Surgery and radiotherapy compared with gamma knife radiosurgery in the treatment of solitary single cerebral metastases of small diameter

Muacevic, Alexander; Kreth, Friedrich W.; Horstmann, Gerhard A.; Schmid-Elsaesser, Robert; Wowra, Berndt; Steiger, Hans Jakob; Reulen, H. J.

doi:10.3171/jns.1999.91.1.0035

Cited by 260 publications

(126 citation statements)

References 38 publications

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“…Bindal et al 21 noted a significant survival benefit for patients treated with surgical resection compared with SRS, while Auchter et al 22 concluded that SRS was as efficacious as resection. In yet a third study, Muacevic et al 23 found no marked difference in survival. Clearly, further studies are warranted regarding the use of SRS in general and in ovarian carcinoma patients with brain metastases.…”

Section: Discussionmentioning

confidence: 99%

Use of the Radiation Therapy Oncology Group recursive partitioning analysis classification system and predictors of survival in 19 women with brain metastases from ovarian carcinoma

Chen¹,

Lee²,

Barnett³

et al. 2005

Cancer

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Section: Discussionmentioning

confidence: 99%

Use of the Radiation Therapy Oncology Group recursive partitioning analysis classification system and predictors of survival in 19 women with brain metastases from ovarian carcinoma

Chen¹,

Lee²,

Barnett³

et al. 2005

Cancer

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“…While there have been no randomized clinical trials comparing surgery plus SRS or surgery versus SRS, retrospective analyses have shown similar survival improvement between SRS and surgery alone, and the decision to perform surgery or SRS should be made on a case-by-case basis, accounting for symptomaticity, tumor site, size, and surgeon's preference [11,[44][45][46]. O'Neill and colleagues have shown that SRS is more effective at preventing local recurrences (0 %, 0/26) than surgery (27 %, 19/74).…”

Section: Surgery and Stereotactic Radiosurgerymentioning

confidence: 99%

Management of Cerebral Brain Metastasis

2014

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Brain metastasis is associated with a poor overall prognosis, but combination therapies have emerged that may prevent recurrence or serve as palliative therapies. There is a wide range of treatment options for those with 1-3 intracranial metastases and stable disease, including combinations of surgery, whole brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS). Those with few, small metastases may be served well by SRS and adjuvant WBRT, whereas those with larger metastases that are amenable to resection may be treated with surgical excision and adjuvant WBRT. Whole brain radiation alone is reserved for individuals with greater than three brain metastases or unstable disease. A number of studies have been conducted to clarify the optimal treatment regimen for patients with varying intracranial disease. This review aims to synthesize the most current findings pertaining to the neurosurgical treatment of brain metastases.

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“…Another advantage of surgical resection is the pathologic confi rmation of the malignant nature of the lesion. Postoperative radiotherapy has demonstrated a decrease in the recurrence of brain metastases, a decrease in the mortality due to neurological deterioration and a delay in neurologic clinical deterioration [2,3].Radiosurgery has emerged as a non-invasive option to treat patients with 1-3 brain metastases, providing similar local control rates to surgery [4][5][6]. However, no randomised trial has compared the two approaches.…”

mentioning

confidence: 99%

“…Radiosurgery has emerged as a non-invasive option to treat patients with 1-3 brain metastases, providing similar local control rates to surgery [4][5][6]. However, no randomised trial has compared the two approaches.…”

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confidence: 99%

Brain metastases: the need for a more tailored approach in non-small-cell lung cancer patients

Martı́nez

Felip

2012

Clin Transl Oncol

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B rain metastases are quite common in cancer patients and their incidence has increased over the last two decades. That may be due to both improvements in diagnostic methods and longer survival of metastatic patients. The most common primary site for patients with brain metastases is the lung and approximately 20% of patients with non-small-cell lung cancer (NSCLC) will develop brain metastases at some point in the course of their disease.Most patients with brain metastases are symptomatic at diagnosis and their presence should be suspected in any patient with a history of lung cancer who presents with a new neurological sign or symptom. Magnetic resonance imaging is the test of choice for diagnosing brain metastases because of its superior resolution and accuracy compared with computed tomography.Overall, the outcome for NSCLC patients who develop brain metastases remains poor, with an average survival of 3-6 months. A number of prognostic indexes have been proposed and validated with a view to predicting more accurately the prognosis of patients with brain metastases [1]. Essentially, all these index scores help us to better select patients for the different options available to treat brain metastases: surgery, stereotactic radiosurgery, whole brain radiotherapy, chemotherapy and corticosteroids. However, these index scores are less than perfect and more precise prognostic tools are clearly needed.For patients with single or 1-3 brain metastases as the only site of disease, or with systemic disease which can be radically treated, the main objective is to completely eradicate or control the brain lesion. Surgical resection is usually employed for potentially resectable lesions, which are symptomatic and/or affecting silent areas of the brain as surgery can provide immediate relief in patients with a good baseline performance status. Another advantage of surgical resection is the pathologic confi rmation of the malignant nature of the lesion. Postoperative radiotherapy has demonstrated a decrease in the recurrence of brain metastases, a decrease in the mortality due to neurological deterioration and a delay in neurologic clinical deterioration [2,3].Radiosurgery has emerged as a non-invasive option to treat patients with 1-3 brain metastases, providing similar local control rates to surgery [4][5][6]. However, no randomised trial has compared the two approaches. Stereotactic radiosurgery is preferable to open surgery in patients with brain metastases with lesions no greater than 30-35 mm who have no symptomatic oedema or mass effect and those unlikely to achieve complete surgical resection. Whole brain radiotherapy is the standard of care in patients with multiple brain metastases. Several randomised trials have explored different doses and fractions; a total of 30 Gy in 10 fractions is considered appropriate in the majority of patients [7]. In patients with brain metastases and symptomatic extracranial metastatic disease, starting treatment with systemic chemotherapy and delaying whole brain radiotherapy could ...

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Surgery and radiotherapy compared with gamma knife radiosurgery in the treatment of solitary single cerebral metastases of small diameter

Abstract: Radiosurgery alone can result in local tumor control rates as good as those for surgery plus WBRT in selected patients. Radiosurgery should not be routinely combined with radiotherapy.

Cited by 260 publications

References 38 publications

Use of the Radiation Therapy Oncology Group recursive partitioning analysis classification system and predictors of survival in 19 women with brain metastases from ovarian carcinoma

Use of the Radiation Therapy Oncology Group recursive partitioning analysis classification system and predictors of survival in 19 women with brain metastases from ovarian carcinoma

Management of Cerebral Brain Metastasis

Brain metastases: the need for a more tailored approach in non-small-cell lung cancer patients

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