Long-Term Survival Possible After Radiosurgery for Brain Metastases

By Will Boggs, MD

NEW YORK JAN 12, 2006 (Reuters Health) - Many patients can survive for years after effective gamma knife radiosurgery for brain metastases, according to a report in the December 15, 2005 issue of Cancer.

Brain metastases complicate as many as 40% of systemic malignancies, the authors explain, and stereotactic radiosurgery of these metastases can extend survival to 13 months or beyond, depending on tumor type.

Dr. Douglas Kondziolka from the University of Pittsburgh Medical Center, Pennsylvania and colleagues assessed 44 patients who survived more than 4 years after radiosurgery to determine clinical and treatment patterns potentially responsible for their outcome.

The patients represented 6.5% of the patients with brain metastases who underwent radiosurgery between 1988 and 2000 at their institution. The median survival of these patients was 68 months, and 16 patients remained alive at the time of last follow-up, with a maximum survival of 156 months so far.

At the last follow-up, 99 of 133 (74.4%) brain metastases had regressed, 22 remained unchanged in volume (16.5%), and 12 (9%) had enlarged, the results indicate. Twenty-one of the patients required additional radiosurgery procedures, the researchers note, with one patient (who lived for more than 10 years) requiring seven radiosurgeries.

Compared with patients who died within the first 3 months after radiosurgery, this group showed no differences in age; gender; percentage of lung carcinoma, melanoma, or renal cell carcinoma; radiosurgery margin dose; use of prior whole brain radiation therapy; volume of the largest tumor; or total tumor volume.

Patients who lived more than 4 years had higher pre-radiosurgery Karnofsky performance scores, fewer metastases, and less extracranial disease burden than did patients who died in the early months after radiosurgery, the investigators observe.

"Despite our traditional methods to predict how patients with cancer will fare (cancer type, extent of cancer), some patients "beat the odds" and do much better than anyone might have predicted," Dr. Kondziolka told Reuters Health.

"In order that we increase the number of such patients, we should continue to offer comprehensive cancer care, whenever appropriate, even in the appearance of negative findings (i.e., the appearance of brain metastases)," Dr. Kondziolka added. "When I discuss things with patients, I offer them hope that perhaps they will do much better than the textbooks might predict."

SOURCE:

• Cancer 2005;104:2784-2791.