© 1995 by Oxford University Press
Journal of the National Cancer Institute, Vol. 87, No. 1, 34-40,
January 4, 1995
© 1995 Oxford University Press
Stereotactic Radiosurgery for the Definitive, Noninvasive Treatment of Brain Metastases
*The Brain Tumor Center of the Brigham and Women's Hospital, Children's Hospital, and Dana-Farber Cancer Institute, the Joint Center for Radiation Therapy, and the Departments of Surgery (Neurosurgery) and Radiation Oncology, Harvard Medical School Boston, Mass
1The Brain Tumor Center of the Brigham and Women's Hospital, Children's Hospital, and Dana-Farber Cancer Institute, and the Department of Surgery (Neurosurgery), Harvard Medical School
2Division of General Medicine, Beth Israel Hospital and the Harvard School of Public Health Boston
3The Brain Tumor Center of the Brigham and Women's Hospital, Children's Hospital, and Dana-Farber Cancer Institute, and Department of Medicine, Harvard Medical School
4The Brain Tumor Center of the Brigham and Women's Hospital, Children's Hospital, and Dana-Farber Cancer Institute, the Joint Center for Radiation Therapy, and Department of Radiation Oncology, Harvard Medical School
Correspondence to: Eben Alexander III, M.D., Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.
Background: The spread of systemic cancer to the brain is a common complication for cancer patients. Conventional radiotherapy offers modest palliation, and surgery is helpful only for the patient with a single metastasis in an accessible location. Stereotactic radiosurgery, a technique that permits the precise delivery of a high dose of radiation to a small in-tracranial target while sparing the surrounding normal brain, has been used as an alternative treatment for brain metastases. Purpose: Our medical center's 7-year experience with radiosurgery for metastases was reviewed to establish the effectiveness of the treatment and to understand the prognoses in patients so treated. Methods: Retrospective analysis of hospital records, from 248 consecutive patients (421 lesions) that were treated with radiosurgery between May 1986 and May 1993, was performed. Patients were only excluded for a Karnofsky performance score of less than 70, evidence of acute neurologic deterioration, or tumor diameter more than 4 cm. Median follow-up was 26.2 months. Seventy-six percent of patients had recurrent disease, 69% had evidence of systemic disease, 69% had a single metastasis. Treatment was performed using a 6-MeV linear accelerator. The median tumor volume was 3 cm3. The median treatment dose was 1500 cGy. Whole brain radiotherapy was given to all newly diagnosed patients. Patients were followed by neurological examination and neuroimaging at regular intervals. Local control of disease was defined as a lack of progression of solid-contrast enhancement on computed tomography scan or magnetic resonance imaging. Results: Median overall survival from radiosurgery was 9.4 months. The absence of active systemic disease, younger than 60 years of age, two or fewer lesions, and female sex were significantly associated with increased survival (two-sided P<.05). Actuarial local control rates were approximately 85% at 1 year and 65% at 2 years. Factors associated with a significantly decreased local control rate were location below the tentorium, recurrent tumor, and larger tumor volume (two-sided P<.05). Radioresponsive and radioresistant tumor types had similar control rates. The median drop in Karnofsky performance score at 1 year was 10%. Conclusions: The results of this retrospective analysis show that radiosurgery is an effective, minimalty invasive outpatient treatment option for small intracranial metastases. Results of this study also indicate that radiosurgery not only provides local control rates equivalent to these from surgical series but is also effective in treating patients with surgically inaccessible lesions, with multiple lesions, or with tumor types that are resistant to conventional treatment. [J Natl Cancer Inst 87: 34-40, 1995]
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