Stereotatic radiosurgery of 468 brain metastases ≤2 cm: Implications for SRS dose and whole brain radiation therapy

Michael K. Shehata, Byron Young, Brady Reid, Roy A. Patchell, William St. Clair, Jackie Sims, Michael Sanders, Ali Meigooni, Mohammed Mohiuddin, William F. Regine

Research output: Contribution to journalArticlepeer-review

136 Scopus citations

Abstract

Purpose The national standard stereostatic radiosurgery (SRS) dose for brain metastases ≤2 cm is 24 Gy as established by the Radiation Therapy Oncology Group study 90-05, in which planned whole brain radiotherapy (WBRT) was not used. On the basis of our institutional experience, the goal of this study was to determine the optimal SRS dose and influence of WBRT on local tumor control among 468 ≤2-cm metastases. Methods and materials Between October 1992 and May 2001, 468 newly diagnosed or recurrent ≤2-cm brain metastases, among 160 patients, were treated with SRS (dose range, 7-30 Gy; median, 20). A total of 240 metastases received planned WBRT (range, 6.75-50.4 Gy; median, 40.5) vs. 228 metastases that did not. The variables tested by multivariate analysis for their potential effect on tumor control included histologic type, site of metastasis, primary diagnosis, tumor volume, SRS dose, newly diagnosed vs. recurrent metastasis, and planned WBRT vs. no planned WBRT. Results Follow-up ranged from 1 to 82 months (median 7). On multivariate analysis, the addition of WBRT was the most significant predictor of local tumor control. Overall, patients who received WBRT had superior local tumor control rates (97% vs. 87% in those who did not receive WBRT; p = 0.0001). Patients receiving WBRT and SRS ≥20 Gy achieved local control rates of 99% compared with 91% control rates when treated with WBRT and SRS <20 Gy (p = 0.0029). Increasing the SRS dose to >20 Gy resulted in no improvement in local tumor control and a higher rate of Grade 3 and 4 neurotoxicity, approaching statistical significance (5.9% vs. 1.9%, p = 0.078). Conclusion First, optimal control of brain metastasis ≤2 cm was seen with 20-Gy SRS combined with planned WBRT. Second, SRS doses >20 Gy resulted in no obvious improvement in local control and appeared to be associated with a greater rate of complications.

Original languageEnglish
Pages (from-to)87-93
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume59
Issue number1
DOIs
StatePublished - May 1 2004

Keywords

  • Brain metastases
  • Brain neoplasms
  • Gamma knife
  • Stereotactic radiosurgery
  • Whole brain radiotherapy

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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