Radiosurgery for brain metastases: who may not benefit?
OBJECTIVE
To select a group of patients with brain metastases for whom stereotactic radiosurgery (SRS) may not be beneficial.


METHODS
Actuarial survival of 87 patients with brain metastases treated with SRS between July 1993 and May 1999 was retrospectively analyzed under stratification by the Score Index for Stereotactic Radiosurgery for Brain Metastases (SIR). To identify the group of patients most likely to survive less than 6 months after SRS, Cox model survival curves were calculated for all SIR values, and Kaplan-Meier survival curves were calculated for two SIR subsets (0-5 and 6-10) and were compared by log-rank test.


RESULTS
Overall median survival after SRS was 6.88 months. The stratification of patients into two SIR subsets (0-5 and 6-10) sustained statistical significance regarding survival with p = 0.0001. The median survival time for the group of patients with SIR between 0 and 5 was 4.52 months (95% confidence interval of 2.82 to 5.84 months). Survival probability at 6 months for this group of patients with poor prognosis was 35.6%.


CONCLUSIONS
Patients with brain metastases and SIR of 5 or lower have an expected median survival of less than 6 months after treatment with radiosurgery. Thus, radiosurgery may not be beneficial for this group of patients.
Weltman
E
E
Department of Radiation Oncology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. weltman@einstein.br
Salvajoli
J V
JV
Brandt
R A
RA
de Morais Hanriot
R
R
Prisco
F E
FE
Cruz
J C
JC
de Oliveira Borges
S
S
Lagatta
M
M
Ballas Wajsbrot
D
D
D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D016634:Radiosurgery; D015996:Survival Rate