| Summary: | Objective: The aim of this study is to select the risk factors forlocal failure requiring salvage neurosurgery in patients with brainmetastases treated with stereotactic radiosurgery in a singleinstitution. Methods: The follow-up of 123 patients, with 255 brainmetastases treated with radiosurgery at the Radiation OncologyDepartment of the Hospital Israelita Albert Einstein from July 1993to August 2001, was retrospectively analyzed. The criteria forsalvage neurosurgery were tumor volume enlargement, or tumorpersistence leading to severe neurological symptoms, lifethreateningsituation or critical steroid dependence. We consideredthe case as local failure when the histopathologic evaluationshowed morphologically preserved cancer cells (tumor recurrence,persistence or progression). We applied the Fisher’s exact test toevaluate the statistical correlation between local failure and primarytumor histology, volume of the brain metastases, prescribedradiosurgery dose, and whole brain radiotherapy. Results: Fourteenof 123 patients (11%) underwent salvage neurosurgery. Histologyshowed preserved cancer cells with necrosis and/or bleeding in11 cases (9% of the total accrual), and only necrosis with or withoutbleeding (without preserved cancer cells) in three cases. Theprimary tumor histology among the 11 patients considered withactive neoplasia was malignant melanoma in five cases (21% ofthe patients with melanoma), breast adenocarcinoma in three(16% of the patients with breast cancer), and other histology in theremaining three. Breast cancer diagnosis, non-elective whole brainirradiation, volume of the brain metastases, and the prescribedradiosurgery dose did not correlate with the risk of local failure.Patients treated with elective whole brain radiotherapy showedfewer local failures, when compared to all patients receiving wholebrain radiotherapy, and to the patients not receiving this treatment,with incidence of failure in 4%,7% and 14%, respectively, but thisdifference did not reach statistical significance. Malignantmelanoma histology was the single risk factor statisticallyassociated with local failure, both at univariate (p = 0.0381) andmultivariate analysis (p = 0.0321). Conclusion: In our experience,the risk of local failure after radiosurgery for brain metastasesrequiring salvage neurosurgical intervention is greater in patientswith malignant melanoma, and also suggests a trend to be greaterin patients not treated with elective whole brain irradiation.
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