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Factors influencing survival after gamma knife radiosurgery for patients with single and multiple brain metastases. 1996

H K Shu, and P K Sneed, and C Y Shiau, and M W McDermott, and K R Lamborn, and E Park, and M Ho, and P L Petti, and V Smith, and L J Verhey, and W M Wara, and P H Gutin, and D A Larson
Department of Radiation Oncology, University of California, San Francisco, San Francisco, California 94143-0226, USA.

OBJECTIVE Radiosurgery has been reported to yield high local control rates for brain metastases. However, further work is needed to define which subgroups of patients may benefit from this treatment modality. METHODS We reviewed 116 patients who underwent stereotactic radiosurgery for initial management or recurrence of solitary or multiple brain metastases from September 1991 through December 1994 at the University of California, San Francisco. Survival time and time to local-regional failure were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the Cox proportional hazards model. RESULTS Median survival was 40 weeks from radiosurgery. In multivariate analysis, smaller total tumor volume, absence of extracranial metastases, higher Karnofsky score, and age < or = 70 had a positive effect on survival. In patients initially managed for brain metastases, the addition of whole brain radiotherapy to radiosurgery had no significant effect on survival. Although the presence of multiple metastases was associated with a significantly worse survival rate in patients initially managed with radiosurgery in univariate analysis, it was not as a significant factor in multivariate analysis. An analysis of patients within this series treated with radiosurgery who would have been eligible for Patchell's study on the role of surgery in the treatment of solitary brain metastasis revealed a favorable median survival of 70 weeks. CONCLUSIONS We conclude that radiosurgical treatment of brain metastases results in survival times that compare favorably with the historic experience in patients treated with whole brain radiotherapy alone or with surgical resection. In patients presenting initially with brain metastases, radiosurgery alone may yield survival results equivalent to radiosurgery with whole brain radiotherapy, but intracranial control and quality of life also need to be evaluated. Also, the presence of multiple brain metastases should not be a contraindication for the use of radiosurgery given the good survival achieved with such patients in this series. Each such case should therefore be evaluated based on other factors such as patient's age, Karnofsky score and systemic disease.

UI MeSH Term Description Entries
D008297 Male Males
D008499 Medical Records Recording of pertinent information concerning patient's illness or illnesses. Health Diaries,Medical Transcription,Records, Medical,Transcription, Medical,Diaries, Health,Diary, Health,Health Diary,Medical Record,Medical Transcriptions,Record, Medical,Transcriptions, Medical
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009364 Neoplasm Recurrence, Local The local recurrence of a neoplasm following treatment. It arises from microscopic cells of the original neoplasm that have escaped therapeutic intervention and later become clinically visible at the original site. Local Neoplasm Recurrence,Local Neoplasm Recurrences,Locoregional Neoplasm Recurrence,Neoplasm Recurrence, Locoregional,Neoplasm Recurrences, Local,Recurrence, Local Neoplasm,Recurrence, Locoregional Neoplasm,Recurrences, Local Neoplasm,Locoregional Neoplasm Recurrences,Neoplasm Recurrences, Locoregional,Recurrences, Locoregional Neoplasm
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D001932 Brain Neoplasms Neoplasms of the intracranial components of the central nervous system, including the cerebral hemispheres, basal ganglia, hypothalamus, thalamus, brain stem, and cerebellum. Brain neoplasms are subdivided into primary (originating from brain tissue) and secondary (i.e., metastatic) forms. Primary neoplasms are subdivided into benign and malignant forms. In general, brain tumors may also be classified by age of onset, histologic type, or presenting location in the brain. Brain Cancer,Brain Metastases,Brain Tumors,Cancer of Brain,Malignant Primary Brain Tumors,Neoplasms, Intracranial,Benign Neoplasms, Brain,Brain Neoplasm, Primary,Brain Neoplasms, Benign,Brain Neoplasms, Malignant,Brain Neoplasms, Malignant, Primary,Brain Neoplasms, Primary Malignant,Brain Tumor, Primary,Brain Tumor, Recurrent,Cancer of the Brain,Intracranial Neoplasms,Malignant Neoplasms, Brain,Malignant Primary Brain Neoplasms,Neoplasms, Brain,Neoplasms, Brain, Benign,Neoplasms, Brain, Malignant,Neoplasms, Brain, Primary,Primary Brain Neoplasms,Primary Malignant Brain Neoplasms,Primary Malignant Brain Tumors,Benign Brain Neoplasm,Benign Brain Neoplasms,Benign Neoplasm, Brain,Brain Benign Neoplasm,Brain Benign Neoplasms,Brain Cancers,Brain Malignant Neoplasm,Brain Malignant Neoplasms,Brain Metastase,Brain Neoplasm,Brain Neoplasm, Benign,Brain Neoplasm, Malignant,Brain Neoplasms, Primary,Brain Tumor,Brain Tumors, Recurrent,Cancer, Brain,Intracranial Neoplasm,Malignant Brain Neoplasm,Malignant Brain Neoplasms,Malignant Neoplasm, Brain,Neoplasm, Brain,Neoplasm, Intracranial,Primary Brain Neoplasm,Primary Brain Tumor,Primary Brain Tumors,Recurrent Brain Tumor,Recurrent Brain Tumors,Tumor, Brain
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults

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