title: Stereotactic radiosurgery alone for patients with 1-4 radioresistant brain metastases.
abstract: Brain metastases from radioresistant histologies are perceived to be less responsive to WBRT compared to other histologies, and stereotactic radiosurgery (SRS) may provide better local control. The aim of this study was to examine the outcomes of patients with 1-4 brain metastasis from radioresistant histologies (renal cell carcinoma and melanoma) treated with SRS alone. Thirty-eight patients with 1-4 radioresistant brain metastases (66 lesions) were treated with SRS alone. The median age was 55 years. Fourteen and 24 patients had renal cell carcinoma (RCC) and melanoma brain metastases, respectively. Distribution of number of lesions was as follows: one lesion, 22 patients; 2 lesions, 8 patients; 3 lesions, 5 patients; and 4 lesions, 3 patients. Distribution of RTOG recursive partitioning analysis (RPA) classes was as follows: II, 37 patients and III, 1 patient. The median marginal dose was 20 Gy. The median follow-up was 6.1 months. The 3-, 6-, 9-, 12-, and 18-month local control (LC) rates were 87.9, 81.4, 67.9, 67.9, and 60.3%, respectively. The corresponding free-from-distant-brain failure (FFDBF) rates were 71.3, 58.1, 49.8, 40.2, and 27.6%. The corresponding progression-free survival (PFS) rates were 55.3, 41.9, 33, 23.3, and 13.3%. RCC histology was associated with better LC (P = 0.0055). Although SRS alone could yield reasonable LC in patients with 1-4 radioresistant brain metastases, the risk of distant brain failure was substantial. The approach of routine omission of WBRT outside of a trial setting should be used judiciously.
authors.affiliation: Department of Radiation Oncology, Arthur G. James Cancer Hospital, Ohio State University Medical Center, 300 West 10th Avenue, Ste 088A, Columbus, OH 43210, USA. Simon.Lo@osumc.edu
authors.forename: Simon S
authors.initials: SS
authors.lastname: Lo
authors.forename: James W
authors.initials: JW
authors.lastname: Clarke
authors.forename: John C
authors.initials: JC
authors.lastname: Grecula
authors.forename: John M
authors.initials: JM
authors.lastname: McGregor
authors.forename: Nina A
authors.initials: NA
authors.lastname: Mayr
authors.forename: Robert
authors.initials: R
authors.lastname: Cavaliere
authors.forename: Kari L
authors.initials: KL
authors.lastname: Kendra
authors.forename: Nilendu
authors.initials: N
authors.lastname: Gupta
authors.forename: Jian Z
authors.initials: JZ
authors.lastname: Wang
authors.forename: Atom
authors.initials: A
authors.lastname: Sarkar
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Olencki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D016371:Cranial Irradiation / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate
references.citation: Neurosurgery. 2005 May;56(5):936-45; discussion 936-45
references.pmid: 15854241
references.citation: Lancet Oncol. 2009 Nov;10(11):1037-44
references.pmid: 19801201
references.citation: N Engl J Med. 1990 Feb 22;322(8):494-500
references.pmid: 2405271
references.citation: J Clin Oncol. 2005 Dec 1;23(34):8870-6
references.pmid: 16314647
references.citation: JAMA. 2006 Jun 7;295(21):2483-91
references.pmid: 16757720
references.citation: Lancet. 2004 May 22;363(9422):1665-72
references.pmid: 15158627
references.citation: Int J Radiat Oncol Biol Phys. 2004 Jul 15;59(4):1097-106
references.pmid: 15234044
references.citation: Int J Radiat Oncol Biol Phys. 2000 Jul 1;47(4):1007-12
references.pmid: 10863072
references.citation: Expert Rev Neurother. 2005 Jul;5(4):487-95
references.pmid: 16026232
references.citation: Acta Neurochir (Wien). 1998;140(6):549-55
references.pmid: 9755321
references.citation: Neurology. 1989 Jun;39(6):789-96
references.pmid: 2725874
references.citation: Int J Radiat Oncol Biol Phys. 2007 Aug 1;68(5):1388-95
references.pmid: 17674975
references.citation: Cancer. 1998 Jul 15;83(2):344-53
references.pmid: 9669818
references.citation: Int J Radiat Oncol Biol Phys. 2002 Apr 1;52(5):1277-87
references.pmid: 11955740
references.citation: Int J Radiat Oncol Biol Phys. 1999 Sep 1;45(2):427-34
references.pmid: 10487566
references.citation: Int J Radiat Oncol Biol Phys. 1997 Aug 1;39(1):25-30
references.pmid: 9300736
references.citation: Neurol Clin. 2003 Feb;21(1):1-23, vii
references.pmid: 12690643
references.citation: J Neurosurg. 2002 Mar;96(3):544-51
references.pmid: 11883840
references.citation: Anticancer Res. 2007 Nov-Dec;27(6C):4255-7
references.pmid: 18214028
references.citation: Int J Radiat Oncol Biol Phys. 1998 Oct 1;42(3):581-9
references.pmid: 9806518