;gt;2. To our knowledge, this is the second study to investigate the efficacy and safety of CyberKnife HFSRT for brainstem metastases. The local control rate was comparable with that of prior stereotactic radiosurgery studies. We propose a new evaluation criterion\u2014\u2018symptomatic control\u2019\u2014to evaluate the efficacy and safety of brainstem radiotherapy.<\/jats:p>","DOI":"10.1093\/jrr\/rrx042","type":"journal-article","created":{"date-parts":[[2017,7,11]],"date-time":"2017-07-11T19:19:17Z","timestamp":1499800757000},"page":"834-839","source":"Crossref","is-referenced-by-count":12,"title":["Investigation of the efficacy and safety of CyberKnife hypofractionated stereotactic radiotherapy for brainstem metastases using a new evaluation criterion: \u2018symptomatic control\u2019"],"prefix":"10.1093","volume":"58","author":[{"given":"Masaki","family":"Nakamura","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima Nakamachi, Chuo-ku, Kobe, Hyogo 650-0046, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideki","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima Nakamachi, Chuo-ku, Kobe, Hyogo 650-0046, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Mayahara","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima Nakamachi, Chuo-ku, Kobe, Hyogo 650-0046, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haruka","family":"Uezono","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima Nakamachi, Chuo-ku, Kobe, Hyogo 650-0046, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aya","family":"Harada","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima Nakamachi, Chuo-ku, Kobe, Hyogo 650-0046, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoki","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima Nakamachi, Chuo-ku, Kobe, Hyogo 650-0046, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuo","family":"Ejima","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeaki","family":"Ishihara","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryo","family":"Nishikawa","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryohei","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2017,8,10]]},"reference":[{"key":"2020010903192844400_rrx042C1","doi-asserted-by":"crossref","first-page":"563","DOI":"10.3171\/jns.1999.91.4.0563","article-title":"Stereotactic radiosurgery for brainstem metastases","volume":"91","author":"Huang","year":"1999","journal-title":"J Neurosurg"},{"key":"2020010903192844400_rrx042C2","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1007\/s00415-002-0870-6","article-title":"Management of brain metastases","volume":"249","author":"Soffietti","year":"2002","journal-title":"J Neurol"},{"key":"2020010903192844400_rrx042C3","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.ijrobp.2010.02.028","article-title":"Minimized doses for linear accelerator radiosurgery of brainstem metastasis","volume":"80","author":"Valery","year":"2011","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2020010903192844400_rrx042C4","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1007\/s11060-010-0514-0","article-title":"Linear accelerator-based stereotactic radiosurgery for brainstem metastases: the Dana-Farber\/Brigham and Women's Cancer Center experience","volume":"104","author":"Kelly","year":"2011","journal-title":"J Neurooncol"},{"key":"2020010903192844400_rrx042C5","first-page":"1026","article-title":"Adult palliative oncology and radiotherapy of locally advanced and metastatic cancers","volume":"2","author":"Cheung","year":"2015","journal-title":"Aust J Cancer Clin Res"},{"key":"2020010903192844400_rrx042C6","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1227\/01.NEU.0000325726.72815.22","article-title":"Radiation tolerance limits of the brainstem","volume":"63","author":"Sharma","year":"2008","journal-title":"Neurosurgery"},{"key":"2020010903192844400_rrx042C7","doi-asserted-by":"crossref","first-page":"S36","DOI":"10.1016\/j.ijrobp.2009.08.078","article-title":"Radiation associated brainstem injury","volume":"76","author":"Mayo","year":"2010","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2020010903192844400_rrx042C8","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.ijrobp.2006.08.081","article-title":"Stereotactic radiosurgery for brainstem metastases: survival, tumor control, and patient outcomes","volume":"67","author":"Hussain","year":"2007","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2020010903192844400_rrx042C9","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s11060-014-1373-x","article-title":"Local control and toxicity outcomes in brainstem metastases treated with single fraction radiosurgery: is there a volume threshold for toxicity?","volume":"117","author":"Kilburn","year":"2014","journal-title":"J Neurooncol"},{"key":"2020010903192844400_rrx042C10","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1016\/j.ijrobp.2016.03.013","article-title":"Single-fraction versus multifraction (3 \u00d7 9 Gy) stereotactic radiosurgery for large (&gt;2 cm) brain metastases: a comparative analysis of local control and risk of radiation-induced brain necrosis","volume":"95","author":"Minniti","year":"2016","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2020010903192844400_rrx042C11","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1007\/s00066-016-0963-2","article-title":"Hypofractionated stereotactic radiotherapy for brain metastases from lung cancer: evaluation of indications and predictors of local control","volume":"192","author":"Ishihara","year":"2016","journal-title":"Strahlenther Onkol"},{"key":"2020010903192844400_rrx042C12","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.ijrobp.2016.06.009","article-title":"Stereotactic radiosurgery for brainstem metastases: an international cooperative study to define response and toxicity","volume":"96","author":"Trifiletti","year":"2016","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2020010903192844400_rrx042C13","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1186\/1748-717X-7-107","article-title":"Prescription dose and fractionation predict improved survival after stereotactic radiotherapy for brainstem metastases","volume":"7","author":"Leeman","year":"2012","journal-title":"Radiat Oncol"},{"key":"2020010903192844400_rrx042C14","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.jocn.2015.10.013","article-title":"CyberKnife radiosurgery for brainstem metastases: management and outcomes and a review of the literature","volume":"25","author":"Liu","year":"2016","journal-title":"J Clin Neurosci"},{"key":"2020010903192844400_rrx042C15","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1227\/NEU.0b013e31823c40fe","article-title":"Accelerator-based stereotactic radiosurgery for brainstem metastases","volume":"70","author":"Lin","year":"2012","journal-title":"Neurosurgery"},{"key":"2020010903192844400_rrx042C16","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1227\/NEU.0b013e31821d31de","article-title":"Outcomes and prognostic factors for patients with brainstem metastases undergoing stereotactic radiosurgery","volume":"69","author":"Hatiboglu","year":"2011","journal-title":"Neurosurgery"},{"key":"2020010903192844400_rrx042C17","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.ijrobp.2009.07.1750","article-title":"Stereotactic radiosurgery for single brainstem metastases: the cleveland clinic experience","volume":"78","author":"Koyfman","year":"2010","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2020010903192844400_rrx042C18","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1227\/01.NEU.0000190655.95669.5C","article-title":"Brainstem metastases: management using gamma knife radiosurgery","volume":"58","author":"Fuentes","year":"2006","journal-title":"Neurosurgery"},{"key":"2020010903192844400_rrx042C19","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.surneu.2008.01.029","article-title":"Brain stem metastases treated with radiosurgery: prognostic factors of survival and life expectancy estimation","volume":"71","author":"Lorenzoni","year":"2009","journal-title":"Surg Neurol"},{"key":"2020010903192844400_rrx042C20","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.wneu.2015.10.089","article-title":"How does brainstem involvement affect prognosis in patients with limited brain metastases? Results of a matched-cohort analysis","volume":"88","author":"Trifiletti","year":"2016","journal-title":"World Neurosurg"}],"container-title":["Journal of Radiation Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jrr\/article-pdf\/58\/6\/834\/31615275\/rrx042.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jrr\/article-pdf\/58\/6\/834\/31615275\/rrx042.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,1,9]],"date-time":"2020-01-09T08:32:33Z","timestamp":1578558753000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jrr\/article\/58\/6\/834\/4080278"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8,10]]},"references-count":20,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2017,8,10]]},"published-print":{"date-parts":[[2017,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jrr\/rrx042","relation":{},"ISSN":["0449-3060","1349-9157"],"issn-type":[{"value":"0449-3060","type":"print"},{"value":"1349-9157","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2017,11]]},"published":{"date-parts":[[2017,8,10]]}}}