STEREOTACTIC INTERSTITIAL RADIOSURGERY WITH THE PHOTON RADIOSURGERY SYSTEM (PRS) FOR METASTATIC BRAIN TUMORS: A PROSPECTIVE SINGLE-CENTER CLINICAL TRIAL

Purpose: To evaluate the efficacy and the treatment outcome of tumor patients being treated stereotactically with a miniature X-ray generator (Photon Radiosurgery System, PRS). Methods and Materials: Thirty-five patients with histologically diagnosed cerebral metastases were treated with a single fraction of stereotactic interstitial irradiation (median, 18 Gy). Clinical and neuroimaging evaluation were assessed at 2-, 6-, and 12-week intervals postoperatively and every 3 months thereafter. Survival, local control, and distant and overall brain freedom from progression were obtained using the Kaplan-Meier method. Results: Median survival was 7.37 months and the actuarial survival rates at 6 and 12 months were 60.0 % and 34.3 %, respectively. Acute complications on six patients were associated with shorter survival. Local tumor control at the initial stage and at the last follow-up were 82 % and 50 %. Eighteen patients (53 %) developed distant brain metastases after treatment. At 1 year, the local control rate and distant and overall brain freedom from progression were 33.0 %, 43.3 %, and 14.7 %, respectively. A shorter local tumor control was observed by PRS treatment of a recurrent tumor and by irregular tumor configuration. Conclusions: Interstitial radiosurgery with the PRS requires continued investigation. It allows for an immediate and potentially cost-efficient treatment for patients with singular, small (<= 6.36 cm(3); or <= 2.3 cm) spherical brain metastasis subsequent to a stereotactic biopsy. (C) 2009 Elsevier Inc.