Combined surgical resection and stereotactic radiosurgery for treatment of cerebral metastases

Department of Neurosurgery, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA.
Surgical Neurology (Impact Factor: 1.67). 05/2008; 71(3):280-8, disucssion 288-9. DOI: 10.1016/j.surneu.2007.12.019
Source: PubMed


Patients with limited intracranial metastatic disease traditionally have been treated with surgery followed by WBRT. However, there is growing concern for the debilitating cognitive effects after WBRT in long-term survivors. We present a series of patients treated with surgery followed by SRS, while reserving WBRT as a salvage therapy for disease progression.
Medical records from 15 patients with 1 to 2 cerebral metastases who underwent both resection and SRS were reviewed. Outcome measures included overall survival, survival by RPA class, EOR, local tumor control, progression of intracranial disease, need for WBRT salvage therapy, and COD.
Fifteen patients with cerebral metastases were treated with the combined surgery-SRS paradigm. Eight of the 15 patients (53.3%) were designated RPA class 1, with 6 of 15 (40.0%) in class 2 and 1 of 15 (6.7%) in class 3. Gross total resection was achieved in 12 cases (80.0%). Overall median survival was 20.0 months, with values of 22.0 and 13.0 months for RPA classes 1 and 2, respectively. Local recurrence occurred in 16.7% of those patients with GTR. Six patients (40.0%) went on to receive WBRT at a median of 8.0 months from initial presentation. Twelve patients (80.0%) had died at the completion of the study, and the COD was CNS progression in 33.3%.
Surgical resection combined with SRS is an effective treatment for selected patients with limited cerebral metastatic disease. Survival using this combined treatment was equivalent to or greater than that reported by other studies using surgery + WBRT or SRS + WBRT.

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    • "Currently SRS is most often performed via a linear accelerator or a Gamma Knife (Elekta Instruments, Norcross, GA). Defining optimal situations for SRS has proved difficult with practitioners using SRS as a planned boost following WBRT [7], a planned boost to a surgical bed [8,9], sole treatment [10], or as a salvage intervention [11]. Here we report our experience treating CNS breast metastasis via Gamma Knife Radiosurgery. "
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