{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:39:39Z","timestamp":1747183179725,"version":"3.40.5"},"reference-count":20,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,3,5]],"date-time":"2019-03-05T00:00:00Z","timestamp":1551744000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Assess clinical outcomes of focal radiotherapy (RT) in patients with limited brain metastasis (LBM) with whole brain RT (WBRT) avoidance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients diagnosed with LBM were entered into a database between January 2010 and February 2017. Patients were recommended WBRT avoidance with focal therapy and three\u2010monthly magnetic resonance imaging. The primary endpoint was overall survival. Secondary endpoints included progression\u2010free survival, initial\u2010site failure (ISF), distant brain relapse (DBF), leptomeningeal disease and rate of WBRT. Analysis involved Kaplan\u2013Meier survival estimate with log\u2010rank tests and Cox\u2010regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred and sixty\u2010six patients were managed with median follow\u2010up of 13\u2009months and median overall survival of 15\u2009months (95% confidence interval (CI) 10.8\u201319.2). Eighty\u2010three patients had central nervous system (CNS) relapse with median progression\u2010free survival of 11\u2009months (95% CI 6.7\u201315.3), of which most failures were DBF (83.1%) with 27 ISF (32.5%). Of the ISFs, 12 (43%) had surgery alone, six had chemotherapy alone and nine received RT. Surgery or chemotherapy alone compared with RT had a significantly higher incidence of ISF with a hazard ratio of 4.96 (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001, 95% CI 2.10\u201311.83) and 6.54 (<jats:italic>P<\/jats:italic>\u2009=\u20090.001, 95% CI 2.26\u201318.87), respectively. WBRT was utilized in only 24 patients, with 83% patients free of WBRT at 12\u2009months. On univariate analysis, number of metastases (<jats:italic>P<\/jats:italic>\u2009=\u20090.04), symptomatic extracranial disease (<jats:italic>P<\/jats:italic>\u2009=\u20090.04) and early CNS relapse within 6 months (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) had worse survival. No grade 3\u20134 toxicity events were noted in 129 patients undergoing RT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Focal RT has a low rate of ISF with low toxicity in patients with LBMs. CNS progression was mainly DBF with low rates of salvage WBRT.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.15040","type":"journal-article","created":{"date-parts":[[2019,3,6]],"date-time":"2019-03-06T04:31:08Z","timestamp":1551846668000},"page":"418-422","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Focal radiation therapy for limited brain metastases is associated with high rates of local control and low subsequent whole brain radiation therapy"],"prefix":"10.1111","volume":"89","author":[{"given":"Michelle","family":"Or","sequence":"first","affiliation":[{"name":"Northern Sydney Cancer Centre Royal North Shore Hospital  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5363-3974","authenticated-orcid":false,"given":"Dasantha","family":"Jayamanne","sequence":"additional","affiliation":[{"name":"Northern Sydney Cancer Centre Royal North Shore Hospital  Sydney New South Wales Australia"},{"name":"Central Coast Cancer Centre Gosford Hospital  Gosford New South Wales Australia"},{"name":"Northern Clinical School, Sydney Medical School The University of Sydney  Sydney New South Wales Australia"},{"name":"Genesis Cancer Care  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lesley","family":"Guo","sequence":"additional","affiliation":[{"name":"Northern Sydney Cancer Centre Royal North Shore Hospital  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Stevens","sequence":"additional","affiliation":[{"name":"Northern Sydney Cancer Centre Royal North Shore Hospital  Sydney New South Wales Australia"},{"name":"Central Coast Cancer Centre Gosford Hospital  Gosford New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathon","family":"Parkinson","sequence":"additional","affiliation":[{"name":"The Brain Cancer Group, Kolling Institute of Medical Research Royal North Shore Hospital  Sydney New South Wales Australia"},{"name":"Department of Neurosurgery Royal North Shore Hospital  Sydney New South Wales Australia"},{"name":"Northern Clinical School, Sydney Medical School The University of Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond","family":"Cook","sequence":"additional","affiliation":[{"name":"The Brain Cancer Group, Kolling Institute of Medical Research Royal North Shore Hospital  Sydney New South Wales Australia"},{"name":"Department of Neurosurgery Royal North Shore Hospital  Sydney New South Wales Australia"},{"name":"Northern Clinical School, Sydney Medical School The University of Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Little","sequence":"additional","affiliation":[{"name":"The Brain Cancer Group, Kolling Institute of Medical Research Royal North Shore Hospital  Sydney New South Wales Australia"},{"name":"Department of Neurosurgery Royal North Shore Hospital  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2363-8333","authenticated-orcid":false,"given":"Michael","family":"Back","sequence":"additional","affiliation":[{"name":"Northern Sydney Cancer Centre Royal North Shore Hospital  Sydney New South Wales Australia"},{"name":"Central Coast Cancer Centre Gosford Hospital  Gosford New South Wales Australia"},{"name":"The Brain Cancer Group, Kolling Institute of Medical Research Royal North Shore Hospital  Sydney New South Wales Australia"},{"name":"Northern Clinical School, Sydney Medical School The University of Sydney  Sydney New South Wales Australia"},{"name":"Genesis Cancer Care  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,3,5]]},"reference":[{"doi-asserted-by":"publisher","key":"e_1_2_8_2_1","DOI":"10.1016\/S0305-7372(03)00105-1"},{"key":"e_1_2_8_3_1","first-page":"2655","volume-title":"Cancer: Principles and Practice of Oncology","author":"Wen PY","year":"2001"},{"key":"e_1_2_8_4_1","first-page":"CD009454","article-title":"Surgery or radiosurgery plus whole brain radiotherapy versus surgery or radiosurgery alone for brain metastases","author":"Soon YY","year":"2014","journal-title":"Cochrane Database Syst. 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