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Outcome variation among "radioresistant" brain
metastases treated with stereotactic radiosurgery
Chang EL, Selek U, Hassenbusch SJ 3rd, Maor MH, Allen PK, Mahajan A,
Sawaya R, Woo SY
Department of Radiation Oncology, The University of Texas M. D. Anderson
Cancer Center, Houston, Texas 77030-4009, USA. echang@mdanderson.org
Objective. To determine the influence of histopathological diagnosis on the
outcome of "radioresistant" brain metastases treated with
stereotactic radiosurgery (SRS).
Methods. Patients (n = 189) with
"radioresistant" brain metastases (n = 264) were consecutively
treated with SRS between August 1991 and July 2002.
The primary site of
brain metastases was melanoma (n = 103), renal cell carcinoma (n = 77), and
sarcoma (n = 9).
The median age of the patients was 52 years, and the median
Karnofsky Performance Scale score was 80.
Initial brain metastasis
presentation was single in 112 patients (59%).
The median SRS dose was 18 Gy
(range, 10-24 Gy).
The median tumor volume was 1.6 cm3 (range, 0.06-27.5
cm3).
The median follow-up of all patients was 7.4 months (range, 0.16-52
mo).
Results. The actuarial freedom from progression after 1 year was 64%
for renal cell carcinoma patients, 47% for melanoma patients, and 0% for
sarcoma patients (P < 0.001).
The median survival time for all patients
from time of SRS was 7.5 months.
The rate of 1-year survival was 40% for
renal cell carcinoma patients, 25% for melanoma patients, and 22% for
sarcoma patients (P = 0.0354).
The incidence of neurological death was lower
among patients diagnosed with renal cell carcinoma (31%) than among patients
with melanoma (66%) or sarcoma (60%) (P = 0.001).
Conclusion. Survival after
SRS is significantly worse for patients with melanoma and sarcoma brain
metastases compared with patients with renal cell carcinoma.
Our data show
that progressive brain metastases seem to cause most of the cancer-related
deaths among patients with SRS-treated melanoma and sarcoma brain
metastases.
Future investigations using chemotherapy or novel agents to
enhance the effectiveness of SRS to melanoma and sarcoma brain metastases
seem warranted.
PMID: 15854241 [PubMed - in process]
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