Stereotactic Radiosurgery Versus Microsurgical Resection for the Initial Treatment of Metastatic Cancer to the Brain

Journal of Radiosurgery - Tập 2 - Trang 1-5 - 1999
P. Charles Garell1, Patrick W. Hitchon1, B. Chen Wen2, David E. Mellenberg2, James Torner3
1Division of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City
2Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City
3Department of Preventative Medicine and Environmental Health, University of Iowa, Iowa City

Tóm tắt

The use of Stereotactic radiosurgery for the treatment of intracranial metastases from systemic cancer has grown considerably in the last few years. Review of the literature, however, reveals a paucity of well-controlled studies to substantiate this expansion. We conducted this study to address the issue of survival after treatment with either stereotactic radiosurgery or surgical resection. Whole brain radiation was instituted in both treatment arms. This was a retrospective, case-controlled study comparing patients whose only treatment for intracranial disease was either stereotactic radio-surgery or a single surgical resection. Controlling for age, histology, whole brain radiation, tumor size, number of intracranial lesions, and pre-procedural Karnofsky performance scores, we believe this study to be the most rigorous analysis to date. Patients in the radiosurgery group survived longer (median survival = 12.5 months) than those in the surgically resected group (median survival = 8 months). Statistical analysis of these curves did not show a significant difference. Considering only length of patient survival, there is no statistical difference between stereotactic radiosurgery and microsurgical resection for the treatment of new brain metastases from systemic cancer. This conclusion is based on strict criteria as outlined in the text. A larger, prospective, randomized investigation is needed to more definitively address the issue.

Từ khóa


Tài liệu tham khảo

Deangelis LM: Management of brain metastases. Cancer Invest 12:156–165, 1994

Routh A, Khansur T, Hickman BT, Bass D: Management of brain metastases: Past, Present and future. South Med J 87:1218–1226, 1994

Leksell L: Stereotaxis and Radiosurgery: An Operative System. Illinois, CC Thomas, 1971

Black, PM: Solitary brain metastases: Radiation, resection, or radiosurgery. Chest (supplement), 103:367S–369S, 1993

Patchell RA, Tibbs PA, Walsh JW, et al.: A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494–500, 1990

Noordijk EM, Vecht CJ, Haaxma-reiche H, et al.: The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys 29:711–717, 1994

Leksell L: The stereotactic method and radiosurgery of the brain. Acta Chir Scand 102:316–319, 1951

Distefano A, Yap HY, Hortobagyi GN, Blumenschein GR: The natural history of breast cancer patients with brain metastases. Cancer 44:1913–1918, 1979

Ruderman NB, Hall TC: Use of glucocorticoids in the palliative treatment of metastatic brain tumor. Cancer 18:298–306, 1965

Weinstein JD, Toy FJ, Jaffe ME, Goldberg HI: The effect of dexamethasone on brain edema in patients with metastatic brain tumors. Neurology 23:121–129, 1972

Zimm S, Wampler GL, Stablein D, Hazra T, Young HF: Intracerebral metastases in solid tumor patients: Natural history and results of treatment. Cancer 48:384–394, 1981

Adler JR, Cox RS, Kaplan I, Martin DP: Stereotactic radiosurgical treatment of brain metastases. J Neurosurg 76:444–449, 1992

Alexander E, Moriarty TM, Davis RB, et al.: Stereotactic radiosurgery for the definitive, noninvasive treatment of brain metastases. J Natl Cancer Inst 87:34–40, 1995

Loeffler JS, Kooy HM, Wen PY, et al.: The treatment of recurrent brain metastases with stereotactic radiosurgery. J Clin Oncol 8:576–582, 1990

Petrovich Z, Luxton G, Formenti S, Jozsef G, Zee CS, Apuzzo MLJ: Stereotactic radiosurgery for primary and metastatic brain tumors. Cancer Invest 14:445–454, 1996

Auchter RM, Lamond JP, Alexander E, et al.: A multi-institutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys 35:27–35, 1996

Bindal AK, Bindal RK, Hess KR, et al.: Surgery versus radiosurgery in the treatment of brain metastasis. J Neurosurg 84:748–754, 1996

Flickinger JC, Kondiolka D, Lunsford LD, et al.: A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys 28:797–802, 1994

Thông tin
Thông tin xuất bản

Journal of Radiosurgery

Tập 2

1-5

Thông tin tác giả