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Title: Stereotactic radiosurgery for four or more intracranial metastases

Abstract

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,more » 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.« less

Authors:
 [1];  [2];  [1];  [3];  [1];  [3]
  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). E-mail: flickingerjc@upmc.edu
  3. (United States)
Publication Date:
OSTI Identifier:
20793362
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 64; Journal Issue: 3; Other Information: DOI: 10.1016/j.ijrobp.2005.08.035; PII: S0360-3016(05)02580-0; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRAIN; FAILURES; LARGE INTESTINE; LUNGS; MAMMARY GLANDS; MELANOMAS; METASTASES; MULTIVARIATE ANALYSIS; PATIENTS; RADIOTHERAPY; SURGERY

Citation Formats

Bhatnagar, Ajay K., Flickinger, John C., Kondziolka, Douglas, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, Lunsford, L. Dade, and Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA. Stereotactic radiosurgery for four or more intracranial metastases. United States: N. p., 2006. Web. doi:10.1016/J.IJROBP.2005.0.
Bhatnagar, Ajay K., Flickinger, John C., Kondziolka, Douglas, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, Lunsford, L. Dade, & Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA. Stereotactic radiosurgery for four or more intracranial metastases. United States. doi:10.1016/J.IJROBP.2005.0.
Bhatnagar, Ajay K., Flickinger, John C., Kondziolka, Douglas, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, Lunsford, L. Dade, and Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA. Wed . "Stereotactic radiosurgery for four or more intracranial metastases". United States. doi:10.1016/J.IJROBP.2005.0.
@article{osti_20793362,
title = {Stereotactic radiosurgery for four or more intracranial metastases},
author = {Bhatnagar, Ajay K. and Flickinger, John C. and Kondziolka, Douglas and Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA and Lunsford, L. Dade and Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA},
abstractNote = {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.},
doi = {10.1016/J.IJROBP.2005.0},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 3,
volume = 64,
place = {United States},
year = {Wed Mar 01 00:00:00 EST 2006},
month = {Wed Mar 01 00:00:00 EST 2006}
}