title: A comparison between surgical resection in combination with WBRT or hypofractionated stereotactic irradiation in the treatment of solitary brain metastases.
abstract: BACKGROUND
  The standard treatment of solitary brain metastases previously has been tumour resection in combination with whole-brain radiation therapy (WBRT). Stereotactic radiotherapy has emerged as a non-invasive treatment option especially for small brain metastases. We now report our results on resection + WBRT or hypofractionated stereotactic irradiation (HCSRT) in the treatment of solitary brain metastases.
  
  
  METHODS
  Between 1993 and 2004 patients with metastatic cancer and solitary brain metastases were selected for surgical resection + WBRT or HCSRT alone at the Umeå University Hospital. Fifty-nine patients were treated with surgical resection + WBRT (34 male, 25 female, mean age 63.3 years). Forty-seven patients were treated with HCSRT alone (15 male, 32 female, mean age 64.9 years).
  
  
  RESULTS
  In patients followed radiologically, 28% treated with resection + WBRT showed a local recurrence after a median time of 8.0 months, whereas there was a lack of local control in 16% in the HCSRT group after a median time of 3.0 months. There was a significantly longer survival time for patients treated with resection + WBRT (median 7.9, mean 12.9 months) compared to HCSRT (median 5.0, mean 7.6 months). Even in patients with a tumour volume <10 cc, there was a significantly longer survival in favour of resection + WBRT (median 8.4, mean 17.4 months) compared to HCSRT (median 5.0, mean 7.9 months).
  
  
  CONCLUSIONS
  This retrospective and non-randomised study indicates that surgical resection in combination with WBRT may be an option even for small brain metastases suitable for treatment with HCSRT. Since survival and local control following resection + WBRT was at least as favourable as compared to HCSRT alone, tumour location and expected neurological outcome may be the strongest aspect when selecting treatment modality.
authors.affiliation: Department of Neurosurgery, Umeå University Hospital, SE-901 85, Umeå, Sweden. peter_lindvall_nkk@hotmail.com
authors.forename: Peter
authors.initials: P
authors.lastname: Lindvall
authors.forename: Per
authors.initials: P
authors.lastname: Bergström
authors.forename: Per-Olov
authors.initials: PO
authors.lastname: Löfroth
authors.forename: A
authors.initials: A
authors.lastname: Tommy Bergenheim
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D016634:Radiosurgery / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055502:Secondary Prevention; D015996:Survival Rate; D016896:Treatment Outcome