Faculty Bibliography

BACKGROUND: A retrospective study of patients undergoing stereotactic radiosurgery for one to four brain metastases from nonsmall lung cell carcinoma (NSCLC) was performed to document outcomes and risks. METHODS: Seventy-seven patients underwent radiosurgery during a 7-year interval; 71 also underwent whole brain radiation therapy. Univariate and multivariate analyses were used to determine significant prognostic factors affecting survival. RESULTS: The overall median survival was 10 months after radiosurgery, and 15 months from the diagnosis of brain metastases. Five factors significantly affected survival: extent of systemic disease, presence of a neurologic deficit, size of the intracranial tumor, initial imaging appearance of intratumoral necrosis, and initial resection of the primary tumor of the chest. Median survival time was 26 months in a subgroup of patients with no extracranial metastases, no neurologic deficits, and a small tumor without necrosis. The authors evaluated 91 tumors with imaging. Local tumor control was achieved in 77 lesions (85%) and tumoral radiation necrosis developed in 4 lesions (4.4%). Nineteen new metastatic tumors developed during the observation interval. CONCLUSIONS: Stereotactic radiosurgery for NSCLC brain metastases is effective and is associated with few complications. The early detection of brain metastases and treatment with radiosurgery combined with radiation therapy provide the opportunity for extended high quality survival.

OBJECTIVE: During an 8-year interval, we evaluated the survival benefit of stereotactic radiosurgery performed in 64 patients with glioblastomas multiforme (GBM) and 43 patients with anaplastic astrocytomas (AA). METHODS: Adjuvant radiosurgery was performed either before disease progression or for recurrent tumor at the time of disease progression. Clinical and imaging follow-up data were obtained for all patients. The diagnosis of GBM was obtained by performing craniotomies in 41 patients and by performing stereotactic biopsies in 23. The diagnosis of AA was obtained by performing craniotomies in 19 patients (44%) and by performing biopsies in 24. RESULTS: Of the entire series, the median survival time after initial diagnosis for patients with GBM was 26 months (standard deviation [SD], 19 mo; range, 5-79 mo) and the median survival time after radiosurgery was 16 months (SD, 16 mo; range, 1-74 mo). The 2-year survival rate was 51%. No survival benefit was identified for patients who underwent intravenously administered chemotherapy in addition to radiosurgery (P = 0.97). After undergoing radiosurgery, 12 patients (19%) underwent craniotomies and resections and 4 (6%) underwent subsequent radiosurgery for regional or remote recurrence. For 45 patients who underwent radiosurgery as part of the initial management plan, the median survival time after diagnosis was 20 months. Of the entire series, the median survival time after diagnosis for patients with anaplastic astrocytomas was 32 months (SD, 23 mo; range 5-96 mo) and the median survival time after radiosurgery was 21 months (SD, 18 mo; range 3-93 mo). The 2-year survival rate was 67%. Ten patients (23%) underwent subsequent craniotomies at a mean of 8 months after initial surgery, and two underwent subsequent radiosurgery. There was no acute neurological morbidity after radiosurgery. Histologically proven radiation necrosis occurred in one patient with GBM (1.6%) and two patients with AA (4.7%). For 21 patients for whom radiosurgery was part of the initial management plan, the median survival time after diagnosis was 56 months. CONCLUSION: In comparison to historical controls, improved survival benefit after radiosurgery was identified for patients with GBM and patients with AA. Although this survival benefit may be related to our selection of patients for radiosurgery based on their having smaller tumor volumes, no selection was made based on location. We observed that radiosurgery was safe and well tolerated. Its effectiveness as an adjuvant therapy deserves a properly stratified randomized trial.