Radiosurgery for large brain metastases.
OBJECTIVE
To determine the efficacy and safety of radiosurgery in patients with large brain metastases treated with radiosurgery.


METHODS
Eighty patients with large brain metastases (>14 cm(3)) were treated with radiosurgery between 1998 and 2009. The mean age was 59 ± 11 years, and 49 (61.3%) were men. Neurologic symptoms were identified in 77 patients (96.3%), and 30 (37.5%) exhibited a dependent functional status. The primary disease was under control in 36 patients (45.0%), and 44 (55.0%) had a single lesion. The mean tumor volume was 22.4 ± 8.8 cm(3), and the mean marginal dose prescribed was 13.8 ± 2.2 Gy.


RESULTS
The median survival time from radiosurgery was 7.9 months (95% confidence interval [CI], 5.343-10.46), and the 1-year survival rate was 39.2%. Functional improvement within 1-4 months or the maintenance of the initial independent status was observed in 48 (60.0%) and 20 (25.0%) patients after radiosurgery, respectively. Control of the primary disease, a marginal dose of ≥11 Gy, and a tumor volume ≥26 cm(3) were significantly associated with overall survival (hazard ratio, 0.479; p = .018; 95% CI, 0.261-0.880; hazard ratio, 0.350; p = .004; 95% CI, 0.171-0.718; hazard ratio, 2.307; p = .006; 95% CI, 1.274-4.180, respectively). Unacceptable radiation-related toxicities (Radiation Toxicity Oncology Group central nervous system toxicity Grade 3, 4, and 5 in 7, 6, and 2 patients, respectively) developed in 15 patients (18.8%).


CONCLUSIONS
Radiosurgery seems to have a comparable efficacy with surgery for large brain metastases. However, the rate of radiation-related toxicities after radiosurgery should be considered when deciding on a treatment modality.
Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
Jung Ho
JH
Han
Dong Gyu
DG
Kim
Hyun-Tai
HT
Chung
Sun Ha
SH
Paek
Chul-Kee
CK
Park
Hee-Won
HW
Jung
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011832:Radiation Injuries / Q000209:etiology* / Q000473:pathology; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden