SURGERY VERSUS RADIOSURGERY IN THE TREATMENT OF BRAIN METASTASIS

Surgery and radiosurgery are effective treatment modalities for brain metastasis. To compare the results of these treat ment modalities, the authors followed 31 patients treated by radiosurgery and 62 patients treated by surgery who were ret respectively matched. Patients were ma tched according to the following criteria: histological characteristic s of the primary tumor, extent of systemic disease, preoperative Karno fsky Performance Scale score, time to brain metastasis, number of brai n metastases, and patient age and sex. For patients treated by radiosu rgery, the median size of the treated lesion was 1.96 cm(3) (range 0.4 1-8.25 cm(3)) and the median dose was 20 Gy (range 12-22 Gy). The medi an survival was 7.5 months for patients treated by radiosurgery and 16 .4 months for those treated by surgery; this difference was found to b e statistically significant using both univariate (p = 0.0018) and mul tivariate (p = 0.0009) analyses. The difference in survival was due to a higher rate of mortality from brain metastasis in the radiosurgery group than in the surgery group (p < 0.0001) and not due to a differen ce in the rate of death from systemic disease (p = 0.28). Log-rank ana lysis showed that the higher mortality rate found in the radiosurgery group was due to a greater progression rate of the radiosurgically tre ated lesions (p = 0.0001) and not due to the development of new brain metastasis (p = 0.75). On the basis of their data, the authors conclud e that surgery is superior to radiosurgery in the treatment of brain m etastasis. Patients who undergo surgical treatment survive longer and have a better local control. The data lead the authors to est that the indications for radiosurgery should be limited to surgically inaccess ible metastatic tumors or patients in poor medical condition. Surgery should remain the treatment of choice whenever possible.