Surgery versus radiosurgery in the treatment of brain metastasis

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✓ Surgery and radiosurgery are effective treatment modalities for brain metastasis. To compare the results of these treatment modalities, the authors followed 31 patients treated by radiosurgery and 62 patients treated by surgery who were retrospectively matched. Patients were matched according to the following criteria: histological characteristics of the primary tumor, extent of systemic disease, preoperative Karnofsky Performance Scale score, time to brain metastasis, number of brain metastases, and patient age and sex. For patients treated by radiosurgery, the median size of the treated lesion was 1.96 cm3 (range 0.41–8.25 cm3) and the median dose was 20 Gy (range 12–22 Gy). The median survival was 7.5 months for patients treated by radiosurgery and 16.4 months for those treated by surgery; this difference was found to be statistically significant using both univariate (p = 0.0018) and multivariate (p = 0.0009) analyses. The difference in survival was due to a higher rate of mortality from brain metastasis in the radiosurgery group than in the surgery group (p < 0.0001) and not due to a difference in the rate of death from systemic disease (p = 0.28). Log-rank analysis showed that the higher mortality rate found in the radiosurgery group was due to a greater progression rate of the radiosurgically treated lesions (p = 0.0001) and not due to the development of new brain metastasis (p = 0.75).

On the basis of their data, the authors conclude that surgery is superior to radiosurgery in the treatment of brain metastasis. Patients who undergo surgical treatment survive longer and have a better local control. The data lead the authors to suggest that the indications for radiosurgery should be limited to surgically inaccessible metastatic tumors or patients in poor medical condition. Surgery should remain the treatment of choice whenever possible.

Article Information

Address reprint requests to: Raymond Sawaya, M.D., Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 64, Houston, Texas 77030.

© AANS, except where prohibited by US copyright law.

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Figures

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    Graph depicting a comparison of survival periods in surgically and radiosurgically treated patients. Radiosurgically treated patients had a shorter overall survival period according to both univariate and multivariate analyses. n = number of patients.

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    Graphs showing comparisons of systemic (left) and neurological (right) survival in the surgical and radiosurgical groups. There was no difference in systemic survival. Radiosurgically treated patients exhibited shorter neurological survival periods according to both univariate and multivariate analyses. n = number of patients.

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    Graphs displaying comparisons between the surgical and radiosurgical groups for freedom from both distant (left) and local (right) recurrence of disease. There was no difference in distant recurrence rates between the two groups. Radiosurgery yielded significantly poorer local tumor control than surgery according to both univariate and multivariate analyses. n = number of patients.

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