PATTERNS OF RELAPSE AND LATE TOXICITY AFTER RESECTION AND WHOLE-BRAINRADIOTHERAPY FOR SOLITARY BRAIN METASTASES

Background: This retrospective analysis was performed in order to eval uate the pattern of relapse and the risk of late toxicity for solitary brain metastases treated with surgery and whole-brain radiotherapy an d to correlate the results with those from radiosurgical trials. Patie nts and Methods: From a total of 66 patients, 52 received 10 x 3 Gy an d 10 were treated with 20 x 2 Gy whole-brain radiotherapy after resect ion of their brain metastases. Results: The actuarial probability of r elapse was 27% and 55% after 1 and 2 year(s), respectively. The local relapse rate (at the original site of resected brain metastases) was r ather high for melanoma, non-breast adenocarcinoma, and squamous-cell carcinoma. No local relapse occurred in breast cancer and small-cell c arcinoma. Failure elsewhere in the brain seemed to be influenced by ex tracranial disease activity. Size of brain metastases and total dose s howed no correlation with relapse rate. Occurrence of brain relapse wa s not associated with a reduced survival time, because 10/15 patients who developed a relapse received salvage therapy. Of the patients, 11 had symptoms of late radiation toxicity (the actuarial probability was 42% after 2 years). Conclusions: Most results of surgical and radiosu rgical studies are comparable to ours. Several randomized trials inves tigate surgical resection versus radiosurgery, as well as the effects of additional whole-brain radiotherapy in order to define the treatmen t of choice. Some data support the adjuvant application of 10 x 3 Gy o ver 2 weeks as a reasonable compromise when local control, toxicity, a nd treatment time have to be considered.