title: Three irradiation treatment options including radiosurgery for brain metastases from primary lung cancer.
abstract: OBJECTIVE
  To determine local control and survival rates in 92 patients with 145 brain metastases treated with three options of radiotherapy including stereotactic radiosurgery (SR).
  
  
  METHODS
  Between July 1994 and August 2002, 92 consecutive patients with 145 metastases were treated with a SR, 34 with initially SR alone, 22 initially with an association of whole-brain radiotherapy (WBRT) and 36 with SR alone for recurrent new brain metastasis after WBRT. At time of treatment, extracranial disease was controlled in 46 (50%) and uncontrolled in 46 (50%). Pathologies were adenocarcinoma in 54 cases (59%), squamous cell carcinoma in 14 cases (15%), small cell carcinoma in 10 cases (11%) and miscellaneous in 14 cases (15%). All patients underwent only one treatment fraction for 1 or 2 metastases in 73 cases (83%) and for more than 2 metastases for the others.
  
  
  RESULTS
  The characteristics of patients and metastases in the group treated initially with SR alone and in the group treated initially with WBRT+SR were comparable. Median follow-up was 29 months (18-36). Overall, the median and the 1- and 2-year rates of overall survival were, respectively, 9 months, 37 and 20%. A controlled extracranial disease, a high Karnofsky index and a low number of metastasis were independent prognostic factor of overall survival, respectively, HR 0.53 (95% CI 0.31-0.90, P=0.01), HR 0.95 (95% CI 0.92-0.97, P=0.0002), and HR 0.48 (95% CI 0.25-0.90, P=0.02). Thirteen metastases were not controlled (9%). Six-month and 1-year local control rate were, respectively, 93 and 86%. High delivered dose was an independent prognostic factor of local control, HR 0.41 (95% CI 0.18-0.95, P=0.03). A controlled extracranial disease was favourable independent prognostic factor of brain free-disease free survival, HR 0.47 (95% CI 0.2-0.98, P=0.04). Although there was a trend of a better local control, overall and brain disease free survivals rates in the WBRT+SR group compared to SR alone one, the difference were not statistically different.
  
  
  CONCLUSIONS
  Local control and survival rates are acceptable for a palliative treatment for the three option of treatment. In this series, the number of patients is not enough great to conclude to the necessity of the association of WBRT to SR. Re-irradiation is a safe treatment after new metastases appeared in previously irradiated area.
authors.affiliation: Radiotherapy department, Groupe Pitié Salpêtrière, AP-HP, 47-83 boulevard de l'hôpital, 75651 Paris Cedex 13, France. noel@ipno.in2p3.fr
authors.forename: Georges
authors.initials: G
authors.lastname: Noel
authors.forename: Jacques
authors.initials: J
authors.lastname: Medioni
authors.forename: Charles-Ambroise
authors.initials: CA
authors.lastname: Valery
authors.forename: Gilbert
authors.initials: G
authors.lastname: Boisserie
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Simon
authors.forename: Philippe
authors.initials: P
authors.lastname: Cornu
authors.forename: Dominique
authors.initials: D
authors.lastname: Hasboun
authors.forename: Dominique
authors.initials: D
authors.lastname: Ledu
authors.forename: Bernadette
authors.initials: B
authors.lastname: Tep
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Delattre
authors.forename: Claude
authors.initials: C
authors.lastname: Marsault
authors.forename: François
authors.initials: F
authors.lastname: Baillet
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Mazeron
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016634:Radiosurgery / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome; D014916:Whole-Body Irradiation