title: Stereotactic Radiosurgery for Metastases in Eloquent Central Brain Locations.
abstract: BACKGROUND
  To examine stereotactic radiosurgery (SRS) following whole brain radiotherapy for metastases in eloquent, central brain locations: brainstem, thalamus, and basal ganglia.
  
  
  METHODS
  We conducted a retrospective review of patients with metastases in eloquent, central brain locations who were treated with SRS between January 2000 and April 2012. All patients had whole brain radiotherapy. Patients eligible for SRS had one to three brain metastases, metastasis size ≤4 cm, and Karnofsky performance status ≥70. Local progression-free survival and overall survival were calculated using the Kaplan-Meier method.
  
  
  RESULTS
  For 24 patients, the median age was 50 years (range, 36-73). Metastases by location were: 11 brainstem, 9 thalamus, and 5 basal ganglia. The median metastasis size was 15 mm (range, 2-33) and the median SRS dose prescription was 15 Gy (range, 12-24). The median local progression-free survival was 13.7 months and median overall survival was 16.4 months. Compared with a cohort of 188 patients with noneloquent brain metastases receiving a median dose of 24 Gy, overall survival of 10.8 months was not significantly different (p=0.16). The only symptomatic complication was grade 2 headache in 8.3%. Asymptomatic adverse radiologic events were radionecrosis in two (8.3%), peritumoural edema in four (16.7%), and hemorrhage in one patient (4.2%).
  
  
  CONCLUSIONS
  Lower SRS marginal doses do not appear to compromise survival in patients with eloquently located brain metastases compared with higher doses for other brain metastases, with minimal symptomatic complications.
authors.affiliation: 1Abbotsford Centre,BC Cancer Agency,Abbotsford,British Columbia,Canada,Vancouver Centre.
authors.forename: Fred
authors.initials: F
authors.lastname: Hsu
authors.affiliation: 2BC Cancer Agency,Vancouver,British Columbia,Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Nichol
authors.affiliation: 2BC Cancer Agency,Vancouver,British Columbia,Canada.
authors.forename: Roy
authors.initials: R
authors.lastname: Ma
authors.affiliation: 3Fraser Valley Centre,BC Cancer Agency,Surrey,British Columbia,Canada.
authors.forename: Para
authors.initials: P
authors.lastname: Kouhestani
authors.affiliation: 2BC Cancer Agency,Vancouver,British Columbia,Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Toyota
authors.affiliation: 2BC Cancer Agency,Vancouver,British Columbia,Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: McKenzie
mesh_terms: D001921:Brain / Q000473:pathology / Q000601:surgery*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000628:therapy*; D016634:Radiosurgery / Q000379:methods*; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed
keywords: Radiation oncology; Radiosurgery; Stereotactic