Radiosurgery for Large Brain Metastases

• Published in: International journal of radiation oncology, biology, physics Vol. 83; no. 1; pp. 113 - 120
• Main Authors: Han, Jung Ho, M.D, Kim, Dong Gyu, M.D, Chung, Hyun-Tai, Ph.D, Paek, Sun Ha, M.D, Park, Chul-Kee, M.D, Jung, Hee-Won, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2012; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; BRAIN; Brain metastases; Brain Neoplasms - mortality; Brain Neoplasms - pathology; Brain Neoplasms - secondary; Brain Neoplasms - surgery; Female; HAZARDS; Hematology, Oncology and Palliative Medicine; Humans; Karnofsky Performance Status; Male; Medical sciences; MEN; METASTASES; Middle Aged; Multivariate Analysis; NEOPLASMS; Neurology; Outcome; PATIENTS; RADIATION DOSES; Radiation Injuries - etiology; Radiation Injuries - pathology; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radiosurgery; Radiosurgery - adverse effects; Radiosurgery - methods; Radiosurgery - mortality; RADIOTHERAPY; Radiotherapy Dosage; Retrospective Studies; SURGERY; Survival; Survival Rate; SURVIVAL TIME; SYMPTOMS; TOXICITY; Tumor Burden; Tumors of the nervous system. Phacomatoses; Brain metastases; Survival; Surgery; Outcome; Radiosurgery; Nervous system diseases; Prognosis; Brain cancer; Malignant tumor; Radiotherapy; Cerebral metastasis; Cerebral disorder; Cancerology; Treatment; Central nervous system disease; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2011.06.1965

Purpose To determine the efficacy and safety of radiosurgery in patients with large brain metastases treated with radiosurgery. Patients and Methods Eighty patients with large brain metastases (>14 cm3 ) were treated with radiosurgery between 1998 and 2009. The mean age was 59 ± 11 years, and 49 (61.3%) were men. Neurologic symptoms were identified in 77 patients (96.3%), and 30 (37.5%) exhibited a dependent functional status. The primary disease was under control in 36 patients (45.0%), and 44 (55.0%) had a single lesion. The mean tumor volume was 22.4 ± 8.8 cm3 , and the mean marginal dose prescribed was 13.8 ± 2.2 Gy. Results The median survival time from radiosurgery was 7.9 months (95% confidence interval [CI], 5.343–10.46), and the 1-year survival rate was 39.2%. Functional improvement within 1–4 months or the maintenance of the initial independent status was observed in 48 (60.0%) and 20 (25.0%) patients after radiosurgery, respectively. Control of the primary disease, a marginal dose of ≥11 Gy, and a tumor volume ≥26 cm3 were significantly associated with overall survival (hazard ratio, 0.479; p = .018; 95% CI, 0.261–0.880; hazard ratio, 0.350; p  = .004; 95% CI, 0.171–0.718; hazard ratio, 2.307; p = .006; 95% CI, 1.274–4.180, respectively). Unacceptable radiation-related toxicities (Radiation Toxicity Oncology Group central nervous system toxicity Grade 3, 4, and 5 in 7, 6, and 2 patients, respectively) developed in 15 patients (18.8%). Conclusion Radiosurgery seems to have a comparable efficacy with surgery for large brain metastases. However, the rate of radiation-related toxicities after radiosurgery should be considered when deciding on a treatment modality.