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Survival time after radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (hfSRT) of brain metastases
Überlebenszeit nach Radiochirurgie (SRS) und hypofraktionierter stereotaktischer Radiotherapie von Hirnmetastasen
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Veröffentlicht: | 30. Mai 2008 |
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Objective: SRS is well known as an effective local treatment for patients with small brain metastases. In case of larger tumors or those located within functional important brain areas, hfSRT can offer an alternate, less risky treatment. The goal of this retrospective study was to investigate SRS and hfSRT with the scope on survival time.
Methods: 268 patients (95 women, 173 men, mean age: 57 y) treated in two centres have been evaluated. 173 patients were treated with SRS (8-35 Gy, mean 19.8 Gy) and 95 patients received a hfSRT (6-7x5 Gy or 10x4 Gy). Larger tumor volume and / or neurological deficits were the reason to use hfSRT. The survival times of both groups have been analyzed under comprehension of prognostic factors.
Results: Within the hfSRT group the mean tumor volume (6.6 ccm ±9.7 ccm) was significant larger than within the SRS group (4.3 ccm ±4.4 ccm). As also expected the hfSRT patients showed a significant higher rate of neurological deficits before treatment (74% vs. 49%, p=0.0001), these deficits did not worsen after the hfSRT and had no influence on the survival time as well as the tumor size (< vs. > 2 cm in diameter). The one year survival rate of all patients was 23% (after SRS 25%, after hfSRT 20%, p=0.63). The mean survival time for SRS patients was 8.6 months vs. 8.1 months for hfSRT patients; in case of lung cancer (n=85) 9.2 vs. 8.1 months; colorectal (n=27) 9.7 vs. 5.7 months; renal cell cancer 9.8 vs. 11 months - Kaplan-Maier analyses showed no significant differences between SRS and hfSRT. Also concerning age, Karnofsky index, local control of primary tumor, singular vs. multiple metastases and RPA classification there were no significant differences between both groups. The number of patients who underwent a whole brain irradiation in advance was significantly higher for SRS patients (37% vs. 18%). Also extracranial metastases were found more often in the SRS group (66% vs. 52%).
Conclusions: With the scope on survival time SRS and hfSRT are both effective methods for the treatment of brain metastases. Particularly for patients with larger tumor volume and/or neurological deficits, hfSRT can be recommended as an efficient and very low-risk therapy option.