Stereotactic Radiosurgery Vs. Whole-brain Radiation Following Resection Of A Solitary Intracranial Metastasis

Keywords: brain metastasis, radiosurgery, radiotherapy, cancer, outcome

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     Surgical resection followed by whole brain radiation therapy (WBRT) is the standard treatment for solitary metastases at most institutions. Despite acceptable control rates, WBRT is accompanied by cognitive decline.    Stereotactic radiosurgery to the resection bed is an alternative strategy that minimizes CNS injury, but remains invalidated. 
     Here we study the efficacy of stereotactic radiosurgery following resection of a solitary metastasis as compared to whole-brain radiotherapy.
     All patients who received surgical resection of a single metastasis followed by WBRT or Gamma Knife radiosurgery between April 1997 and September 2009 were identified.  One hundred and sixty-six patients received Gamma Knife radiosurgery to the resection bed, the largest reported experience in the literature. The WBRT group consisted of twenty case matched patients. 
     The two groups were compared in terms of local recurrence rates, the incidence of re-operation, morbidity, and survival.
     There were no significant differences between the two groups in age at surgery, age at onset of primary diagnosis, or presence of extracranial systemic disease.
     This is a retrospective study.
     There were no significant differences for local or distal recurrences, reoperation rates, treatment-related morbidity, or survival between the two groups.  
     Surgical resection followed by gamma Knife radiosurgery offers comparable survival and local tumor control for patients diagnosed with a solitary metastasis, without the complications of cognitive decline associated with WBRT.


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