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59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

Linac-based radiosurgery for the treatment of brain metastases

Meeting Abstract

  • corresponding author L. Gorgoglione - Divisione di Neurochirurgia, Ospedale Casa Sollievo della Sofferenza, I.R.C.C.S., S.Giovanni Rotondo, Italy
  • C. De Bonis - Divisione di Neurochirurgia, Ospedale Casa Sollievo della Sofferenza, I.R.C.C.S., S.Giovanni Rotondo, Italy
  • A. Bonfitto - Divisione di Neurochirurgia, Ospedale Casa Sollievo della Sofferenza, I.R.C.C.S., S.Giovanni Rotondo, Italy
  • N. Icolaro - Divisione di Neurochirurgia, Ospedale Casa Sollievo della Sofferenza, I.R.C.C.S., S.Giovanni Rotondo, Italy
  • A. Berardi - Divisione di Neurochirurgia, Ospedale Casa Sollievo della Sofferenza, I.R.C.C.S., S.Giovanni Rotondo, Italy
  • S. Parisi - Servizio di Radioterapia, Ospedale Casa Sollievo della Sofferenza, I.R.C.C.S., S.Giovanni Rotondo, Italy
  • P. Lauriola - Servizio di Fisica Sanitaria, Ospedale Casa Sollievo della Sofferenza, I.R.C.C.S., S.Giovanni Rotondo, Italy
  • V. A. d’Angelo - Divisione di Neurochirurgia, Ospedale Casa Sollievo della Sofferenza, I.R.C.C.S., S.Giovanni Rotondo, Italy

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocSO.01.11

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2008/08dgnc011.shtml

Veröffentlicht: 30. Mai 2008

© 2008 Gorgoglione et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: This study included 452 patients harboring 568 lesions and was conducted to determine prognostic factors for tumor response and patient survival after stereotactic radiosurgery (SRS) for brain metastases.

Methods: The metastatic lesion was treated with multiple arcs up to a median dose of 17 Gy. Surgical resection and whole brain radiotherapy (WBRT) have been the mainstays of the treatment of cerebral metastases. Several recent publications and our own experience suggest that the mean survival (10-12 months) can be achieved with stereotactic radiosurgery using the linear accelerator radiosurgical techniques. In addition, radiosurgery can effectively treat metastatic tumors in surgically inaccessible sites, e.g., the brainstem. Radiosurgery can also effectively treat multiple intracranial metastases in widely separated areas of the brain. In fact, we have shown that patients with multiple metastases have similar lengths and qualities of survival as do patients with single metastases treated with stereotactic radiosurgery. The technique has advantages of reduced cost and low morbidity compared with open surgical treatment. A great benefit of radiosurgery is the virtual lack of perioperative complications and the minimal interference with quality of life compared either to surgery or to fractionated whole brain radiotherapy.

Even so-called ‘radioresistant’ tumors (e.g., melanoma, renal cell) show a favourable response to radiosurgery.

Results: The most important predictor of success in radiosurgical treatment of cerebral metastases is the neurological status of the patient, usually expressed as the Karnofsky Performance Status (KPS).

The histological type of primary cancer is not an outcome predictor.

The mean survival duration following SRS was 11 months.

Long-term complications of radiosurgery are infrequent and primarily relate to failure of local tumor control and radiation-induced edema or necrosis. The latter can usually be controlled with corticosteroids, but occasionally, craniotomy may be required to treat life-threatening mass effects.

Conclusions: We believe that radiosurgery is the treatment of choice for most cerebral metastases. Only large lesions (>4 cm diameter) and those which require immediate decompression to treat life-threatening mass effects require surgical treatment. Radiosurgery may also be used to treat residual disease after surgical resection. This study confirms the role of SRS as an acceptable treatment option for patients with solitary or limited brain metastases.