Stereotactic radiosurgery for four or more intracranial metastases

Journal Article · Wed Mar 01 04:00:00 EST 2006 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2005.0· OSTI ID:20793362

Bhatnagar, Ajay K ^[1]; Flickinger, John C ^[2]; Kondziolka, Douglas ^[1]; Lunsford, L Dade ^[1]

---

1. Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States)
2. Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States) and Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States)

Purpose: To evaluate the outcomes after a single stereotactic radiosurgery procedure for the care of patients with 4 or more intracranial metastases. Methods and Materials: Two hundred five patients with primary malignancies, including non-small-cell lung carcinoma (42%), breast carcinoma (23%), melanoma (17%), renal cell carcinoma (6%), colon cancer (3%), and others (10%) underwent gamma knife radiosurgery for 4 or more intracranial metastases at one time. The median number of brain metastases was 5 (range, 4-18) with a median total treatment volume of 6.8 cc (range, 0.6-51.0 cc). Radiosurgery was used as sole management (17% of patients), or in combination with whole brain radiotherapy (46%) or after failure of whole brain radiotherapy (38%). The median marginal radiosurgery dose was 16 Gy (range, 12-20 Gy). The mean follow-up was 8 months. Results: The median overall survival after radiosurgery for all patients was 8 months. The 1-year local control rate was 71%, and the median time to progressive/new brain metastases was 9 months. Using the Radiation Therapy Oncology Group recursive partitioning analysis (RPA) classification system, the median overall survivals for RPA classes I, II, and III were 18, 9, and 3 months, respectively (p < 0.00001). Multivariate analysis revealed total treatment volume, age, RPA classification, and marginal dose as significant prognostic factors. The number of metastases was not statistically significant (p 0.333). Conclusion: Radiosurgery seems to provide survival benefit for patients with 4 or more intracranial metastases. Because total treatment volume was the most significant predictor of survival, the total volume of brain metastases, rather than the number of metastases, should be considered in identifying appropriate radiosurgery candidates.

• OSTI ID: 20793362
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 64; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BRAIN
FAILURES
LARGE INTESTINE
LUNGS
MAMMARY GLANDS
MELANOMAS
METASTASES
MULTIVARIATE ANALYSIS
PATIENTS
RADIOTHERAPY
SURGERY