Stereotactic Radiosurgery for Patients with Single Brain Metastasis

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The efficacy of stereotactic radiosurgery (SRS) was evaluated for patients with single brain metastasis from extracranial primary cancer and the outcome was compared with that of external whole brain irradiation (WBI) alone or with surgical resection. Between January 1976 and December 1996, 225 patients with single brain metastases were treated in the Department of Therapeutic Radiology—Radiation Oncology at the University of Minnesota Hospital. One hundred six patients (47%) were treated with WBI alone (Group 1), 71 patients (32%) underwent surgical resection prior to WBI (Group 2), and 48 patients (21%) underwent SRS ± WBI (Group 3). The most common site of primary cancer was the lung (40%), followed by breast (14%), unknown primary (11%), skin (malignant melanoma, 9%), gastrointestinal tract (8%), kidney (renal cell carcinoma, 8%), gynecological organs (3%), and other (6%). Median dose to the whole brain was 3750 cGy in 15 fractions (range, 2000–5000 cGy). Median radiosurgical dose of 1750 cGy (range, 1200–4000 cGy) was delivered to the 40 to 90% isodose line encompassing the target. Actuarial survival was calculated from the date of treatment using the Kaplan–Meier method and statistical significance was assessed with the log-rank test. Actuarial median survival was 3.8 months for Group 1 (range, 1–84 months), 10.5 months for Group 2 (range, 1–125 months), and 9.8 months for Group 3 (range, 1–51 months). Survival at 1 and 2 years was 20% and 8% for Group 1, 47% and 18% for Group 2, and 37% and 27% for Group 3, respectively. Group 2 (surgery + WBI) and Group 3 (SRS ± WBI) had a statistically significant survival advantage over Group 1 (WBI alone) (p < 0.0001, log-rank test). No survival advantage was found between Groups 2 and 3 (p = 0.69, log-rank test). Our retrospective data suggest that SRS (± WBI) improves survival when compared to WBI alone and is comparable to surgical resection and WBI. Given that SRS is minimally invasive, is able to treat lesions in surgically inaccessible locations, and is potentially more cost-effective than surgery, it is a reasonable and potentially more attractive alternative to surgery in the management of single brain metastasis.

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