First treatment for brain metastases by stereotactic radiosurgery

Local central of brain metastases is better with first treatment by stereot actic radiosurgery than with radiosurgery for recurrence We reported a retr ospective analysis of the influence of clinical and technical factors on lo cal control ann survival after radiosurgery realised in first intention. Fr om January 1994 to December 1997, 26 patients presenting with 43 metastases underwent radiosurgery. The median age was 61 years and the median Karnofs ky index 70. Primary sites included: lung (12 patients), kidney (7 patients ), breast (2 patients), colon (1 patient), melanoma (2 patients), osteosarc oma (1 patient), it was unknown for one patient. Seven patients had extracr anial metastases. Twenty-one sessions of radiosurgery have been realized fo r one metastase, and 9 for two, three or four lesions. The median diameter runs 21 mm ann the median volume 1.8 cm(3). The median peripheral dose to t he lesion was 14 Gy, and the median nose at the isocenter 20 Gy. Forty-two metastases were evaluable for response analysis. The overall local control rate was 90.5% and the 1-year, 2- and 3-year actuarial rates were 85% and 7 5%. In univariate analysis, theorical radioresistance was significantly ass ociated with better local control (100% versus 77%, P < 0.05). All patients were evaluable for survival. The median survival rate was 15 months. Four patients had a symptomatic oedema (RTOG grade II). Two lesions have require d a surgical excision. In conclusion, low dose radiosurgery (14 Gy delivere d at the periphery of metastasis) can be proposed in first intention for br ain metastases, in particulary for theorical radioresistant lesions.