A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis

John C. Flickinger, Douglas Kondziolka, L. Dade Lunsford, Robert J. Coffey, Michael L. Goodman, Edward G. Shaw, W. Robert Hudgins, Richard Weiner, Griffith R. Harsh IV, Penny K. Sneed, David A. Larson

Research output: Contribution to journalArticlepeer-review

560 Scopus citations

Abstract

Purpose: A multi-institutional experience in radiosurgery for solitary brain metastases was combined to identify factors associated with safety, efficacy, tumor control, and survival. Materials and Methods: A review of 116 patients with solitary brain metastases who underwent gamma knife stereotactic radiosurgery at five institutions was performed. The median follow-up was 7 months following radiosurgery and 12 months following diagnosis. Minimum tumor doses varied from 8-30 Gy (mean, 17.5 Gy). Forty-five patients failed prior radiotherapy and 71 had no prior brain irradiation. Fifty-one patients had radiosurgery alone and 65 underwent combined radiosurgery with fractionated large-field radiotherapy (mean dose, 33.8 Gy). Results: Median survival was 11 months after radiosurgery and 20 months after diagnosis. Follow-up documented local tumor control in 99 patients (85%), tumor recurrence in 17 (15%), and documented radiation necrosis in one (1%). The 2-year actuarial tumor control rate was 67 ± 8%. Tumor histology affected survival (better for breast cancer, p = .004) and local control (better for melanoma and renal cell, p = .0003) in multivariate analyses. Combined fractionated radiotherapy and radiosurgery improved local control (p = .0111), but not survival in multivariate testing. Conclusion: Radiosurgery is effective in controlling solitary brain metastases with low morbidity. Further study is needed to better define optimum treatment parameters for radiosurgery.

Original languageEnglish (US)
Pages (from-to)797-802
Number of pages6
JournalInternational journal of radiation oncology, biology, physics
Volume28
Issue number4
DOIs
StatePublished - Mar 1 1994
Externally publishedYes

Keywords

  • Metastases
  • Radiosurgery
  • Stereotactic

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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