Stereotactic Radiosurgery for the Definitive, Noninvasive Treatment of Brain Metastases

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...

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Bibliographic Details
Published in:JNCI : Journal of the National Cancer Institute 1995-01, Vol.87 (1), p.34-40
Main Authors: Alexander, Eben, Moriarty, Thomas M., Davis, Roger B., Wen, Patrick Y., Fine, Howard A., Black, Peter M., Kooy, Hanne M., Loeffler, Jay S.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Analysis of Variance
Biological and medical sciences
Brain
Brain Neoplasms - radiotherapy
Brain Neoplasms - secondary
Brain Neoplasms - surgery
Cancer
Female
Humans
Male
Medical research
Medical sciences
Middle Aged
Neurosurgery
Radiosurgery
Radiotherapy Dosage
Radiotherapy, Adjuvant
Retrospective Studies
Skull, brain, vascular surgery
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Survival Analysis
Treatment Outcome
Tumors
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Summary: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
ISSN:0027-8874
1460-2105
DOI:10.1093/jnci/87.1.34