Linear accelerator and Greitz-Bergstrom's head fixation system in radiosurgery of single cerebral metastases. A report of 86 cases

Abstract

Between 1984 and 1991 86 patients with single cerebral metastases underwent linear accelerator radiosurgery using the atraumatic and reproducible Greitz-Bergström head-fixation device. Routine one-month follow-up documented disappearance of the tumour in 16 patients, with resolution of the oedema and ventricular shift. Shrinkage of the metastasis occurred in 51 patients. In 9 patients the tumour remained stable, in 7 there was progression of tumour size. Among the patients showing shrinkage of the tumour or unchanged tumour volume, repeated radiosurgery resulted in disappearance of the metastasis in 5 and further shrinkage in 28. In 14 patients routine stereotactic CT follow-up study led to the detection of a new metastasis, again treated with excellent results. Local recurrence occurred in 2 patients and radiation necrosis in the target area in 5 patients. Radiosurgery thus proves to be an appropriate alternative to surgery. The versatility of our non-invasive and painless method permits CT staging (which we consider essential) without hospitalization of the patient.

Current treatment of patients with multiple brain metastases

“…Median survival time after radiosurgery (range 6.4-10 months) 9,13,15,19,21,22,32,36 is comparable with that demonstrated after resection followed by conventional fractionated radiotherapy (survival range 4-13) months, 14,34 with good local control. 9,13,19,21,22,[31][32][33]36 In recent studies investigators have shown that patients undergoing radiosurgery for one or two brain metastases experience an equivalent, prolonged survival length similar to that observed in patients in whom the metastases have been resected. 2,15,18 Furthermore, the effect of stereotactic radiosurgery combined with WBRT in patients harboring two to four metastases has recently been shown to be superior to WBRT alone in the control of metastic brain disease.…”

Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991

“…1,8,30 The latest reports show a median survival of 10 months in 68 patients with resected single metastases and a median survival of 14 months in 18 patients who underwent craniotomy followed by radiosurgery. 71 In a less encouraging study, the 40 patients survived a median of only 6.5 months and only 25% survived 1 year. 35 It should be emphasized that, in the latter study, complete response was achieved in only 61% of brain lesions (not patients) with a volume of less than 2 cm 3 .…”

Stereotactic radiosurgery in patients with multiple brain metastases

“…Because most patients with metastases eventually succumb to their underlying malignancy, the primary benefits of radiosurgery are palliation of symptoms and some modest prolongation of survival length. Radiosurgical treatment of patients with either one or two brain metastases has been shown to result in good local control and a median patient survival (range 6-10 months) 2,6,8,[10][11][12]14,15,22,24 comparable to that obtained after surgical resection and WBRT (range 4-13 months). 9,23 Furthermore, stereotactic radiosurgery combined with WBRT in patients with two to four metastases may be superior to WBRT alone in the control of brain disease.…”

“…Historically treatment has generally consisted of WBRT once the diagnosis of multiple brain metastases is made. However, because of its noninvasive nature and based on results obtained in patients with solitary metastatic brain tumors, 6,8,10,12,14,15,22,24 stereotactic radiosurgery can be an important treatment option in a select subgroup of patients with multiple brain metastases. The authors of recent studies have shown that in patients treated with radiosurgery for one or two brain metastases, equivalent, prolonged survival times similar to those in patients treated with surgical resection have been achieved, 2,11 and stereotactic radiosurgery combined with WBRT in patients with two to four metastases has been shown in one series to be superior to WBRT alone in the control of brain disease.…”