STEREOTAXIC RADIOSURGERY FOR METASTATIC BRAIN-TUMORS

We report on a prospective phase TI study utilizing stereotactic radio surgery for patients with intracranial parenchymal metastases. Fifty p atients ranging in age from 38 to 77 years with 1 to 3 intraparenchyma l brain metastases were treated with stereotactic radiosurgery either immediately following whole brain radiotherapy or at the time of intra cranial disease progression following failure of whole brain radiother apy. Twenty patients treated with adjuvant therapy received a median r adiosurgical dose of 20 Gy. Thirty patients treated with salvage thera py received a median radiosurgical dose of 20 Gy. No immediate neuroto xicity was seen following radiosurgery however, 4 patients (8%) develo ped symptomatic radiation necrosis. Median survival was 6.5 and 6.0 mo nths for patients treated with adjuvant and salvage radiosurgery respe ctively. In patients with oligometastatic brain metastases manifesting intracranial disease progression after whole brain radiotherapy, salv age radiotherapy appears to offer improved palliation when compared to retreatment with whole brain radiotherapy. The results of patients tr eated with up-front adjuvant radiosurgery when compared to historical controls treated with whole brain radiotherapy only are less clear as to benefit and require a phase III study before definitive recommendat ions can be made.