Surgery and radiotherapy compared with gamma knife radiosurgery in the treatment of solitary single cerebral metastases of small diameter

作者：Alexander Muacevic, Friedrich Wilhelm Kreth, Gerhard A. Horstmann, Robert Schmid-Elsaesser, Berndt Wowra, Hans Jakob Steiger, H. J. Reulen · 发表于：Journal of neurosurgery · 年份：1999 · DOI：10.3171/jns.1999.91.1.0035 · 被引用次数：274 · 研究领域：Brain Metastases and Treatment、Management of metastatic bone disease、Glioma Diagnosis and Treatment

OBJECT: The aim of this retrospective study was to compare treatment results of surgery plus whole-brain radiation therapy (WBRT) with gamma knife radiosurgery alone as the primary treatment for solitary cerebral metastases suitable for radiosurgical treatment. METHODS: Patients who had a single circumscribed tumor that was 3.5 cm or smaller in diameter were included. Treatment results were compared between microsurgery plus WBRT (52 patients, median tumor dose 50 Gy) and radiosurgery alone (56 patients, median prescribed tumor dose 22 Gy). In case of local/distant tumor recurrence in the radiosurgery group, additional radiosurgical treatment was administered in patients with stable systemic disease. Survival time was analyzed using the Kaplan-Meier method, and prognostic factors were obtained from the Cox model. The patient groups did not differ in terms of age, gender, pretreatment Karnofsky Performance Scale (KPS) score, duration of symptoms, tumor location, histological findings, status of the primary tumor, time to metastasis, and cause of death. Patients who suffered from larger lesions underwent surgery (p < 0.01). The 1-year survival rate (median survival) was 53% (68 weeks) in the surgical group and 43% (35 weeks) in the radiosurgical group (p = 0.19). The 1-year local tumor control rates after surgery and radiosurgery were 75% and 83%, respectively (p = 0.49), and the 1-year neurological death rates in these groups were 37% and 39% (p = 0.8). Shorter overall surviva...