Surgery versus radiosurgery in the treatment of brain metastasis

Abstract

Surgery and radiosurgery are effective treatment modalities for brain metastasis. To compare the results of these treatment modalities, the authors followed 13 patients treated by radiosurgery and 62 patients treated by surgery who were retrospectively matched. Patients were matched according to the following criteria: histological characteristics of the primary tumor, extent of systemic disease, preoperative Karnofsky Performance Scale score, time to brain metastasis, number of brain metastases, and patient age and sex. For patients treated by radiosurgery, the median size of the treated lesion was 1.96 cm3 (range 0.41-8.25 cm3) and the median dose was 20 Gy (range 12-22 Gy). The median survival was 7.5 months for patients treated by radiosurgery and 16.4 months for those treated by surgery; this difference was found to be statistically significant using both univariate (p = 0.0018) and multivariate (p = 0.0009) analyses. The difference in survival was due to a higher rate of mortality from brain metastasis in the radiosurgery group than in the surgery group (p < 0.0001) and not due to a difference in the rate of death from systemic disease (p = 0.28). Log-rank analysis showed that the higher mortality rate found in the radiosurgery group was due to a greater progression rate of the radiosurgically treated lesions (p = 0.0001) and not due to the development of new brain metastasis (p = 0.75). On the basis of their data, the authors conclude that surgery is superior to radiosurgery in the treatment of brain metastasis. Patients who undergo surgical treatment survive longer and have a better local control. The data lead the authors to suggest that the indications for radiosurgery should be limited to surgically inaccessible metastatic tumors or patients in poor medical condition. Surgery should remain the treatment of choice whenever possible.

Stereotactic radiosurgical treatment of brain metastases in older patients

“…Similar general findings have been noted in prospective trials of WBRT, alone or with SRS, 8,13 in retrospective trials, 5,7,10,11 and in retrospective surgical series. 16 In the current series, only the number of brain metastases (single vs multiple) was found to be an independent prognostic factor of survival.…”

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

“…Studies are conflicting regarding the use of SRS in groups of brain metastasis patients with differing primaries. 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.…”

Intracranial microcapsule chemotherapy delivery for the localized treatment of rodent metastatic breast adenocarcinoma in the brain

“…The treatment of brain metastases is often multimodal, with surgery, whole-brain radiotherapy (WBRT), stereotactic radiosurgery, and chemotherapy all playing a role (18,19). The selection of specific modalities of treatment is dependent on patientspecific factors, such as number, size, and location of metastases, patient's overall health and prognosis, and degree of symptoms attributable to these metastases.…”