title: Stereotactic radiosurgery with or without whole brain radiotherapy for patients with a single radioresistant brain metastasis.
abstract: OBJECTIVE
  To examine the outcomes of patients with a single brain metastasis from radioresistant histologies (renal cell carcinoma and melanoma) treated with stereotactic radiosurgery (SRS) with or without whole brain radiotherapy (WBRT).
  
  
  METHODS
  We reviewed the medical records of 27 patients treated at our institution between 2000 and 2007 with a single radioresistant brain metastasis. Patients were treated with Gamma Knife based SRS. Tumor histologies included renal cell carcinoma and melanoma.
  
  
  RESULTS
  Patients were treated to a median marginal dose was 20 Gy (range, 15-22 Gy). At follow-up intervals ranging from 1.8 to 23.2 months, the radiographic responses were as follows: progression in 7 patients; stable in 5 patients; and shrinkage in 15 patients. Fifteen patients (56%) developed distant brain failure. Seven of the 27 patients were alive at last follow-up. The 3-, 6-, 9-, 12-, and 18-months after SRS local control rates were 82.8%, 77.9%, 69.3%, 69.3%, and 55.4%, respectively. None of the 5 patients who received WBRT developed distant brain failure although the follow-up intervals were short (range, 3.5-13.7 months; median, 5.1 months). WBRT did not appear to affect local control, progression free survival, and overall survival (P = 0.32, 0.87, 0.69). One patient developed worsening of symptoms attributable to SRS.
  
  
  CONCLUSIONS
  Gamma Knife SRS is a safe and feasible strategy for treatment of patients with a single radioresistant brain metastasis. Radiosurgery alone is a reasonable treatment option, but may carry a greater likelihood of distant brain recurrence.
authors: Department of Radiation Medicine, The Ohio State University Arthur G. James Cancer Hospital, Columbus, Ohio 43210, USA.
authors: James W
authors: JW
authors: Clarke
authors: Steven
authors: S
authors: Register
authors: John M
authors: JM
authors: McGregor
authors: John C
authors: JC
authors: Grecula
authors: Nina A
authors: NA
authors: Mayr
authors: Jian Z
authors: JZ
authors: Wang
authors: Kaile
authors: K
authors: Li
authors: Nilendu
authors: N
authors: Gupta
authors: Kari L
authors: KL
authors: Kendra
authors: Thomas E
authors: TE
authors: Olencki
authors: Robert
authors: R
authors: Cavaliere
authors: Atom
authors: A
authors: Sarkar
authors: Simon S
authors: SS
authors: Lo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D011836:Radiation Tolerance; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome