Stereotactic Radiosurgery in the Treatment of Metastatic Disease to the Brain

Authors: Joseph C.T. Chen, Zbigniew Petrovich, Steven O'Day, et al.
Source: Neurosurgery, Volume 47:268-281, (August) 2000

Introduction

Whole brain radiation therapy (WBRT) has been the standard care for the majority of patients with brain metastasis. However, the outcome of these patients has been dismal due to both local and systemic failure. In this study, the researchers reported the outcome of patients with brain metastasis who underwent gamma knife stereotactic radiosurgery.

Method

A total of 190 patients who underwent gamma knife stereotactic radiosurgery for intracerebral metastatic tumors were included.

Results

• Median survival after radiosurgery was 34 weeks.
• Median survival was significantly longer in patients with controlled systemic disease (>50 weeks) than with active systemic disease (28 weeks).
• 6% of treated lesions demonstrated late recurrence (>6 months after treatment) and 6% of lesions showed continued tumor progression despite radiosurgical treatment.

Discussion

In this study, stereotactic radiosurgery slowed progression and improved survival in some patients with metastatic disease to the brain. Two randomized trials from the Radiation Therapy Oncology Group (RTOG) and Brown University recently presented at the Annual Meeting of American Society for Therapeutic Radiology and Oncology (ASTRO) showed stereotactic boost following WBRT in patients with 2-3 brain lesions slightly improved local tumor control and quality of life but had no impact on survival. Further study will be required to identify subgroups of patients who may benefit the most from this therapy.