title: Radiosurgery for metastatic brain tumors.
abstract: Stereotactic radiosurgery (SRS) precisely delivers high-dose radiation to a small target (usually less than 3-4 cm in diameter), in a single session with steep dose-fall, employing various radiation methods. SRS provides good tumor control for small brain metastases from various primary cancers, with minimal untoward effects on surrounding normal brain. This excellent tumor control prevents neurological death and maintains good activity of daily life. Although surgery with whole-brain radiation therapy (WBRT) remains an important option for patients with a solitary brain metastasis, SRS with or without WBRT should be considered in patients with a limited number of small tumors and a good prognosis. Many reports, as well as both retrospective and prospective reviews, have shown WBRT before or after SRS to improve local control and reduce new distant lesion emergence. However, upfront WBRT does not improve survival. There are two major delivery techniques, Gamma Knife (GK; Elekta AB, Stockholm, Sweden) SRS and linear accelerator (LINIAC)-based SRS. They are based on quite different concepts, and have different techniques and clinical applications. These differences complicate the discussion of the limitations of and indications for SRS and the necessity for prophylactic WBRT. This review discusses numerous aspects of SRS, its value as compared with other treatment modalities, the necessity for prophylactic WBRT with SRS, the limitations of and indications for SRS, and the difference between GK and LINIAC SRS, based on the literature and our experience, and proposes a new strategy for the treatment of brain metastases in view of the available clinical data and experience.
authors.affiliation: Tsukiji Neurological Clinic, Tokyo Gamma Unit Center, 1-9-9 Tsukiji, Chuo-ku, Tokyo, Japan. gamma-knife.serizawa@nifty.com
authors.forename: Toru
authors.initials: T
authors.lastname: Serizawa
mesh_terms: D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016371:Cranial Irradiation; D019317:Evidence-Based Medicine; D006801:Humans; D016634:Radiosurgery / Q000009:adverse effects / Q000295:instrumentation; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome
references.citation: Int J Radiat Oncol Biol Phys. 2007 Apr 1;67(5):1492-8
references.pmid: 17276617
references.citation: Lancet. 2004 May 22;363(9422):1665-72
references.pmid: 15158627
references.citation: J Neurosurg. 2008 Dec;109 Suppl:118-21
references.pmid: 19123897
references.citation: Ann Surg Oncol. 1994 Mar;1(2):169-78
references.pmid: 7834443
references.citation: Int J Radiat Oncol Biol Phys. 1999 Feb 1;43(3):549-58
references.pmid: 10078636
references.citation: Int J Radiat Oncol Biol Phys. 1997 Sep 1;39(2):445-54
references.pmid: 9308949
references.citation: Technol Cancer Res Treat. 2007 Jun;6(3):153-60
references.pmid: 17535022
references.citation: Int J Radiat Oncol Biol Phys. 2003 Oct 1;57(2):452-64
references.pmid: 12957257
references.citation: Cancer J. 2000 Mar-Apr;6(2):88-92
references.pmid: 11069225
references.citation: Radiother Oncol. 2000 Nov;57(2):207-13
references.pmid: 11054525
references.citation: Int J Radiat Oncol Biol Phys. 1992;24(4):619-25
references.pmid: 1429083
references.citation: Neurosurgery. 2005 May;56(5):936-45; discussion 936-45
references.pmid: 15854241
references.citation: N Engl J Med. 1990 Feb 22;322(8):494-500
references.pmid: 2405271
references.citation: Future Oncol. 2007 Feb;3(1):95-102
references.pmid: 17280506
references.citation: Neurosurgery. 2007 Feb;60(2):277-83; discussion 283-4
references.pmid: 17290178
references.citation: J Neurosurg. 1999 Jul;91(1):35-43
references.pmid: 10389878
references.citation: Int J Radiat Oncol Biol Phys. 2000 May 1;47(2):291-8
references.pmid: 10802351
references.citation: Int J Radiat Oncol Biol Phys. 2002 Jul 1;53(3):527-32
references.pmid: 12062593
references.citation: J Clin Oncol. 2005 Dec 1;23(34):8870-6
references.pmid: 16314647
references.citation: J Neurosurg. 2005 Jan;102 Suppl:147-50
references.pmid: 15662799
references.citation: JAMA. 2006 Jun 7;295(21):2483-91
references.pmid: 16757720
references.citation: J Neurosurg. 2005 Jan;102 Suppl:128-33
references.pmid: 15662795
references.citation: Int J Radiat Oncol Biol Phys. 2002 Jul 1;53(3):519-26
references.pmid: 12062592
references.citation: J Neurosurg. 2002 Dec;97(5 Suppl):499-506
references.pmid: 12507085
references.citation: J Neurosurg. 2002 Dec;97(6):1276-81
references.pmid: 12507123
references.citation: Int J Radiat Oncol Biol Phys. 1997 Mar 1;37(4):745-51
references.pmid: 9128946
references.citation: Acta Oncol. 1999;38(2):165-9
references.pmid: 10227437
references.citation: Acta Neurochir (Wien). 2005 Jul;147(7):721-6; discussion 726
references.pmid: 15891808
references.citation: J Clin Oncol. 1998 Nov;16(11):3563-9
references.pmid: 9817276
references.citation: Int J Radiat Oncol Biol Phys. 1994 Mar 1;28(4):797-802
references.pmid: 8138431
references.citation: J Neurosurg. 2006 Dec;105 Suppl:86-90
references.pmid: 18503337
references.citation: Cancer. 2007 Jun 15;109(12):2515-21
references.pmid: 17487853
references.citation: Acta Neurochir Suppl. 2004;91:79-87
references.pmid: 15707029
references.citation: Neurosurgery. 2003 Jun;52(6):1318-26; discussion 1326
references.pmid: 12762877
references.citation: Neurosurgery. 2007 Mar;60(3):471-81; discussion 481-2
references.pmid: 17327791
references.citation: J Neurosurg. 2005 Jan;102 Suppl:75-80
references.pmid: 15662785
references.citation: Stereotact Funct Neurosurg. 1998 Oct;70 Suppl 1:41-9
references.pmid: 9782234
references.citation: Neurosurgery. 2003 May;52(5):1066-73; discussion 1073-4
references.pmid: 12699548
references.citation: Int J Radiat Oncol Biol Phys. 2004 May 1;59(1):87-93
references.pmid: 15093903
references.citation: J Neurosurg. 2000 Dec;93 Suppl 3:32-6
references.pmid: 11143259
references.citation: Neurology. 1989 Jun;39(6):789-96
references.pmid: 2725874
references.citation: Int J Radiat Oncol Biol Phys. 2000 Jul 1;47(4):993-9
references.pmid: 10863070
references.citation: Cancer. 2007 Jan 1;109(1):135-45
references.pmid: 17133440
references.citation: Prog Neurol Surg. 2007;20:106-128
references.pmid: 17317980
references.citation: J Clin Oncol. 1990 Apr;8(4):576-82
references.pmid: 2179476
references.citation: Int J Radiat Oncol Biol Phys. 2006 Mar 1;64(3):898-903
references.pmid: 16338097
references.citation: Prog Neurol Surg. 2009;22:154-169
references.pmid: 18948727
references.citation: Int J Cancer. 2001 Jun 20;96(3):191-7
references.pmid: 11410888
references.citation: Neurol Med Chir (Tokyo). 1996 Jun;36(6):364-9
references.pmid: 8700312
references.citation: Int J Radiat Oncol Biol Phys. 2006 Jul 1;65(3):809-16
references.pmid: 16682138
references.citation: Neurosurgery. 2000 Aug;47(2):268-79; discussion 279-81
references.pmid: 10942000
references.citation: Int J Radiat Oncol Biol Phys. 1999 Sep 1;45(2):427-34
references.pmid: 10487566
references.citation: Neurosurg Clin N Am. 1999 Apr;10(2):243-56
references.pmid: 10099090
references.citation: J Neurosurg. 2005 Jan;102 Suppl:266-71
references.pmid: 15662823
references.citation: Int J Radiat Oncol Biol Phys. 1996 Apr 1;35(1):27-35
references.pmid: 8641923
references.citation: J Neurosurg. 2002 Dec;97(5 Suppl):484-8
references.pmid: 12507082
references.citation: Int J Radiat Oncol Biol Phys. 2002 Aug 1;53(5):1279-83
references.pmid: 12128130
references.citation: JAMA. 1998 Nov 4;280(17):1485-9
references.pmid: 9809728
references.citation: J Neurooncol. 2003 Jan;61(2):143-9
references.pmid: 12622453