title: Multimodality treatment of brain metastases: an institutional survival analysis of 275 patients.
abstract: BACKGROUND
  Whole brain radiation therapy (WBRT), surgical resection, stereotactic radiosurgery (SRS), and combinations of the three modalities are used in the management of patients with metastatic brain tumors. We present the previously unreported survival outcomes of 275 patients treated for newly diagnosed brain metastases at Cancer Care Northwest and Gamma Knife of Spokane between 1998 and 2008.
  
  
  METHODS
  The effects treatment regimen, age, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS), primary tumor histology, number of brain metastases, and total volume of brain metastases have on patient overall survival were analyzed. Statistical analysis was performed using Kaplan-Meier survival curves, Andersen 95% confidence intervals, approximate confidence intervals for log hazard-ratios, and multivariate Cox proportional hazard models.
  
  
  RESULTS
  The median clinical follow up time was 7.2 months. On multivariate analysis, survival statistically favored patients treated with SRS alone when compared to patients treated with WBRT alone (p<0.001), patients treated with resection with SRS when compared to patients treated with SRS alone (p=0.020), patients in ECOG-PS class 0 when compared to patients in ECOG-PS classes 2 (p=0.04), 3 (p<0.001), and 4 (p<0.001), patients in the non-small-cell lung cancer group when compared to patients in the combined melanoma and renal-cell carcinoma group (p<0.001), and patients with breast cancer when compared to patients with non-small-cell lung cancer (p<0.001).
  
  
  CONCLUSIONS
  In our analysis, patients benefited from a combined modality treatment approach and physicians must consider patient age, performance status, and primary tumor histology when recommending specific treatments regimens.
authors: Gamma Knife of Spokane, 910 W 5th Ave, Suite 102, Spokane, WA 99204, USA.
authors: Ameer L
authors: AL
authors: Elaimy
authors: Alexander R
authors: AR
authors: Mackay
authors: Wayne T
authors: WT
authors: Lamoreaux
authors: Robert K
authors: RK
authors: Fairbanks
authors: John J
authors: JJ
authors: Demakas
authors: Barton S
authors: BS
authors: Cooke
authors: Benjamin J
authors: BJ
authors: Peressini
authors: John T
authors: JT
authors: Holbrook
authors: Christopher M
authors: CM
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology