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  • A Phase II Trial of Focal Fractionated Radiosurgery with/without Surgery in Patients with 1 to 3 Symptomatic Brain Metastases

    Final Number:

    Mario Ammirati MD; Tariq T. Lamki MD; John Grecula MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Radiosurgery is a well-known adjunct in the treatment of brain metastasis. Stereotactic Radiosurgery in the treatment of brain metastasis is still burgeoning in the field neuro-oncology. Evidence based studies are few and limited in authority. This study is a Phase II trial of focal fractionated radiosurgery with or without surgery in patients found to suffer from 1 to 3 symptomatic brain metastases.

    Methods: 40 patients with 1-3 symptomatic brain metastases were prospectively treated with Fractionated Stereotactic Radiosurgery (FSR) ± surgery. Metastases were deemed symptomatic when they were associated with clinical symptoms/signs related to them or when there was neuroradiological evidence of mass effect. All patients were treated with FSR using serial tomotherapy with an intensity modulated algorithm. All patients received 30 Gy in 5 fractions.

    Results: Median age was 60 years and median Karnofsky Rate was 80. Follow-up ranged from 3 to 41 months. 11 patients were in RPA class I and 29 in class II. There were 63 metastases. 42 metastases were treated with surgery and 51 with FSR; 12 non symptomatic brain metastases were observed. The target consisted of the surgical cavity or of the brain metastasis respectively for patients who had undergone surgery or not. Target volume ranged from 0.9 to 64 cm3 (mean 17.4 cm3, median 11.5 cm3). Overall median survival was 9 months; RPA class I survival was 22 months and class II survival was 8 months. Patients spent 62% of their survival time with a Karnofsky Rate of at least 70. Of the 19 patients who died 14 died of non-neuro death, 3 of neuro-death and 2 of unknown causes. There were a total of 20 failures in 15 patients. 2 patients failed at the site of treatment while 12 patients failed outside of the treatment area and 1 patient failed at both sites. Failure treatment consisted of Surgery + FSR at 5 sites, of Gamma knife at 3 sites, of FSR at 7 sites , of WBRT in 5 patients.

    Conclusions: FSR ± surgery, without whole brain radiotherapy, seems to be an effective modality to control neurological diseases in patients with 1-3 symptomatic brain metastases.

    Patient Care: This study will add magnitude to the perception that fractionated stereotactic radiosurgery can effectively be used to treat brain metastasis. This reduces patient exposure to complications associated with whole brain radiation. It also preserves this more aggressive approach for future recurrence.

    Learning Objectives: Fractionated stereotactic radiosurgery is effective in controlling symptomatic brain metastasis.


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