TABLE III.
Studies investigating stereotactic radiosurgery (srs)
| Reference | Study type | Treatment | Patients (n) | Metastasis diameter (cm) | Median survival (months) | Comments |
|---|---|---|---|---|---|---|
| wbrt with or without srs | ||||||
| Andrews et al. 200411 | rct |
wbrt WBRT + SRS |
94
92 |
≤4 | 4.9a 6.5a p=0.0393 |
Patients with prior surgery not excluded.
Patients with active disease excluded. wbrt: 37.5 Gy in 15 fractions srs: 15–24 Gy, linac or GammaKnifeb |
| srs versus surgical resection | ||||||
| Muacevic et al. 199918 | rr |
srs Surgery + wbrt |
56
52 |
≤3.5 | 8.1
15.7 |
srs group: No surgery or wbrt.
Surgical re-treatment not excluded from surgery group. wbrt: 40 Gy + 10-Gy boost. srs: 14–27 Gy, GammaKnifeb. |
| Schöggl et al. 200019 | rr |
srs + wbrt Surgery + wbrt |
67
66 |
<3 | 12
9 p=0.55 |
Limited systemic disease.
wbrt: 30 Gy in 10 fractions. srs: median 17 Gy, GammaKnifeb |
| O’Neill et al. 200321 | rr |
srsc Surgeryc |
23
74 |
<3.5 | 13
16 |
No prior treatment.
Patients are candidates for SRS and surgery. Patients with active systemic disease included. |
| srs with or without wbrt | ||||||
| Sneed et al. 200220 | rr |
srs srs + wbrt |
168
175 |
nr | 8.3
8.4 p=0.94 |
No prior surgery.
srs + wbrt within 1 month. Some patients received salvage therapy >1 month after initial treatment. srs: linac or GammaKnifeb |
| Coffey et al. 199112 | cs | srs + wbrt | 24 | ≤3 | 10 | 3 patients received prior wbrt. srs: margin, 16–20 Gy; centre, 18–40 Gy; GammaKnifeb |
| Auchter et al. 199617 | rr | srs + wbrt | 122 | nr | 12.9 | All metastases resectable.
No prior treatment. wbrt: 25–40 Gy; fractions: 2–3 Gy. srs: 10–27 Gy (median: 17 Gy), linac. |
| Flickinger et al. 199415 | rr |
srs +some
wbrt |
116 | ≤3.6 | 11 | 39% of patients treated for recurrent tumours following prior wbrt.
56% of patients received srs plus wbrt. srs: mean minimum dose, 17.9 Gy; mean maximum dose, 34.8 Gy; GammaKnife b. |
| Alexander et al. 199516 | rr | srs + wbrt | 171 | nr | 10.3 | srs: minimum dose, 9–25 Gy; maximum dose, 14–31.23 Gy. |
| Sturm et al. 199113 | cs | srs | 30 | nr | 6.5a | All patients inoperable.
srs: 20–30 Gy, linac. |
| Lutterbach et al. 200314 | cs | srs | 55 | ≤3 | 7.7 | No prior treatment.
srs: 18 Gy, linac. |
a
Mean survival time.
b
Elekta, Stockholm, Sweden.
c
Most patients also received whole-brain radiation therapy (82% of surgery group and 96% of srs group).
rct = randomized controlled trial; wbrt = whole-brain radiation therapy; rr = retrospective review; nr = not reported; linac = linear accelerator; cs = case series.