A comparison of surgical resection and stereotactic radiosurgery in the treatment of solitary brain metastases.
OBJECTIVE
To determine whether neurosurgery (NS) or stereotactic radiosurgery (RS) provided better local tumor control and enhanced patient survival.


METHODS
Retrospective review of all solitary brain metastases (SBM) patients newly diagnosed at Mayo Clinic Rochester between 1991 and 1999. Eligible patients satisfied tumor size and SBM site criteria to qualify for both NS and RS.


RESULTS
There were no significant differences between 74 NS and 23 RS patients in terms of baseline characteristics (age, gender, systemic disease type, systemic disease status, signs/symptoms at SBM presentation) or percent of patients who received whole brain radiotherapy. Median follow-up for alive patients was 20 months (range 0-106 months). There was no significant difference in patient survival (p = 0.15); the 1-year survival rate was 56% for the RS patients and 62% for the NS patients. Multivariate Cox regression analysis found that a significant prognostic factor for survival was a performance score of 0 or 1. There was a significant (p = 0.020) difference in local tumor control between NS and RS for solitary brain metastasis; none of the RS group had local recurrence compared to 19 (58%) of the NS group.


CONCLUSIONS
The need for a Phase III study comparing these two techniques appears to be supported by the data from this study.
O'Neill
Brian Patrick
BP
Department of Neurology, Mayo Clinic and Foundation, Rochester, MN 55905, USA. boneill@mayo.edu
Iturria
Nancy J
NJ
Link
Michael J
MJ
Pollock
Bruce E
BE
Ballman
Karla V
KV
O'Fallon
Judith R
JR
D000368:Aged; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017567:Karnofsky Performance Status; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D016634:Radiosurgery / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome