RADIOSURGERY ALONE OR IN COMBINATION WITH WHOLE-BRAIN RADIOTHERAPY FOR BRAIN METASTASES

Purpose: Evaluation of the treatment outcome after radiosurgery (RS) a lone or in combination with whole-brain radiotherapy (WBRT) with speci al attention to prescribed dose and its influence on local control and survival. Patients and Methods: Between September 1984 and January 19 97, 236 patients with 311 brain metastases treated with radiosurgery m et the following inclusion criteria: one to three brain metastases per patient; no previous WBRT; and Karnofsky performance status (KPS) gre ater than or equal to 50%. One,hundred fifty-eight patients treated on ly with RS received a median dose of 20 Gy prescribed to the 80% isodo se line; 78 patients received RS with a median dose of 15 Gy/80% and a n additional course of WBRT. Results: For the entire series, overall m edian survival was 5.5 months, with control of CNS disease achieved in 92% of the treated brain metastases; the results were not significant ly different between patients treated by RS with or without WBRT. Howe ver, in patients without evidence of extracranial disease, median surv ival wets increased for patients who received WBRT (15.4 vs 8.3 months ; P = .08). Additionally, there was a suggestion that increased doses for patients treated with RS only resulted in improved outcome. Four l esions were suspicious for radiation necrosis by magnetic resonance im aging (MRI); in one of the four lesions, radiation necrosis was confir med histologically. the incidence of transient low-grade toxicity was 18%; symptoms could be treated by the temporary administration of ster oids. Conclusion: RS is an effective, noninvasive means of controlling brain metastases when used alone or in combination with WBRT. There i s a trend for superior local control and especially in patients withou t extracranial disease for superior survival when RS is used in conjun ction with WBRT. Randomized trials would seem to be warranted, compari ng the benefit of RS with or without additional WBRT. (C) 1998 by Amer ican Society of Clinical Oncology.