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2017; 63(7):559-563
respectively, were demonstrated at 12 months. There was
more benefit for lesions < 3 cm and deep.
49
(
B
) Several
other studies with patients treated similarly showed lo-
cal control rates of approximately 75 to 90% and 60 to
80% after one and two years of follow-up, respectively.
These results are comparable with the local control
achieved in patients who received postoperative whole
brain radiotherapy.
50-54
(
B
)
Moreover, postoperative radiosurgery improves local
control compared with observation alone for completely
resected brain metastases. Data from a randomized phase
3 trial demonstrated that local control rates are statisti-
cally significant higher in patients who received radiosur-
gery (local control rates in 6 months and 12 months were
83%, 57% and 72%, 45%, for radiosurgery and observation
groups, respectively).
55
(
A
)
Recently, two important studies were presented in
ASCO and ASTRO. Kayama et al. conduced a non-inferi-
ority phase 3 trial (JCOG0504) to assess the effectiveness
of radiosurgery for residual and recurrent brain metasta-
ses after surgical resection. Patients were randomized to
receive radiosurgery or whole brain radiotherapy. The
overall survival rates were similar in both groups.
56
(
A
)
Similarly, Brown et al. randomized patients with 1 to 4
brain metastases to either whole brain radiotherapy or
radiosurgery after surgical resection. More cognitive de-
terioration was observed in whole brain radiotherapy
group. No differences in overall survival were demon-
strated between the groups and better quality of life was
reported in the radiosurgery arm.
57
(
A
)
Recommendation
After surgery, adjuvant radiosurgery may be employed to
replace whole brain radiotherapy.
A
ppendix
1
Search strategy – MEDLINE
(Central Nervous System [Mesh] OR Central Nervous
Systems OR Nervous System, Central OR Nervous Sys-
tems, Central OR System, Central Nervous OR Systems,
Central Nervous) AND (Neoplasm Metastasis [Mesh]
OR Metastases, Neoplasm OR Neoplasm Metastases OR
Metastasis OR Metastases OR Metastasis, Neoplasm)
AND (Radiosurgery [Mesh] OR Radiosurgeries OR Ra-
diosurgery, Stereotactic OR Radiosurgeries, Stereotactic
OR Stereotactic Radiosurgeries OR Stereotactic Radio-
surgery OR Gamma Knife Radiosurgery OR Gamma
Knife Radiosurgeries OR Radiosurgeries, Gamma Knife
OR Radiosurgery, Gamma Knife OR Stereotactic Body
Radiotherapy OR Body Radiotherapies, Stereotactic OR
Body Radiotherapy, Stereotactic OR Radiotherapies,
Stereotactic Body OR Radiotherapy, Stereotactic Body
OR Stereotactic Body Radiotherapies OR CyberKnife
Radiosurgery OR CyberKnife Radiosurgeries OR Radio-
surgeries, CyberKnife OR Radiosurgery, CyberKnife OR
Radiosurgery, Linear Accelerator OR Linear Accelerator
Radiosurgeries OR Radiosurgeries, Linear Accelerator
OR Linear Accelerator Radiosurgery OR Radiosurgery,
Linac OR Radiosurgeries, Linac OR LINAC Radiosurgery
OR Radiosurgeries, LINAC)
C
onflict
of
interest
The authors declare no conflict of interest.
R
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