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Stereotactic radiosurgery for brainstem metastases: Survival, tumor control, and patient outcomes
Aamir Hussain1, Paul D Brown, Scott L Stafford
1Department of Radiation Oncology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Purpose:
Patients with brainstem metastases have limited treatment options. In this study, we reviewed outcomes after stereotactic radiosurgery (SRS) in the management of patients with brainstem metastases.
Methods And Materials:
Records were reviewed of 22 consecutive patients presenting with brainstem metastases who underwent SRS. The most frequent primary malignancy was the lung (n = 11), followed by breast (n = 3) and kidney (n = 2). Three patients (14%) also underwent whole-brain radiation therapy (WBRT). The median tumor volume was 0.9 mL (range, 0.1-3.3 mL); the median tumor margin dose was 16 Gy (range, 14-23 Gy).
Results:
Median survival time after SRS was 8.5 months. Although local tumor control was achieved in all patients with imaging follow-up (n = 19), 5 patients died from development and progression of new brain metastases. Two patients (9%) had symptom improvement after SRS, whereas 1 patient (5%) developed a new hemiparesis after SRS.
Conclusions:
Radiosurgery is safe and provides a high local tumor control rate for patients with small brainstem metastases. Patients with limited systemic disease and good performance status should be strongly considered for SRS.
Insights
Stereotactic radiosurgery (SRS) offers a safe and effective treatment for brainstem metastases, achieving high local tumor control. Patients with limited disease and good performance status benefit most from this approach.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Oncology
Background:
- Brainstem metastases present limited therapeutic options.
- Stereotactic radiosurgery (SRS) is an emerging treatment modality.
Purpose of the Study:
- To review outcomes of SRS for brainstem metastases.
- To evaluate the safety and efficacy of SRS in this patient population.
Main Methods:
- Retrospective review of 22 patients with brainstem metastases treated with SRS.
- Analysis of primary malignancy, tumor volume, radiation dose, and survival.
- Concurrent whole-brain radiation therapy (WBRT) was noted in 14% of patients.
Main Results:
- Median survival post-SRS was 8.5 months.
- 100% local tumor control was observed in patients with follow-up imaging.
- Symptom improvement occurred in 9% of patients; 5% developed new hemiparesis.
Conclusions:
- SRS is a safe treatment for small brainstem metastases.
- High local tumor control rates are achievable with SRS.
- Consider SRS for patients with limited systemic disease and good performance status.
