Defining the Role of Stereotactic Radiosurgery Versus Microsurgery in the Treatment of Single Brain Metastases

Abstract

Stereotactic radiosurgery (RS) and surgery have proved to be effective treatment modalities for brain metastasis. We followed 133 patients whose treatment for intracranial disease was either RS or a single surgical resection at the University of Vienna from August 1992 through October 1996. All patients who received additional Whole Brain Radiotherapy were included. This was a retrospective, case-control study comparing these treatment modalities. Sixty-seven patients were treated by RS and 66 patients were treated by microsurgery. The median size of the treated lesions for RS patients was 7800 mm3, and 12500 mm3 for microsurgery patients, respectively. The median dose delivered to the tumour margin for RS patients was 17 gray. The median survival for patients after RS was 12 months, and 9 months for patients after microsurgery. This difference was not statistically significant (p = 0.19). Comparison of local tumour control, defined as absence of regrowth of a treated lesion, showed that tumours following RS had a preferred local control rate (p < 0.05). Univariate and multivariate analysis showed that this fact was due to a greater response rate of "radioresistant" metastasis to RS (p < 0.005). Postradiosurgical complications included the onset of peritumoural oedema (n = 5) and radiation necrosis (n = 1). Two patients after microsurgery experienced local wound infection. One postoperative death occurred due to pulmonary embolism in this group. On the basis of our data we conclude that RS and microsurgery combined with Whole Brain Radiotherapy are comparable modalities in treating single brain metastasis. Concerning morbidity and local tumour control, in particular in cases of "radioresistant" primary tumours, RS is superior. Therefore we advocate RS except for cases of large tumours (> 3 cm in maximum diameter) and for those with mass effect.

The History of Stereotactic Radiosurgery Development and Its Role in the Treatment of Brain Metastases

“…Послеоперационное облучение ложа опухоли (или ТОГМ) является обязательным после хирургической резекции, но не требуется после СРХ. В нескольких ретроспективных исследованиях [31][32] предполагается, что при проведении радиохирургии и хирургической резекции достигаются аналогичные результаты. Единственное рандомизированное иссле-дование [33] по сравнению СРХ и операции (в комби-нации с ТОГМ) у пациентов с солитарным метастазом в головной мозг не выявило различий в выживаемости или смертности от неврологических причин; при СРХ реже наблюдалась токсичность I-II степени.…”

Role of Gamma Knife Radiosurgery in Neurosurgery: Past and Future Perspectives

“…15,21) Two retrospective studies that compared the efficacy of radiosurgery and surgery showed better local control in the radiosurgery group and the same effect on survival for both groups. 96,124) Gamma knife radiosurgery has been widely utilized as a primary treatment or in combination with whole brain radiation therapy. Even with multiple brain metastases, gamma knife radiosurgery can be effective for selected patients.…”

Brain metastases: the need for a more tailored approach in non-small-cell lung cancer patients

“…Another advantage of surgical resection is the pathologic confi rmation of the malignant nature of the lesion. Postoperative radiotherapy has demonstrated a decrease in the recurrence of brain metastases, a decrease in the mortality due to neurological deterioration and a delay in neurologic clinical deterioration [2,3].Radiosurgery has emerged as a non-invasive option to treat patients with 1-3 brain metastases, providing similar local control rates to surgery [4][5][6]. However, no randomised trial has compared the two approaches.…”

“…Radiosurgery has emerged as a non-invasive option to treat patients with 1-3 brain metastases, providing similar local control rates to surgery [4][5][6]. However, no randomised trial has compared the two approaches.…”