title: Local control of brain metastases by stereotactic radiosurgery in relation to dose to the tumor margin.
abstract: OBJECTIVE
  The maximal tolerated dose (MTD) for stereotactic radiosurgery (SRS) for brain tumors was established by the Radiation Therapy Oncology Group (RTOG) in protocol 90-05, which defined three dose groups based on the maximal tumor diameter. The goal in this retrospective study was to determine whether differences in doses to the margins of brain metastases affect the ability of SRS to achieve local control.
  
  
  METHODS
  Between 1997 and 2003, 202 patients harboring 375 tumors that met study entry criteria underwent SRS for treatment of one or multiple brain metastases. The median overall follow-up duration was 10.7 months (range 3-83 months). A dose of 24 Gy to the tumor margin had a significantly lower risk of local failure than 15 or 18 Gy (p = 0.0005; hazard ratio 0.277, confidence interval [CI] 0.134-0.573), whereas the 15- and 18-Gy groups were not significantly different from each other (p = 0.82) in this regard. The 1-year local control rate was 85% (95% CI 78-92%) in tumors treated with 24 Gy, compared with 49% (CI 30-68%) in tumors treated with 18 Gy and 45% (CI 23-67%) in tumors treated with 15 Gy. Overall patient survival was independent of dose to the tumor margin.
  
  
  CONCLUSIONS
  Use of the RTOG 90-05 dosing scheme for brain metastases is associated with a variable local control rate. Tumors larger than 2 cm are less effectively controlled than smaller lesions, which can be safely treated with 24 Gy. Prospective evaluations of the relationship between dose to the tumor margin and local control should be performed to confirm these observations.
authors.affiliation: Brain Tumor Institute and Departments of Biostatistics, Neurosurgery, and Radiation Oncology, Cleveland Clinic, Cleveland, Ohio 44195, USA. vogelbm@neus.ccf.org
authors.forename: Michael A
authors.initials: MA
authors.lastname: Vogelbaum
authors.forename: Lilyana
authors.initials: L
authors.lastname: Angelov
authors.forename: Shih-Yuan
authors.initials: SY
authors.lastname: Lee
authors.forename: Liang
authors.initials: L
authors.lastname: Li
authors.forename: Gene H
authors.initials: GH
authors.lastname: Barnett
authors.forename: John H
authors.initials: JH
authors.lastname: Suh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome