title: Treatment of brain metastases in patients with non-small cell lung cancer (NSCLC) by stereotactic linac-based radiosurgery: prognostic factors.
abstract: A restrospective study of patients with brain metastases from non-small cell lung cancer (NSCLC) is performed to identify patients who benefit from radiosurgery and to determine prognostic factors for survival. Eighty-six consecutive patients with a total of 110 brain metastases from NSCLC were treated with linac-based radiosurgery. Six patients with eight brain metastases who received radiosurgery as a focal boost to whole brain radiotherapy where excluded. Median age at treatment was 60 years. Median dose was 20 Gy/80%-isodose. A chi(2)-test was used to identify potential prognostic factors for local control of brain metastases and survival of the patients. Median follow-up was 6 months (range 1 1/2-77 months) with 17/80 patients still alive. Median actuarial survival was significantly longer (P<0.004) in patients with metachronous onset of brain metastases in comparison to synchronous onset (8.3 vs. 3.3 months). Survival was significantly increased after radiosurgery in the absence of extracranial tumor progression (P<0.03). Eleven patients (14%) developed new brain metastases after radiosurgery after a latency of median 5 months. Actuarial local control rate was 96% after 3 months. Local control was significantly increased with a prescribed dose > or=18 Gy/80%-isodose (P<0.01). We conclude that especially patients with poor prognostic factors and a limited number of brain metastases may be palliatively treated with radiosurgery alone. This approach allows to effectively control CNS manifestation of the disease and can be integrated into chemotherapeutic protocols.
authors.affiliation: Department of Radiotherapy, German Cancer Research Center, Heidelberg, Germany. a.zabel@dkfz.de
authors.forename: Angelika
authors.initials: A
authors.lastname: Zabel
authors.forename: Stefanie
authors.initials: S
authors.lastname: Milker-Zabel
authors.forename: Christoph
authors.initials: C
authors.lastname: Thilmann
authors.forename: Ivan
authors.initials: I
authors.lastname: Zuna
authors.forename: Bernhard
authors.initials: B
authors.lastname: Rhein
authors.forename: Michael
authors.initials: M
authors.lastname: Wannenmacher
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000556:secondary*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D018579:Patient Selection; D011446:Prospective Studies; D016634:Radiosurgery; D012189:Retrospective Studies; D012307:Risk Factors; D013534:Survival