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Linear Accelerator Radiosurgery in the Treatment of Brain Metastases

Ulm, Arthur J. M.D.; Friedman, William A. M.D.; Bova, Frank J. Ph.D.; Bradshaw, Patrick Ph.D.; Amdur, Robert J. M.D.; Mendenhall, William M. M.D.

doi: 10.1227/01.NEU.0000141084.28973.76
Clinical Studies

OBJECTIVE: To review a 12-year experience treating metastatic brain disease with linear accelerator-based stereotactic radiosurgery (SRS).

METHODS: We performed a retrospective analysis of all patients treated between 1989 and 2001 with linear accelerator radiosurgery for brain metastases. Patients were followed up both clinically and with imaging studies to document local control, regional control, and survival. Demographic data, dosing parameters, number of lesions, histology, history of whole-brain radiation therapy, and other factors were obtained prospectively. Cox proportional-hazards regression with multivariate and univariate analysis was performed with Stata 8.0 software.

RESULTS: A total of 383 patients received SRS for brain metastases during the study interval. Median survival was 9 months. Patients with tumor-type melanoma or multiple metastatic lesions had decreased survival. Actuarial 1-year local control was 75%. Differences in regional control rates were not statistically significant between patients treated with SRS and whole-brain radiation therapy versus SRS alone.

CONCLUSION: Radiosurgery is an effective and safe method for treating selected patients with brain metastases.

Department of Neurosurgery, University of Florida, Gainesville, Florida (Ulm, Friedman, Bova)

Center for Epidemiology and Biostatistics, University of Texas, San Antonio, Texas (Bradshaw)

Department of Radiation Oncology, University of Florida, Gainesville, Florida (Amdur, Mendenhall)

Reprint requests: William A. Friedman, M.D., Department of Neurosurgery, P.O. Box 100265, UFBI, University of Florida, Gainesville, FL 32610. Email: friedman@neurosurgery.ufl.edu

Received, November 6, 2003.

Accepted, May 28, 2004.

Copyright © by the Congress of Neurological Surgeons