Long-term follow-up for brain metastases treated by percutaneous stereotactic single high-dose irradiation

Abstract

Surgery is considered the treatment of choice for solitary brain lesions, and radiation therapy is indicated for metastases only in vital or sensitive regions that cannot be excised without risk of disabling neurologic defects. In these cases, radiosurgery may be an alternative to conventionally fractionated radiation therapy. At the Heidelberg linear accelerator‐based radiosurgery facility, 69 patients were treated for 102 inoperable brain metastases. The primary tumor sites included non‐small cell lung carcinoma (n = 24), renal cell carcinoma (n = 14), melanoma (skin) (n = 14), colorectal carcinoma (n = 6), carcinoma of unknown primary (n = 4), and others (n = 7). Eleven patients were treated for relapse after surgery or after conventional whole‐brain irradiation. The doses at the isocenter varied from 15–50 Gy (mean, 21.5 Gy). Ten patients with multiple metastases received a planned combination of whole‐brain irradiation plus a single boost of 15 Gy. The median survival time for the entire group was 6 months, with a 1‐year‐survival of 28.3%. Factors associated with significant improvement of survival were brain metastases without other metastatic disease and good response to radiation therapy. Five of 22 patients (22.9%) with metastases located only in the brain survived longer than 2 years. An improvement in neurologic function was found in 81% within a period of 3 months. With imaging techniques, complete remission was found in 20%, partial remission in 35%, stable disease in 40%, and relapse in 5%. The authors concluded that radiosurgery is an effective and safe therapy for brain metastases. It can be applied as primary treatment, as boost in combination with whole‐brain irradiation, or as treatment for patients with relapse in a previously irradiated field.

Management of brain metastases

“…They are generally small, spherical, and minimally invasive, with radiographically distinct margins: all these characteristics are favorable for the dose distribution of SRS. In patients with newly diagnosed brain metastases, a rapid decrease of symptoms, local tumor response ("control") rate of 80-90 % and a median survival of 7-12 months have been reported [3,7,39,44,77,80,115,120]. An homogeneous baseline enhancement and a good initial radiographic response to SRS are good predictors of long-term control [97], whereas a diameter more than 3 cm is a negative prognostic factor [4].…”

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“…Isso significa que 70% dos doentes poderiam ser candidatos à radioterapia focalizada. A radiocirurgia e a radioterapia intersticial são alternativas para o tratamento de doentes com lesões irressecáveis ou recidivadas quando as condições clínicas ou teciduais não possibilitam a realização da cirurgia ou quando há recusa para a sua realização 21,69 . Esses últimos procedimentos proporcionam controle local da lesão em mais de 90% dos casos.…”

Ambulante Radiochirurgie bei zerebral metastasiertem Nierenzellkarzinom Fünfjahresergebnisse von 58 Patienten

“…Die Methode der Strahlenchirurgie zur Behandlung von wenig strahlensensiblen HM wurde von Sturm [33] eingeführt und zwischenzeitlich von vielen anderen Autoren mit Linearbeschleunigern oder GK abgesichert [6,7,10,11,18,25,27]. Gegenüber der konventionellen Kombinationsbehandlung (Operation plus WBRT, evtl.…”

“…Dabei werden v. a. 60 Co-Gamma-Strahler ("Gamma-Knife", GK) und speziell modifizierte Linearbeschleuniger benutzt [6,7,10,11,18,25,27]. Leider besitzen viele bisher veröf-fentlichte Studien methodische Mängel aufgrund kleiner Fallzahlen, der Vermischung von verschiedenen Tumorentitä-ten und der Benutzung uneinheitlicher Dosierungsschemata.…”