title: Combined surgical resection and stereotactic radiosurgery for treatment of cerebral metastases.
abstract: BACKGROUND
  Patients with limited intracranial metastatic disease traditionally have been treated with surgery followed by WBRT. However, there is growing concern for the debilitating cognitive effects after WBRT in long-term survivors. We present a series of patients treated with surgery followed by SRS, while reserving WBRT as a salvage therapy for disease progression.
  
  
  METHODS
  Medical records from 15 patients with 1 to 2 cerebral metastases who underwent both resection and SRS were reviewed. Outcome measures included overall survival, survival by RPA class, EOR, local tumor control, progression of intracranial disease, need for WBRT salvage therapy, and COD.
  
  
  RESULTS
  Fifteen patients with cerebral metastases were treated with the combined surgery-SRS paradigm. Eight of the 15 patients (53.3%) were designated RPA class 1, with 6 of 15 (40.0%) in class 2 and 1 of 15 (6.7%) in class 3. Gross total resection was achieved in 12 cases (80.0%). Overall median survival was 20.0 months, with values of 22.0 and 13.0 months for RPA classes 1 and 2, respectively. Local recurrence occurred in 16.7% of those patients with GTR. Six patients (40.0%) went on to receive WBRT at a median of 8.0 months from initial presentation. Twelve patients (80.0%) had died at the completion of the study, and the COD was CNS progression in 33.3%.
  
  
  CONCLUSIONS
  Surgical resection combined with SRS is an effective treatment for selected patients with limited cerebral metastatic disease. Survival using this combined treatment was equivalent to or greater than that reported by other studies using surgery + WBRT or SRS + WBRT.
authors.affiliation: Department of Neurosurgery, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA. limbrickd@nsurg.wustl.edu
authors.forename: David D
authors.initials: DD
authors.lastname: Limbrick
authors.forename: Eriks A
authors.initials: EA
authors.lastname: Lusis
authors.forename: Michael R
authors.initials: MR
authors.lastname: Chicoine
authors.forename: Keith M
authors.initials: KM
authors.lastname: Rich
authors.forename: Ralph G
authors.initials: RG
authors.lastname: Dacey
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Dowling
authors.forename: Robert L
authors.initials: RL
authors.lastname: Grubb
authors.forename: Eric A
authors.initials: EA
authors.lastname: Filiput
authors.forename: Robert E
authors.initials: RE
authors.lastname: Drzymala
authors.forename: David B
authors.initials: DB
authors.lastname: Mansur
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Simpson
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001932:Brain Neoplasms / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology; D016634:Radiosurgery / Q000379:methods*; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome