ISSN:
1573-8752
Keywords:
Brain metastases
;
prognostic factors
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract The last decade has witnessed an exponential proliferation of radiosurgery facilities in the United States and around the globe, and consequently, several tens of thousands of patients have undergone this procedure for a variety of intracranial and skull-base abnormalities. Since brain metastases represent the most common intracranial neoplasm, these have become a common target for radiosurgery. We present a review paper summarizing the major issues surrounding the management of brain metastases as well as an English-language literature review of 20 independent reports, using either γ-knife or linear accelerator-based radiosurgery, with 〉1250 patients and 〉2100 lesions available for analysis. Variable reporting in the studies precludes a definitive analysis and comparison of all factors in a rigorous statistical fashion, but the composite data reveal an average local control rate of 83% and a median survival of 9.6 months, which are comparable to those in recent surgical reports. Prognostic factors for survival are beginning to be unraveled, and the most important ones appear to be the presence of fewer than three lesions, controlled extracranial disease, and Karnofsky performance score. The exact impact of dose has not been clarified, but a dose–response relationship, especially for ≥18 Gy, is emerging. The role of whole-brain radiotherapy remains unresolved; it may enhance local control but does not convincingly improve survival and, in some series, is associated with an increased risk of late complications, which appear to be less than 5% on average. The concerns regarding chronic steroid dependance and increased intracranial edema do not appear to be a common problem. With such a large base of uncontrolled evidence, this is an opportune time for conducting and completing randomized trials to validate these observations.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1023/B:JORA.0000010873.43368.21
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