A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis

Richard M Auchter; John P Lamond; Eben Alexander; John M Buatti; Rick Chappell; William A Friedman; Timothy J Kinsella; Allan B Levin; William R Noyes; Christopher J Schultz; Jay S Loeffler; Minesh P Mehta

doi:10.1016/S0360-3016(96)85008-5

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A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis

Journal article

Peer reviewed

A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis

Richard M Auchter, John P Lamond, Eben Alexander, John M Buatti, Rick Chappell, William A Friedman, Timothy J Kinsella, Allan B Levin, William R Noyes, Christopher J Schultz, …

International journal of radiation oncology, biology, physics, Vol.35(1), pp.27-35

1996

DOI: 10.1016/S0360-3016(96)85008-5

PMID: 8641923

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Abstract

Purpose : Recent randomized trials of selected patients with single brain metastasis comparing resection followed by whole-brain radiotherapy (WBRT) to WBRT alone have shown a statistically significant survival advantage for surgery and WBRT. A multiinstitutional retrospective study was performed, which identified comparable patients who were treated with stereotactic radiosurgery (RS) and WBRT. Methods and Materials : The RS databases of four institutions were reviewed to identify patients who met the following criteria: single-brain metastasis; no prior cranial surgery or WBRT; age > 18 years; surgically resectable lesion; Karnofsky Performance Status (KPS) ≥ 70 at time of RS; nonradiosensitive histology. One hundred twenty-two patients were identified who met these criteria. Patients were categorized by: (a) status of the primary, (b) status of non-CNS metastasis, (c) age, (d) baseline KPS (from 70–100), (e) histology, (f) time from diagnosis of primary to the detection of the brain metastasis, (g) gender, and (h) tumor volume. RS was performed with a linear accelerator based technique (peripheral dose range was 10–27 Gy, median was 17 Gy). WBRT was performed in all but five patients who refused WBRT (dose range was 25–40 Gy, median was 37.5 Gy). Results : The median follow-up for all patients was 123 weeks. The overall local control rate (defined as lack of progression in the RS volume) was 86%. Intracranial recurrence outside of the RS volume was seen in 27 patients (22%). The actuarial median survival from date of RS is 56 weeks, and the 1-year and 2-year actuarial survival rates are 53 and 30%. The median duration of functional independence (sustained KPS ≥ 70) is 44 weeks. Nineteen of 77 deaths were attributed to CNS progression (25% of all deaths). Multivariate analysis revealed the following factors to be statistically significant predictors of survival: baseline KPS ( p < .0001) and absence of other sites of metastasis ( p = 0.008). Conclusion : The RS in conjunction with WBRT for single brain metastasis can produce substantial functional survival, especially in patients with good performance status and without extracranial metastasis. These results are comparable to recent randomized trials of resection and WBRT. The advantages of RS over surgery in terms of cost, hospitalization, morbidity, and wider applicability strongly suggest that a randomized trial to compare RS with surgery is warranted.

Brain

Metastasis

Stereotactic

Radiosurgery

Details

Title: Subtitle: A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis
Creators: Richard M Auchter - Department of Human Oncology, University of Wisconsin—Madison, Madison, WI U.S.A
John P Lamond - Department of Human Oncology, University of Wisconsin—Madison, Madison, WI U.S.A
Eben Alexander - Brain Tumor Center, Brigham and Women's Hospital Boston, MA, U.S.A
John M Buatti - University of Florida Department of Radiation Oncology, University of Florida—Gainesville, Gainesville, FL, U.S.A
Rick Chappell - Department of Statistics and Biostatistics, University of Wisconsin—Madison, Madison, WI, U.S.A
William A Friedman - Department of Neurosurgery, University of Florida—Gainesville, Gainesville, FL, U.S.A
Timothy J Kinsella - Department of Human Oncology, University of Wisconsin—Madison, Madison, WI U.S.A
Allan B Levin - Department of Statistics and Biostatistics, University of Wisconsin—Madison, Madison, WI, U.S.A
William R Noyes - Department of Human Oncology, University of Wisconsin—Madison, Madison, WI U.S.A
Christopher J Schultz - Department of Radiation Oncology Medical College of Wisconsin, Milwaukee, WI U.S.A
Jay S Loeffler - Joint Center for Radiation Therapy, Boston, MA, U.S.A
Minesh P Mehta - Department of Human Oncology, University of Wisconsin—Madison, Madison, WI U.S.A
Resource Type: Journal article
Publication Details: International journal of radiation oncology, biology, physics, Vol.35(1), pp.27-35
DOI: 10.1016/S0360-3016(96)85008-5
PMID: 8641923
NLM abbreviation: Int J Radiat Oncol Biol Phys
ISSN: 0360-3016
eISSN: 1879-355X
Publisher: Elsevier Inc
Language: English
Date published: 1996
Academic Unit: Radiation Oncology; Neurosurgery; Otolaryngology
Record Identifier: 9984040332202771

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