This study (452 patients harboring 568 lesions) was conducted to determine prognostic factors for tumor response and patient survival after stereotactic radiosurgery for brain metastasis. The metastatic lession was treated with multiple arcs to a median dose of 17 Gy. Surgical resection and whole brain radiotherapy have been the mainstays of the treatment of cerebral metastases. Several recent publications and our own experience suggest that the median survival (10-12 months) can be achieved with stereotactic radiosurgery using the linear accelerator radiosurgical techniques, In addition, radiosurgery can effectively treat metastatic tumors in surgically inaccessible sites, e.g., the brainstem. Radiosurgery can also effectively treat multiple intracranial metastases in widely separated areas of the brain. In fact, we have shown that patients with multiple metastases have similar lengths and qualities of survival as do patients with single metastases treated with stereotactic radiosurgery. The technique has advantages of reduced cost and low morbidity compared with open surgical treatment. A great benefit of radiosurgery is the virtual lack of perioperative complications and the minimal interference with quality of life compared either to surgery or to fractionated whole brain radiotherapy. Even so-called "radioresistant" tumors (e.g., melanoma, renal cell) respond favorable to radiosurgery. The most important predictor of success in radiosurgical treatment of cerebral metastases is the neurological status of the patient, usually expressed as the Karnofsky Performance Status. The histological type of primary cancer is not an outcome predictor. The median survival duration from SRS was 11 months. Long-term complications of radiosurgery are infrequent and primarily relate to failure of local tumor control and radiation-induced edema or necrosis. The later usually can be controlled with corticosteroids, but occasionally, craniotomy may be required to treat life-threatening mass effects. We believe that radiosurgery is the treatment of choice for most cerebral metastases. Only large lesions (> 4 cm diameter) and those which require immediate decompression to treat life-threatening mass effects require surgical treatment. Radiosurgery also may be used to treat residual disease after surgical resection. This study confirms the role of stereotactic radiosurgery as an acceptable treatment option for patients with solitary or limited brain metastases.
|Translated title of the contribution||LINAC-based radiosurgery for the treatment of brain metastases|
|Number of pages||7|
|Publication status||Published - Mar 2007|
ASJC Scopus subject areas