WESTPORT, Sep 04 (Reuters Health) – Stereotactic radiosurgery slows progression and improves survival in some patients with metastatic disease to the brain, according to a report in the August issue of Neurosurgery.

Although chemotherapy helps few patients with intracerebral metastases, external beam radiotherapy, radiosurgical ablation, and surgical removal of metastases have demonstrated some effectiveness, the authors explain.

Dr. Joseph C. T. Chen, of the University of Southern California, in Los Angeles, and colleagues reviewed their series of 190 patients who underwent gamma knife stereotactic radiosurgery for intracerebral metastatic tumors.

Median survival after radiosurgery was 34 weeks, the authors report, but survival was better among non-melanoma patients (39 weeks) than among melanoma patients (28 weeks). These survival figures are similar to those reported in open surgical series.

Median survival was significantly longer in patients with controlled disease (more than 50 weeks) than with active disease (28 weeks), the investigators note, and in patients with posterior fossa metastases (40.5 weeks) rather than supratentorial lesions (30.3 weeks).

Most metastases followed during the study were controlled for the lifetime of the patient, the report indicates, with only 6% showing late progression and only 6% progressing despite therapy.

“In the absence of clear data demonstrating the advantage of one modality over the other with respect to overall survival,” the authors conclude, “the choice between surgery and radiosurgery must be made on the basis of time, cost, patient acceptance and the availability of the procedure.”

“Radiosurgery should not be considered as a panacea or a miracle treatment,” Dr. Chen told Reuters Health.. “It simply is a less invasive, better tolerated, and safer alternative to open surgical intervention and whole brain irradiation for most, but not all patients with metastatic disease to the brain.”

He added, “We must recognize that just because we are trained as neurosurgeons to use a knife, this may not be the best treatment for all patients. Neurosurgeons must change the nature of their practice to be able to use radiosurgical methods in the treatment of their patients.”

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