title: Does Modern Management of Malignant Extracranial Disease Prolong Survival in Patients with ≥3 Brain Metastases?
abstract: OBJECTIVE
  To assess if modern management of extracranial malignant diseases has prolonged the survival times for patients with more than 2 brain metastases (BM).
  
  
  METHODS
  Data from 2385 patients treated with Gamma Knife surgery (GKS) for ≥3 BM between 1982 and 2011 were retrospectively analyzed. The patients were divided into 6 groups based on the treatment year and the median and 10% survival times were compared with the median and mean treatment dates in each group.
  
  
  RESULTS
  The later the treatment date, the longer the median as well as the 10% survival times. The relation between the median treatment date and both the 10% and median survival times could be accurately expressed by a linear as well as an exponential curve fit. The median and 10% survival times increased by around 80% and 150%, respectively, between 1990 and 2010.
  
  
  CONCLUSIONS
  Both the median and 10% survival times have increased in recent years among patients with more than 2 BM treated with GKS. Both linear and exponential regressions accurately expressed the increase in both median and 10% survival times during the years 1990-2010. Findings from other published data support the observation of longer survival times among patients treated more recently, independent of the patients being treated with GKS or with whole-brain radiation therapy with or without radiosurgery. Thus, earlier findings of short survival times for patients with multiple BM are no longer valid, at least not for patients deemed suitable for radiosurgery. Aggressive management is thus warranted for these patients.
authors.affiliation: Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore. Electronic address: nykuttram@yahoo.se.
authors.forename: Bengt
authors.initials: B
authors.lastname: Karlsson
authors.affiliation: Katsuta Hospital Mito GammaHouse, Ibaraki, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: St. Elizabeth Ziekenhuis, Tilburg, The Netherlands.
authors.forename: Patrick
authors.initials: P
authors.lastname: Hanssens
authors.affiliation: St. Elizabeth Ziekenhuis, Tilburg, The Netherlands.
authors.forename: Guus
authors.initials: G
authors.lastname: Beute
authors.affiliation: Katsuta Hospital Mito GammaHouse, Ibaraki, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Kawabe
authors.affiliation: Katsuta Hospital Mito GammaHouse, Ibaraki, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Koiso
authors.affiliation: Karolinska Hospital, Stockholm, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Söderman
authors.affiliation: Department of Radiation Oncology, National University Hospital, Singapore.
authors.forename: Keith
authors.initials: K
authors.lastname: Lim
authors.affiliation: West Virginia University, Morgantown, West Virginia, USA.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Rosen
authors.affiliation: Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore.
authors.forename: Tseng Tsai
authors.initials: TT
authors.lastname: Yeo
mesh_terms: D001932:Brain Neoplasms / Q000150:complications / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D019468:Disease Management; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Multiple brain metastases; Radiation therapy; Survival time