LINAC Radiosurgery as Single Treatment in Cerebral Metastases |
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Authors: | R Deinsberger J Tidstrand |
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Institution: | (1) Department of Neurosurgery, Landesklinikum St. Poelten, Propst Führerstrasse 4, A-3100 St. Poelten, Austria;(2) Department of Radiation Oncology, Klagenfurt General Hospital, A 9020 Klagenfurt, Austria |
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Abstract: | Summary Objective: Stereotactic radiosurgery is a radiation technique of high radiation dose focused on a stereotactic intracranial target
in a single fraction with high precision. LINAC Radiosurgery has gained increasing relevance in the treatment of brain metastases
since it was introduced by Sturm (1987).
Method and patient selection: From January 1996 to August 2003 110 patients were treated with LINAC Radiosurgery. A combination of the University of Florida
system and the X Knife System developed by Radionics was used in all patients. Seventy patients had a single and 40 patients
multiple metastatic lesions at the time of diagnosis and treatment. Overall 161 intracerebral metastases were treated. Median
tumor volume was 3.1 ccm (0.3–15 ccm). Median radiation dose to the tumor margin was 1830 cGy (range 1100–2200 cGy) prescribed
to the 80% isodose line. Whole brain radiation therapy with a total dose of 30 Gy in 10 fractions was performed in 35 patients
because of multiple metastases and LINAC Radiosurgery was used as boost for recurrences. In 75 patients LINAC Radiosurgery
was used as single treatment.
Results: The follow-up period was between 6 and 72 months. Local tumor control rate was 89.4%. Seventeen out of 161 metastases treated
showed local recurrence. Eleven out of 75 patients treated with radiosurgery as single treatment developed distant recurrence
and 3 out of 35 patients who were treated with whole brain radiation therapy (WBRT) and radiosurgery as boost. The 1-year
survival rate is 54.9% with a median survival of 54 weeks.
Conclusion: LINAC Radiosurgery is an effective and safe treatment modality in patients with cerebral metastases located in any area
of the brain. WBRT should be preserved for patients with multiple metastases or be delayed until multiple recurrence occurs.
Surgery is still the treatment of choice in metastases with mass effect and surgical accessible location. |
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Keywords: | brain metastases LINAC Radiosurgery local control radiotherapy single treatment survival |
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