title: A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis.
abstract: OBJECTIVE
  A multi-institutional experience in radiosurgery for solitary brain metastases was combined to identify factors associated with safety, efficacy, tumor control, and survival.
  
  
  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 = 0.111), but not survival in multivariate testing.
  
  
  CONCLUSIONS
  Radiosurgery is effective in controlling solitary brain metastases with low morbidity. Further study is needed to better define optimum treatment parameters for radiosurgery.
authors.affiliation: University of Pittsburgh School of Medicine, PA.
authors.forename: J C
authors.initials: JC
authors.lastname: Flickinger
authors.forename: D
authors.initials: D
authors.lastname: Kondziolka
authors.forename: L D
authors.initials: LD
authors.lastname: Lunsford
authors.forename: R J
authors.initials: RJ
authors.lastname: Coffey
authors.forename: M L
authors.initials: ML
authors.lastname: Goodman
authors.forename: E G
authors.initials: EG
authors.lastname: Shaw
authors.forename: W R
authors.initials: WR
authors.lastname: Hudgins
authors.forename: R
authors.initials: R
authors.lastname: Weiner
authors.forename: G R
authors.initials: GR
authors.lastname: Harsh
authors.forename: P K
authors.initials: PK
authors.lastname: Sneed
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D016634:Radiosurgery / Q000009:adverse effects; D015996:Survival Rate