Stereotactic radiosurgery alone for patients with up to 10 brain metastases
The role of stereotactic radiosurgery (SRS) for patients with multiple metastases remains uncertain. A prospective observational study published in Lancet Oncology evaluates the use of SRS without addition of whole brain irradiation on survival for 1194 patients (KPS>70) with 1-10 newly diagnosed brain metastases. Inclusion criteria included largest tumor <10cc and <3cm in diameter and cumulative tumor volume <15cc. Rates of median overall survival for patients with solitary metastasis, 2-4 metastases, and 5-10 metastases were 13.9, 10.8, and 10.8 months respectively. While study interpretation may be limited by mixed tumor types and systemic treatments, this study demonstrates non-inferiority of only using SRS treatment on survival for patients with 5-10 metastases compared to those with 2-4 metastases, and supports the use of SRS alone in patients with 5-10 cerebral metastases. The impact of number of metastases on quality of life and neuro-cognition of the treated patients remains unclear.