Table 1. . Summary of published studies assessing post-operative stereotactic radiosurgery in brain metastasis .
| Study | Sample size | Dose (range) | Local control | Distant recurrence | Survival |
|---|---|---|---|---|---|
| Minniti G et al. (2013) | 101 patients with large resection cavities (>3 cm). included 2-mm margin |
Multidose 9 Gy x 3 | 1 year: 93% 2 year: 84% |
1 year: 50% 2 year: 66% |
1-year: 69% 2-year: 34% |
| Hwang SW et al. (2010) | 25 patients underwent surgical resection + SRS. 18 patients underwent surgical resection + WBRT |
(15–20 Gy) depending on size of cavity |
GKS patients: No known local failure WBRT: 3 patients with local failures |
GKS patients: 28% WBRT: 17% |
Median survival treated with GKS: 15 months. Median survival treated with WBRT: 6.81 months |
| Iwai Y et al. (2008) | 21 patients | 17 Gy (13–20 Gy) | 76% | 48% | Median survival: 20 months |
| Jensen CA et al. (2010) | 106 patients (112 resection cavities) | Median dose: 17 Gy | 1 year: 80.3% | 1 year: 35.4% | Median overall survival: 10.9 months Overall survival at 1 year: 46.8% |
| Jagannathan J et al. (2009) | 47 patients | Mean dose: 19 Gy (6–22 Gy) | 94% | 34 patients (72%) underwent additional radiosurgery for 140 new metastases | Mean of 12 months |
| Hartford AC et al. (2013) | 47 patients (49 lesions) | 15.3 Gy (10.75–23.5 Gy) depending on size of tumor | 1 year: 85.5% 2 year: 66.9% |
63% patients developed DR 1-year actuarial rate: 56% 2-year acturial: 76% |
1 year: 52.5% 2 year: 31.7% |
| Do L et al. (2009) | 30 patients | (15–18 Gy) | 86.70% | 63% developed recurrences in new intracranial sites | 1 year overall survival: 51% |
| Quigley MR et al. (2008) | 32 patients | 14 Gy (10–18 Gy) | 93.75% | 4 patients required SRS for new lesions | Median survival: 16.4 months |
| Kelly PJ et al. (2012) | 18 patients | 18 Gy (15–18 Gy) | 89% | Distant recurrence occurred in 6 patients | 1 year actuarial overall survival rate: 93% |
| Karlovits BJ et al. (2011) | 52 patients | 15 Gy (8–18 Gy) | 92.30% | 23 patients (44%) developed distant brain recurrences at a median of 16 months postresection | Median survival: 15 months |
| Soltys SG et al. (2008) | 72 patients (76 cavities) | 18.6 Gy (15–30 Gy) | 6 month: 88%. 1 year: 79% |
49% | 6 month: 77% 12 month: 57% |
| Choi CYH et al. (2012) | 112 patients (120 cavities). added a 2-mm margin |
Median marginal dose: 20 Gy (12–30 Gy) in 1–5 fractions. | 1 year LF: 9.5% 1 year cumulative incidence rate of LF: with 2-mm margin: 3% without margin: 16% |
1 year DF: 54% | Median OS time: 17 months 12-month OS: 62% |
| Brennan C et al. (2014) (Phase II study) |
49 patients (50 lesions) | 18 Gy (15–22 Gy) | 70% | Cumulative 1 year RF rate: 44% | |
| Limbrick DD et al. (2009) | 15 patients | (16–24 Gy) | 83.30% | 6 developed remote disease | Overall median survival: 20.0 months |
| Nataf F et al. (2008) | 93 patients had single metastasis. 2-mm margin: 51/93 patients. No margin. 42/93 patients |
10–20 Gy | 2 mm margin: 1 year: 69.1% 2 year: 64% No margin: 1 year: 72.4% 2 year: 54.7% |
2 mm margin: Median: 19 months 1 year: 60.2% No margin: Median: 11.3 months 1 year: 41.6% |
|
| Atalar B et al. (2013) | 63 patients (68 cavities) | 18 Gy (13–27) in 1–3 fractions | LF: 7 of 68 cavities Cumulative incidence rate of LF: 6 month: 2.9% 12 month: 12% 24 month: 11.2% |
Median: 17 months 6 month: 83% 12 month: 60% 24 month: 42% |
|
| Jarvis LA et al. (2012) | 41 patients (43 lesions) | 5 cavities had local progression | 4 patients had progression elsewhere in brain 1 patient had both local and distant progression |
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SRS: Stereotactic radiosurgery; WBRT: Whole brain radiation therapy.