Joseph Randall Kelley MD,PHD, Presenter: Nothing to Disclose

Brian Cameron MD, Abstract Co-Author: Nothing to Disclose

Drew Dill, Abstract Co-Author: Nothing to Disclose

Stanley H. Benedict PhD, Abstract Co-Author: Nothing to Disclose

William Broaddus, Abstract Co-Author: Nothing to Disclose

Theodore Dookjong Chung, Abstract Co-Author: Nothing to Disclose

To evaluate the benefit of stereotactic radiosurgery and fractionated stereotactic radiotherapy in the care of patients with multiple brain metastases from lung carcinoma

Between 1995 and 2005, 125 patients with primary lung cancer metastatic to the brain were treated with fractionated stereotactic radiotherapy or single fraction radiosurgery in combination with whole brain radiotherapy. We present here an interim analysis of 40 patients from within this cohort. Adjuvant stereotactic therapy (35%) and stereotactic salvage therapy (65%) were evaluated for toxicity, disease response, site of recurrence and overall survival. Patients were treated with a range of 1 to 10 isocenters. Single fraction stereotactic radiosurgery was delivered at a dose of 11-21Gy. Fractionated therapy was delivered in 3 doses totaling 27-33Gy.

With a median follow-up of 12 months (range 1-38 months) both treatments are well tolerated. Headache (17%), seizure (10%), and one case of audiovisual hallucinations were the only reported neurological toxicities. Most patients had a significant reduction in tumor burden after therapy. A total of 13 patients (32%) developed local CNS failure with 6 of the 13 patients having both distant and local failure. The median survival for all patients was 17 months. Adjuvant and salvage treatment groups had median survivals of 14.6 and 19.4 months respectively compared to a median survival of 5 months in historical controls treated with whole brain radiotherapy alone. Four patients were still alive at the time of this analysis. The one year survival rate of patients treated with stereotactic therapy was 67% compared to a 10% one year survival rate in whole brain radiotherapy controls.

Stereotactic radiosurgery and fractionated stereotactic radiotherapy are well tolerated and effective in controlling local disease in patients with multiple brain metastases. Both treatments appear to delay CNS progression and may offer a substantial survival benefit in both the adjuvant and salvage setting for metastatic lung cancer patients. These results improve on the survival benefit previously reported for stereotactic radiosurgery and suggest that dose escalation using fractionated stereotactic radiotherapy may be beneficial.

Kelley, J, Cameron, B, Dill, D, Benedict, S, Broaddus, W, Chung, T, Stereotactic Radiosurgery and Stereotactic Radiotherapy for the Treatment of Patients with Multiple Brain Metastases from Lung Cancer.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/8001474.html