Stereotactic radiosurgical treatment of brain metastases

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✓ In a series of 33 patients with reasonably controlled primary cancers, stereotactic radiosurgery was used to treat 52 brain metastases. After a mean radiological follow-up time of 5.5 months, six lesions (12%) had stabilized in size, 26 (50%) were significantly reduced, and 15 (29%) had disappeared. One large melanoma metastasis progressed relentlessly despite treatment. Five lesions (9%) had decreased in size slightly before enlarging. In two of these lesions, biopsy revealed only necrosis. In almost all cases, treatment was associated with decreased peritumoral edema. However, a group of patients with large metastases and extensive prior brain irradiation has been identified in whom prolonged symptomatic cerebral edema poses a problem. It is concluded that radiosurgery is a viable alternative to surgical resection for some cases of brain metastasis.

Article Information

Address reprint requests to: John R. Adler, M.D., Department of Neurosurgery, 300 Pasteur Drive, Stanford, California 94305–5327.

© AANS, except where prohibited by US copyright law.

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Figures

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    Contrast-enhanced magnetic resonance images of brain metastases obtained in a 51 -year-old woman with metastatic colon cancer at the time of radiosurgery (a), and at 1 month (b), 3 months (c), and 6 months (d) after radiosurgical treatment (25 Gy). Note the inhomogeneity of contrast enhancement of b and c. Photomicrographs of this patient are displayed in Fig. 3.

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    Scatterplot of 52 metastatic lesions as a function of initial tumor volume and whole-brain radiation dose. Note that multiple datapoints overlap one another. The diagonal lines represent the 20th (0.2), 50th (0.5), and 80th (0.8) percentile probability contours for a lesion becoming symptomatic according to the logistic regression model described in text.

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    Photomicrographs of sections taken from a region of radiosurgical treatment. Left: Two small islands (arrows) of apparently viable tumor are shown surrounded by necrosis. H & E, × 39. Right: Higher magnification of the peripheral site of tumor seen at left. H & E, × 230.

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