Authors' objectives:

This report was written by the Management Decision and Research Center (MDRC) Technology Assessment (TA) Program in response to requests for information about the effectiveness of stereotactic radiosurgery (SRS) for the treatment of metastases to the brain.

Authors' results and conclusions: The findings about SRS were fairly encouraging and consistent for comparable groups of patients. However, they should be considered preliminary and interpreted with caution, given the design of the studies available for inclusion. Evidence suggested that SRS was a relatively safe and effective technology for the definitive treatment of newly diagnosed and recurrent metastases to the brain in selected patients. Most of the reported side effects were mild, temporary, and could be relieved by medication. Treatment resulted in very few major complications and very rare deaths. All of the types of cancers treated responded to therapy. The spread of melanomas, breast cancers and kidney cancers was controlled for a longer period of time than for other cancer. For breast cancers, this improved tumor control was accompanied by an increased length of survival. Median survival after SRS ranged from 26 to 56 weeks. This compared favorably with outcomes from other treatments. Patients with limited numbers of relatively small tumors, and who had well-controlled systemic cancer, may have gained the greatest benefits from treatment. Valid comparisons of the relative effectiveness of treatment options are not possible using existing research. It is too early to draw definite conclusions about optimal treatment parameters.

Authors' recommendations: In the absence of data from high quality studies, uncertainty remains about the true effectiveness of SRS for the treatment of metastases to the brain. One randomized clinical trial is in progress, and further trials are needed, to address the many unanswered questions about the use of SRS for this application. Such trials will provide stronger evidence on which to base clinical and policy decisions.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www4.va.gov/VATAP/docs/StereotacticRadiosurgeryMetastasesBrainGammaKnife1997tm.pdf

Year Published: 1997

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: VA Technology Assessment Program

Contact Address: Liz Adams, VA Technology Assessment Program, Office of Patient Care Services (11T), VA Boston Healthcare System Room 4D-142, 150 South Huntington Avenue, Boston, MA 02130 USA Tel: +1 617 278 4469; Fax: +1 617 264 6587;

Contact Name: elizabeth.adams@med.va.gov

Contact Email: elizabeth.adams@med.va.gov

Copyright: U. S. Department of Veterans Affairs, 1997