Is stereotactic radiosurgery under-utilised in the treatment of surgically excisable cerebral metastases?. (October 2013)

• Record Type: Journal Article
• Authors: Lee, M. K.; Javadpour, M.; Jenkinson, M. D.
• Is Part Of: British journal of neurosurgery. Volume 27:Number 5(2013:Oct.)
• Page Start: 658
• Page End: 661
• Publication Date: 2013-10
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48
• DOI: 10.3109/02688697.2013.791666
• Languages: English
• ISSNs: 0268-8697

Abstract

<abstract> <title>Abstract</title> <p> <italic>Background/Objective.</italic> Brain metastases are a significant cause of morbidity and mortality. Treatment options included surgery, whole brain radiotherapy and stereotactic radiosurgery alone or in combination. There has been a significant increase in stereotactic radiosurgery (SRS) provision in the UK over the last 5 years. We investigated the proportion of surgically resected brain metastases that would be suitable for SRS. <italic>Methods.</italic> We retrospectively collected data on 116 consecutive patients undergoing surgical resection of brain metastases. Suitable radiological targets for SRS were defined as solid tumours < 30 mm maximum diameter with no hydrocephalus and no symptomatic mass effect. <italic>Results.</italic> One hundred and two cases (88%) were solitary metastasis and fourteen (12%) had multiple metastases. Median maximum tumour diameter was 34 mm (range: 12–70 mm). Approximately one-third of patients (n = 41) had surgically resected brain metastasis suitable for SRS. Median OS was 7.7 months for those suitable for SRS and 5.4 months for those not suitable for SRS (<xref ref-type="fig" rid="F3">Fig. 3</xref>; Log Rank: P = 0.52). <italic>Conclusions.</italic> In surgically amenable tumours, day case SRS could also be used in approximately one-third of cases, thereby avoiding craniotomy and reducing length of stay. These data may be useful in planning service provision, and for drawing up business plans for a new SRS services. Nationally agreed guidelines for SRS for brain metastases have been developed and a full health economic analysis warrants further investigation to determine the cost effectiveness of SRS compared to craniotomy.</p> </abstract>