The role of radiosurgery for multiple brain metastases

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors evaluated the role of stereotactic radiosurgery (SRS) in patients with multiple brain metastases by analyzing prognostic factors that predict survival.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Between March 1991 and January 1999, 83 patients with multiple brain metastases underwent SRS in which they used a 6 mV linear accelerator. The median radiation dose of 15 Gy (range 6–50 Gy) was delivered to the 40 to 90% (median 87%) isodose line encompassing the target. Actuarial overall survival was calculated from the date of SRS by using the Kaplan–Meier method. Univariate comparisons of survival between different groups were performed using a log-rank test. All 83 patients were included in the calculation of overall survival. Actuarial overall survival was 22% at 1 year and 13% at 2 years, and a median survival of 5.4 months (range, 0.3–28.8 months) was demonstrated. Variables that predicted survival were Karnofsky Performance Scale (KPS) score, extracranial disease status, and the number of intracranial metastases. Median survival in patients with a KPS score greater than as compared with less than 70 was 9.1 and 2.7 months, respectively (p = 0.002). Median survival when comparing absence and presence of extracranial disease was 9.9 and 4.1 months, respectively (p = 0.02). Median survival in patients harboring two, three, or four or more lesions was 6.6 months, 5.4 months, and 2.7 months, respectively (p = 0.02). In patients with a KPS score greater than or equal to 70 and with three or fewer lesions, median survival was 7 months or longer. In patients with four or more lesions median survival was 7.4 months for those with no extracranial disease and 2.4 months for those with extracranial disease. Other variables tested (sex, histological tumor type, previous resection, location of metastases, treatment modality, and tumor status) did not influence outcome.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The absence of extracranial disease, a KPS score greater than or equal to 70, and fewer number of metastases were shown to be significant predictors of longer survival. Stereotactic radiosurgery appears to be a reasonable therapeutic option in patients with up to three lesions when their KPS score is greater than or equal to 70, regardless of extracranial disease status. In those with four or more metastases, however, SRS should be limited to those with no extracranial disease.</jats:p></jats:sec>

Stereotactic radiosurgical treatment of brain metastases in older patients

“…5,7,8,10,11,[13][14][15] Among those factors, there is a consensus regarding the survival benefit with single brain metastases compared with multiple lesions. The University of Minnesota published a retrospective review of 729 patients with brain metastases treated over a 20-year period.…”

Incidence, timing, and treatment of new brain metastases after Gamma Knife surgery for limited brain disease: the case for reducing the use of whole-brain radiation therapy

“…Only 12% of patients in our series died of progressive neurological disease, which is comparable to the reported rates from other SRS series (4%-43%). [2][3][4]6,13,15,16,25,[27][28][29][30][31]33,35,36,52,56,59,61,63,64,66…”

A Simple and Practical Scoring System for Radiosurgical Treatment in Patients with Brain Metastases

“…We acknowledge that our study is retrospectively designed and, therefore, has the inherent limitation of potential selection bias because only the patients with ≤10 BMs visible on screening MRI and KPS ≥60 can be considered as candidates for stereotactic radiosurgery in cases of newly diagnosed BMs according to our national health insurance service. However, stereotactic radiosurgery has become the preferred primary treatment for oligo-metastatic brain tumors among various available treatment modalities and may be considered as a safe and effective treatment option in selected patients with multiple BMs although not supported by randomized controlled studies [23][24][25][26][27]. Although this study could have a selection bias and our results should be further validated within larger cohorts and prospective designs, our simple and practical scoring system, the PIBM, could be useful to predict survival time and inform appropriate manage-ment of patients with BMs in current clinical practice.…”