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Safety and effectiveness of volumetric modulated arc therapy-based stereotactic radiosurgery for posterior fossa brain metastases: a single-centre experience

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dc.contributor.authorSánchez-Villalobos, José Manuel
dc.contributor.authorSerna-Berna, Alfredo
dc.contributor.authorSalinas-Ramos, Juan
dc.contributor.authorEscolar-Pérez, Pedro Pablo
dc.contributor.authorLuengo-Gil, Ginés
dc.contributor.authorAndreu-Gálvez, Marina
dc.contributor.authorMartínez Alonso, Emma
dc.contributor.authorAlcaraz Baños, Miguel
dc.contributor.departmentBiología Celular e Histología
dc.contributor.otherFacultad de Medicina
dc.date.accessioned2026-02-13T11:34:49Z
dc.date.available2026-02-13T11:34:49Z
dc.date.copyright© 2025 by the authors
dc.date.issued2025-12-02
dc.description.abstractBackground/Objectives: Posterior fossa brain metastases (PFBMs) pose particular risks owing to their proximity to the brainstem and fourth ventricle. We evaluated the safety (treatment-related complications), local effectiveness, and procedural efficiency of volumetric modulated arc therapy (VMAT)-based stereotactic radiosurgery (VMAT-SRS) for PFBMs. Methods: This single-centre, retrospective study derived a PFBM subgroup from an overall institutional cohort of 123 patients treated with VMAT-RapidArc SRS/fSRS. The doses were 12–20 Gy (single fraction) or 5 × 6 Gy (selected cases). Local response (mRECIST) and predefined safety endpoints (symptomatic oedema with brainstem/IV-ventricle compromise, obstructive hydrocephalus, haemorrhagic transformation, CSF diversion, and urgent neurosurgery) were assessed. Overall survival and procedural time were analysed. Results: Thirty-one patients (39 lesions) were included; 76.9% of them received single-fraction SRS. In addition, 74.2% of patients had supratentorial metastases with posterior fossa involvement. Kaplan–Meier overall survival at 6, 12, 24, and 48 months was 74%, 58%, 26%, and 9.7%, respectively; the median survival time was 12.6 months. Among evaluable lesions, local control was 84.5% (per-lesion response: 15.5% PD, 28.1% SD, 34.4% PR, and 22.0% CR). No clinically significant posterior fossa local complications were observed. Three patients developed radiation-induced leukoencephalopathy after whole-brain radiotherapy (WBRT) and radiosurgery for synchronous supratentorial metastases. The median procedural time was 25.0 min (IQR 9.0) with one isocentre versus 52.5 min (IQR 9.75) with two. Conclusions: VMAT-SRS/fSRS for PFBMs achieved high local control, very low posterior fossa toxicity, and favourable procedural efficiency, supporting its use as a safe, rapid, frameless alternative to WBRT and other radiosurgical platforms such as Gamma Knife in appropriately selected patients.
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dc.identifier.citationJ. Clin. Med. 2025, 14, 8540
dc.identifier.doihttps://doi.org/10.3390/JCM14238540
dc.identifier.eissn2077-0383
dc.identifier.urihttp://hdl.handle.net/10201/204981
dc.languageeng
dc.publisherMDPI
dc.relationThis research was carried out using institutional resources. Publication costs were supported by internal funds from the Genetics, Molecular Pathology and Rare Diseases Research Group at the Catholic University of San Antonio (UCAM).
dc.relation.publisherversionhttps://www.mdpi.com/2077-0383/14/23/8540
dc.rightsAttribution 4.0 International*
dc.rights.accessRightsinfo:eu-repo/semantics/openAccess
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectPosterior fossa metastases
dc.subjectVMAT
dc.subjectStereotactic radiosurgery
dc.subjectComplications
dc.subjectLocal control
dc.subjectBrainstem
dc.subjectProcedure time
dc.subjectNeuro-oncology
dc.subject.odsObjetivo 3: Salud
dc.titleSafety and effectiveness of volumetric modulated arc therapy-based stereotactic radiosurgery for posterior fossa brain metastases: a single-centre experience
dc.typeinfo:eu-repo/semantics/article
dc.type.versioninfo:eu-repo/semantics/publishedVersion
dspace.entity.typePublicationes
relation.isAuthorOfPublication3fd5eb36-2d6e-4f9e-8e3f-fa44f8982697
relation.isAuthorOfPublication2e41afa5-fcbc-4bba-8b0f-6de98bb63713
relation.isAuthorOfPublication.latestForDiscovery3fd5eb36-2d6e-4f9e-8e3f-fa44f8982697
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