Abstract
Treatment outcomes were analyzed retrospectively for 135 patients with brain metastases, who were treated with stereotactic radiosurgery (RS) or whole brain radiotherapy (WBRT) at Osaka City General Hospital between January 1994 and September 1996. The major primary site was the lung (74.8%). RS only was administered to 52 patients, WBRT only to 49 patients, and both RS and WBRT to 34 patients. Of the last group, 15 patients received a combination of WBRT and RS within a month of one another (sequential treatment), 19 patients (previously WBRT was administered to 12 patients, RS to 7 patients) were treated with RS or WBRT at the time of metastatic brain tumor recurrence (recurrence treatment).
RS was performed with the Leksell Gamma knife (maximum dose range: 17.5-57.5Gy, median 40Gy: peripheral dose range was 12.0-28.0 Gy, median 21 Gy). The dose range for WBRT was 30-50 Gy (generally, 1.5Gy b.i.d. for a total dose of 39Gy, which was used for WBRT only, and 1.5 Gy b.i.d. for a total dose of 30 Gy for sequential and recurrence treatment).
The median survival time for patients receiving RS only was 9 months, for WBRT only 7 months, for sequential treatment was 12 months and for recurrence treatment 19 months. There was no significant difference in survival rate between treatment RS only and WBRT only, but there was a significant difference (p<0.01) between sequential treatment and treatment with WBRT only. The death of 10 of the 61 patients was attributed to CNS progression (16% of all deaths). Improvement of neurologic signs and symptoms was seen in 34 of the 62 patients (54.8%). In the recurrence group, intracranial recurrence outside of the RS volume was seen in three of the six patients who were treated with RS only as the initial treatment.
It is concluded that WBRT in conjunction with RS for brain metastases as the initial treatment may be more effective for prolonging survival, especially for cases with no active extracranial disease.
