Jc. Breneman et al., STEREOTAXIC RADIOSURGERY FOR THE TREATMENT OF BRAIN METASTASES - RESULTS OF A SINGLE INSTITUTION SERIES, Cancer, 79(3), 1997, pp. 551-557
BACKGROUND. Stereotactic radiosurgery is being used with increasing fr
equency for the treatment of brain metastases. Optimal patient selecti
on and treatment factors continue to be defined. This study provides o
utcome data from a single institutional experience with radiosurgery a
nd identifies parameters that may be useful for the proper selection a
nd treatment of patients. METHODS. Eighty-four patients underwent ster
eotactic radiosurgery for brain metastases between September 1989 and
November 1995. Seventy-nine patients (93%) were treated at recurrence
after previous whole brain radiotherapy. Patients had between 1 and 6
lesions treated with a median minimum tumor dose of 1600 centigrays (c
Gy). Thirty-eight patients (45%) had active extracranial disease at th
e time of radiosurgery. RESULTS. Median survival for the entire group
was 43 weeks from the date of radiosurgery and 71 weeks from the origi
nal diagnosis of brain metastases. Patients with 1 or 2 metastases had
significantly improved survival compared with patients with greater t
han or equal to 3 metastases (P = 0.02), and patients without active e
xtracranial tumor survived longer than those with extracranial disease
(P = 0.03). Median time to failure for 145 evaluable lesions was 35 w
eeks. Local control was significantly improved for radiosurgery doses
of >1800 cGy, and for melanoma histology. CONCLUSIONS. These results a
re comparable to reports of patients treated with resection and signif
icantly superior to results observed after whole brain radiotherapy. T
he authors conclude that stereotactic radiosurgery is an effective, lo
w risk treatment for extending the survival of patients with recurrent
brain metastasis. Although survival is best for patients with less th
an or equal to two lesions and no active extracranial disease, selecte
d patients with >two lesions or active extracranial tumor map benefit
well. (C) 1997 American Cancer Society.