Original Article

Management Strategies for Patients with Brain Metastases: Has Radiosurgery Made a Difference?

Authors: Ajay Jawahar, MD, Federico Ampil, MD, Christina Wielbaecher, BS, Golda H. Hartman, BS, John H. Zhang, MD, PHD, Anil Nanda, MD

Abstract

Background: Brain metastases develop in up to 50% of all patients with cancer. The purpose of this retrospective study was to compare the outcomes for brain metastases patients treated with adjuvant whole-brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS).


Methods: Between 1990 and 1995, 86 patients with brain metastases received external beam WBRT with a megavoltage beam at our center. Between January 2000 and July 2001, 48 patients with 84 tumors diagnosed as cerebral metastases were treated with SRS using the Leksell Gamma Knife. A comparative analysis of the outcomes in the two different groups was made to determine a possible statistically significant difference in survival.


Results: In the WBRT group, the median follow-up was 11 months. Thirty-nine patients (45.3%) experienced an improvement in neurologic status. The median overall survival was 5 months (range, 1–40 months). In the SRS group, the median follow-up for this group was 9 months. Thirty-four patients experienced an improvement in their neurologic signs and symptoms. The median survival was 12 months (range, 1–16 months).


Conclusion: SRS appears to be a safe and effective treatment option for those patients with a limited number of brain metastases and in patients with controlled or limited systemic disease.

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