Microsurgery plus whole brain irradiation versus Gamma Knife surgery alone for treatment of single metastases to the brain: a randomized controlled multicentre phase III trial

Muacevic, Alexander; Wowra, Berndt; Siefert, Axel; Tonn, Joerg‐Christian; Steiger, Hans‐Jakob; Kreth, Friedrich W.

doi:10.1007/s11060-007-9510-4

Cited by 307 publications

(156 citation statements)

References 35 publications

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“…5,34,38,42 Furthermore, the rate was comparable to those in previous reports of patients with a single metastasis treated via surgery and adjuvant SRS or WBRT. 8,15,18,26,32 In a recent review of literature on the use of SRS to the tumor bed following resection of a single intracranial metastasis, Gans et al reviewed 14 studies comprising 629 patients who had undergone resection followed by SRS. The authors reported a median survival of 14 months with a 1-year local control rate of 85%.…”

Section: Discussionmentioning

confidence: 99%

“…Although WBRT may, in theory, suppress micrometastatic lesions outside the field of SRS, it has not been shown to improve mortality. 26,42 In light of the significant neurocognitive sequelae associated with WBRT, we now favor SRS as adjuvant treatment for intracranial metastatic lesions. Our stratified analysis demonstrated a significant correlation between female sex and increased survival, which probably reflects the increased incidence of primary breast malignancy in females.…”

Section: Discussionmentioning

confidence: 99%

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Survival after surgery and stereotactic radiosurgery for patients with multiple intracranial metastases: results of a single-center retrospective study

Smith¹,

Lall²,

Lall³

et al. 2014

JNS

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Object Patients with systemic cancer and a single brain metastasis who undergo treatment with resection plus radiotherapy live longer and have a better quality of life than those treated with radiotherapy alone. Historically, whole-brain radiotherapy (WBRT) has been the mainstay of radiation therapy; however, it is associated with significant delayed neurocognitive sequelae. In this study, the authors looked at survival in patients with single and multiple intracranial metastases who had undergone surgery and adjuvant stereotactic radiosurgery (SRS) to the tumor bed and synchronous lesions. Methods The authors retrospectively reviewed the records from an 8-year period at a single institution for consecutive patients with brain metastases treated via complete resection of dominant lesions and adjuvant radiosurgery. The cohort was analyzed for time to local progression, synchronous lesion progression, new intracranial lesion development, systemic progression, and overall survival. The Kaplan-Meier method (stratified by age, sex, tumor histology, and number of intracranial lesions prior to surgery) was used to calculate both progression-free and overall survival. A Cox proportional-hazards regression model was also fitted with the number of intracranial lesions as the predictor and survival as the outcome controlling for disease severity, age, sex, and primary histology. Results The median overall follow-up among the 150-person cohort eligible for analysis was 17 months. Patients had an average age of 46.2 years (range 16–82 years), and 62.7% were female. The mean (± standard deviation) number of intracranial lesions per patient was 2.5 ± 2.3. The mean time between surgery and stereotactic radiosurgery (SRS) was 3.2 ± 4.1 weeks. Primary cancers included lung cancer (43.3%), breast cancer (21.3%), melanoma (10.0%), renal cell carcinoma (6.7%), and colon cancer (6.7%). The average number of isocenters per treated lesion was 7.6 ± 6.6, and the average treatment dose was 17.8 ± 2.8 Gy. One-year survival for patients in this cohort was 52%, and the 1-year local control rate was 77%. The median (±standard error) overall survival was 13.2 ± 1.9 months. There was no difference in survival between patients with a single lesion and those with multiple lesions (p = 0.319) after controlling for age, sex, and histology of primary tumor. Patients with primary breast histology had the greatest overall median survival (22.9 ± 6.2 months); patients with colorectal cancer had the shortest overall median survival (5.3 ± 1.8 months). The most common cause of death in this series was systemic progression (79%). Conclusions These results confirm that 1-year survival for patients with multiple intracranial metastases treated with resection followed by SRS to both the tumor bed and synchronous lesions is similar to established outcomes for patients with a single intracranial metastasis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Survival after surgery and stereotactic radiosurgery for patients with multiple intracranial metastases: results of a single-center retrospective study

Smith¹,

Lall²,

Lall³

et al. 2014

JNS

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“…Patients aged between 18 and 80 years harboring a single, resectable metastasis ≤ 3 cm in diameter, a KPS ≥ 70, and a stable systemic disease were randomly assigned to microsurgery plus WBRT or gamma knife surgery alone. Local control rates at 1 year were 82% in the combined group and 96.8% in the radiosurgery group [35]. Therefore, there is no evidence of superiority of a surgical approach over SRS.…”

Section: Metastasesmentioning

confidence: 95%

Stereotactic radiosurgery (SRS) and stereotactic radiation therapy (SRT) for neurooncological and neurological diseases: state of the art and future perspectives

Münter

Welker

Jensen

et al. 2013

Innovative Neurosurgery

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Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) are well established in a high number of neurooncological and neurological lesions. Modern technologies discussed in this review, especially the integration of multimodality imaging in the daily clinical routine, will further improve the results of SRS and SRT. Currently, the different technical methods used are comparable regarding the clinical results in different clinical indications. The technological advances allow high treatment flexibility, and therefore, new treatment indications can be established based on the new technologies. In the future, it has to be defined more clearly whether a single fraction, hypofractionated concepts, or fractionated stereotactic radiotherapy is more effective regarding the clinical results and side effects of the therapy. The main area of development for radiosurgery will be stereotactic body radiosurgery. More randomized clinical studies for all possible indications are needed in the next few decades in order to establish radiosurgery more precisely, and also to determine its true value, especially in normal-fractionated radiotherapy. In technological development, the next step has been completed and proton or particle based stereotactic radiosurgery may have increased use in the future.

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“…It offers a noninvasive alternative to surgery in properly selected patients. [1][2][3] Although the majority of patients treated with radiosurgery in Ontario are those with brain metastases from a primary tumor, the clinical indications for radiosurgery are expanding. Encouraging clinical trial results have been reported for the primary treatment of early-stage lung cancer, prostate cancer, liver metastases, bone metastases, and a number of benign tumors.…”

Section: Introductionmentioning

confidence: 99%

Technology Resource Planning in Radiation Oncology: Application of a Needs-Based Analytic Framework to Radiosurgery Planning in Ontario

Greenspoon

O’Reilly²,

Wright³

et al. 2012

JOP

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Purpose: With the emergence of radiosurgery as a new radiotherapeutic technique, health care decision makers are required to allocate capital radiotherapy resources to meet both current and future radiosurgery requirements. The goal of this article is to demonstrate the feasibility of applying an explicit, needs-based model to resource planning in radiation oncology. Methods:Using an analytic model that relates radiosurgery need to population size, epidemiology, level of service planned, and productivity, the current radiosurgical need for single brain metastases in Ontario was estimated. The model was populated using Ontario-specific data where possible and supplemented with information from the published literature. Multiway sensitivity analyses were performed to calculate the minimum and maximum technology requirements. Results:The calculated number of full-time radiosurgical units required to treat patients with single brain metastases in Ontario was 5.9. Sensitivity analyses performed varying both level of service planned and productivity yielded a range of requirements from 2.5 to 12.2 full-time radiosurgery units. Conclusion:We have shown through the example of single brain metastases in Ontario that it is feasible to perform explicit, needs-based resource planning in radiation oncology. As the availability of new specialized technology increases, health care decision makers may use this approach to ensure the needs of their population are met while maximizing productivity and minimizing opportunity cost.

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Microsurgery plus whole brain irradiation versus Gamma Knife surgery alone for treatment of single metastases to the brain: a randomized controlled multicentre phase III trial

Cited by 307 publications

References 35 publications

Survival after surgery and stereotactic radiosurgery for patients with multiple intracranial metastases: results of a single-center retrospective study

Survival after surgery and stereotactic radiosurgery for patients with multiple intracranial metastases: results of a single-center retrospective study

Stereotactic radiosurgery (SRS) and stereotactic radiation therapy (SRT) for neurooncological and neurological diseases: state of the art and future perspectives

Technology Resource Planning in Radiation Oncology: Application of a Needs-Based Analytic Framework to Radiosurgery Planning in Ontario

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