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Radiosurgical treatment of brain metastases in a community oncologic practice
1 Department of Radiation Oncology and Biophysics, Eastern Virginia Medical School, and 2 Neurosurgical Specialists, Inc., Norfolk, VA
Stereotactic radiosurgery (SRS), which delivers a single high dose of radiation to an intracranial target, has been found to improve local control and quality of life in patients with unresectable tumors. We retrospectively analyzed 44 consecutive patients treated with SRS and whole-brain radiation therapy (WBRT) for 71 brain metastases in our largely community-based practice. Exclusion criteria included a Karnofsky performance score < 70, requirement for urgent neurosurgical intervention, largest tumor diameter > 4 cm, and > 4 lesions. Median follow-up was 6.8 months postprocedure. Prior to SRS, 84% of patients had recurrent intracranial disease, 48% had uncontrolled primary disease, and 59% had a single brain metastasis. Median overall survival from time of radiosurgery was 7.3 months. Female sex and lesions £ 2 cm were significantly associated with increased survival (P < 0.05). Local control was 87% and 77% at 6 and 9 months, respectively. Factors associated with improved local control included female sex and radiosensitive cell types (P < 0.05). Systemic progression occurred in 28% of patients at 6 months and 46% at 1 year. Neurological assessment at a median of 6 months revealed 57% of patients with improved or stable neurological symptoms and 30% with increased neurological symptoms, only 14% of which were due to local tumor progression. No mortality was associated with SRS, and morbidity was minimal. This retrospective analysis shows that treatment of unresectable brain metastases with SRS and WBRT in a community-based center is comparable in safety and efficacy with that performed in regional specialty centers.
| Commun Oncol 2004;1:149–158 | full text |  215 kb |