For patients with single brain lesions and no other active disease, their survival will be prolonged with radiosurgery over standard whole brain irradiation and if the tumor is symptomatic they will probably have a longer period of good neurologic function. Whether radiosurgery is as effective as surgical resection is still unclear ( Auchter: the same, Bindal:surgery better and Schoggel: RS better see below.) In the recent comparison study from the Mayo Clinic the survival was the same (go here) and the study from Germany radiosurgery was slightly better than surgical resection (go here) though the benefit was more in local control that over all survival (go here). |
Therapy | Median Survival | Functional Survival |
whole brain radiation | 15 - 26 weeks | 8 - 15 weeks |
surgical resection | 40 - 43 weeks | 33 - 38 weeks |
radiosurgery | 56 weeks | 44 weeks |
Int J Radiat Oncol Biol Phys 1996 Apr 1;35(1):27-35
A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis.Auchter RM, Lamond JP, Alexander E, Buatti JM, Chappell R, Friedman WA, Kinsella TJ, Levin AB, Noyes WR, Schultz CJ, Loeffler JS, Mehta MPDepartment of Human Oncology, University of Wisconsin-Madison, USA. The RS databases of four institutions were reviewed to identify patients who met the following criteria: single-brain metastasis; no prior cranial surgery or WBRT; age > 18 years; surgically resectable lesion; Karnofsky Performance Status (KPS) > or = 70 at time of RS; nonradiosensitive histology. One hundred twenty-two patients were identified who met these criteria. RS was performed with a linear accelerator based technique (peripheral dose range was 10-27 Gy, median was 17 Gy). WBRT was performed in all but five patients who refused WBRT (dose range was 25-40 Gy, median was 37.5 Gy). RESULTS: The median follow-up for all patients was 123 weeks. The overall local control rate (defined as lack of progression in the RS volume) was 86%. Intracranial recurrence outside of the RS volume was seen in 27 patients (22%). The actuarial median survival from date of RS is 56 weeks, and the 1-year and 2-year actuarial survival rates are 53% and 30%. The median duration of functional independence (sustained KPS > or = 70) is 44 weeks. Nineteen of 77 deaths were attributed to CNS progression (25% of all deaths). CONCLUSION: The RS in conjunction with WBRT for single brain metastasis can produce substantial functional survival, especially in patients with good performance status and without extracranial metastasis. These results are comparable to recent randomized trials of resection and WBRT. The advantages of RS over surgery in terms of cost, hospitalization, morbidity, and wider applicability strongly suggest that a randomized trial to compare RS with surgery is warranted. J Neurosurg 1996 May;84(5):748-54 Surgery versus radiosurgery in the treatment of brain metastasis.Bindal AK, Bindal RK, Hess KR, Shiu A, Hassenbusch SJ, Shi WM, Sawaya RDepartment of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, USA. Surgery and radiosurgery are effective treatment modalities for brain metastasis. To
compare the results of these treatment modalities, the authors followed 13 patients
treated by radiosurgery and 62 patients treated by surgery who were retrospectively
matched. Patients were matched according to the following criteria: histological
characteristics of the primary tumor, extent of systemic disease, preoperative Karnofsky
Performance Scale score, time to brain metastasis, number of brain metastases, and patient
age and sex. For patients treated by radiosurgery, the median size of the treated lesion
was 1.96 cm3 (range 0.41-8.25 cm3) and the median dose was 20 Gy (range 12-22 Gy). The median survival was 7.5 months for patients treated by radiosurgery
and 16.4 months for those treated by surgery; this difference was found to be
statistically significant using both univariate (p = 0.0018) and multivariate (p = 0.0009)
analyses. The difference in survival was due to a higher rate of mortality from brain
metastasis in the radiosurgery group than in the surgery group (p < 0.0001) and not due
to a difference in the rate of death from systemic disease (p = 0.28). Log-rank analysis
showed that the higher mortality rate found in the radiosurgery group was due to a greater
progression rate of the radiosurgically treated lesions (p = 0.0001) and not due to the
development of new brain metastasis (p = 0.75).On the basis of their data, the authors
conclude that surgery is superior to radiosurgery in the treatment of brain metastasis.
Patients who undergo surgical treatment survive longer and have a better local control. The data lead the authors to suggest that the indications for
radiosurgery should be limited to surgically inaccessible metastatic tumors or patients in
poor medical condition. Surgery should remain the treatment of choice whenever possible. |