pattyz
04-07-2004, 09:53 AM
Original Article
Stereotactic radiosurgery for multiple brain metastases from breast
carcinoma
Feasibility and outcome of a local treatment concept
Alexander Muacevic, M.D. 1 *, Friedrich W. Kreth, M.D. 1,
Jörg-Christian Tonn, M.D. 1, Berndt Wowra, M.D. 2
1Department of Neurosurgery, Ludwig-Maximilians-University, Klinikum
Großhadern, Munich, Germany
2Gamma Knife Center, Munich, Germany
email: Alexander Muacevic (amuacevi@helios.med.uni-muenchen.de)
*Correspondence to Alexander Muacevic, Department of Neurosurgery,
Ludwig-Maximilians-University, Klinikum Großhadern, 81377 Munich,
Germany
Fax: (011) 49 89 7095 2592
Keywords
breast carcinoma • brain metastases • radiosurgery • gamma knife •
radiotherapy
Abstract
BACKGROUND
The current study analyzed the feasibility and outcome of stereotactic
radiosurgery (SRS) for treatment of brain metastases from breast
carcinoma.
METHODS
During an 8-year period, 151 patients with a combined total of 620
brain metastases from breast carcinoma underwent 197 outpatient SRS
procedures. Sixty-three percent of all patients had multiple brain
metastases. The median tumor volume was 2.2 cm3 (range, 0.1-20.9 cm3).
The mean prescribed tumor dose was 19 ± 4 grays. Local/distant tumor
recurrences were treated with additional radiosurgical therapy for
patients with stable systemic disease. All patients were categorized
according to the Radiation Therapy Oncology Group classification.
Survival time and freedom from local tumor recurrence were analyzed
using the Kaplan-Meier method. Prognostic factors were identified using
the Cox proportional hazards model.
RESULTS
The overall median survival duration was 10 months after SRS.
Ninety-four percent of patients did not experience local brain tumor
recurrence after radiosurgery. In addition, 70.2% of patients did not
have disease recurrence in the brain. Most patients died of
systemically progressing malignancy. A Karnofsky performance score > 70
and recursive partitioning analysis Class I were related to prolonged
survival in the univariate and multivariate analyses. Age, whole-brain
radiotherapy, surgery, number of metastases, chemotherapy, and latency
period from diagnosis of the primary tumor to the development of brain
metastases did not reach prognostic relevance in the multivariate
model. Patients with RPA I, II, and III survived 34.9, 9.1, and 7.9
months, respectively. There was no treatment related permanent
morbidity and mortality. The transient morbidity rate was 17%. Sixteen
patients exhibited symptomatic transient complications related to
treatment.
CONCLUSIONS
The results of the current study indicate that SRS is a feasible
treatment concept for selected patients with multiple brain metastases
from breast carcinoma.
pattyz
Stereotactic radiosurgery for multiple brain metastases from breast
carcinoma
Feasibility and outcome of a local treatment concept
Alexander Muacevic, M.D. 1 *, Friedrich W. Kreth, M.D. 1,
Jörg-Christian Tonn, M.D. 1, Berndt Wowra, M.D. 2
1Department of Neurosurgery, Ludwig-Maximilians-University, Klinikum
Großhadern, Munich, Germany
2Gamma Knife Center, Munich, Germany
email: Alexander Muacevic (amuacevi@helios.med.uni-muenchen.de)
*Correspondence to Alexander Muacevic, Department of Neurosurgery,
Ludwig-Maximilians-University, Klinikum Großhadern, 81377 Munich,
Germany
Fax: (011) 49 89 7095 2592
Keywords
breast carcinoma • brain metastases • radiosurgery • gamma knife •
radiotherapy
Abstract
BACKGROUND
The current study analyzed the feasibility and outcome of stereotactic
radiosurgery (SRS) for treatment of brain metastases from breast
carcinoma.
METHODS
During an 8-year period, 151 patients with a combined total of 620
brain metastases from breast carcinoma underwent 197 outpatient SRS
procedures. Sixty-three percent of all patients had multiple brain
metastases. The median tumor volume was 2.2 cm3 (range, 0.1-20.9 cm3).
The mean prescribed tumor dose was 19 ± 4 grays. Local/distant tumor
recurrences were treated with additional radiosurgical therapy for
patients with stable systemic disease. All patients were categorized
according to the Radiation Therapy Oncology Group classification.
Survival time and freedom from local tumor recurrence were analyzed
using the Kaplan-Meier method. Prognostic factors were identified using
the Cox proportional hazards model.
RESULTS
The overall median survival duration was 10 months after SRS.
Ninety-four percent of patients did not experience local brain tumor
recurrence after radiosurgery. In addition, 70.2% of patients did not
have disease recurrence in the brain. Most patients died of
systemically progressing malignancy. A Karnofsky performance score > 70
and recursive partitioning analysis Class I were related to prolonged
survival in the univariate and multivariate analyses. Age, whole-brain
radiotherapy, surgery, number of metastases, chemotherapy, and latency
period from diagnosis of the primary tumor to the development of brain
metastases did not reach prognostic relevance in the multivariate
model. Patients with RPA I, II, and III survived 34.9, 9.1, and 7.9
months, respectively. There was no treatment related permanent
morbidity and mortality. The transient morbidity rate was 17%. Sixteen
patients exhibited symptomatic transient complications related to
treatment.
CONCLUSIONS
The results of the current study indicate that SRS is a feasible
treatment concept for selected patients with multiple brain metastases
from breast carcinoma.
pattyz