ORIGINAL ARTICLE Survival in Relation to Radiotherapeutic Modality for Brain Metastasis Whole Brain Irradiation vs. Gamma Knife Radiosurgery Ratna Datta,* Ajay Jawahar,† Federico L. Ampil,* Runhua Shi,‡ Anil Nanda,† and Horacio D’Agostino* Abstract: The purpose of this report is to evaluate and compare the survival of patients with brain metastasis (BRM) treated by whole brain irradiation (WBI) using linear energy accelerator (LINAC) and by stereotactic radiosurgery using gamma knife. This study consists of a series of 67 patients with BRM treated with WBI between 1998 and 1999 and 53 patients with BRM treated with gamma knife radiosurgery (GKRS) between 2000 and 2001. A retrospective study of the data was performed and the overall survival between these 2 groups was analyzed. The comparability of these 2 groups was tested by  2 and t test values. Log-rank test was used in the survival comparison. The 1-year survival rate was 26.3% and 22.6%, and corresponding mean survival was 7.8 months and 6.7 months for WBI and GKRS groups, respectively. There was no statistically significant difference between these 2 groups’ survival. It was evident from imaging defined lesions that with GKRS the lesions were reduced, stabilized, or disappeared in 89% of cases. Survival of patients with BRM treated with WBI or GKRS was similar in these series. The present study suggests that good tumor response by GKRS does not translate in longer patient survival. Key Words: radiotherapy, whole brain irradiation, stereotactic radiosurgery, gamma knife radiosurgery, brain metastasis, overall survival (Am J Clin Oncol 2004;27: 420 – 424) T he frequency of brain metastasis (BRM) diagnosis in a population of patients with malignancy is rising. It has been stated that in the United States, between 80,000 and 170,000 individuals develop BRM each year. 1,2,3 Manage- ment of such patients often include the use of systemic steroids and whole brain irradiation (WBI). The prognosis of patients with BRM remains poor despite treatment. Median survival of patients with BRM treated with WBI is only 14 –21 weeks, even though 60%–90% of these patients obtain palliation of neurologic symptoms and 37%–52% of patients are functionally improved. 4,5 Approximately 25%–50% of these patients will die because of uncontrolled recurrent brain metastases. 5 If this subgroup of patients could be identified early and their tumor could be targeted by an appropriate more vigorous treatment modality, useful remission of brain symptoms may be achieved, and this may both enhance the quality of the patient’s life and prolong survival. Radiosur- gery with gamma knife provides us with such an opportunity. The purpose of this study is to evaluate and compare the survival of patients with BRM who were treated with WBI and with gamma knife radiosurgery (GKRS). Addition- ally, the data were analyzed to identify any other parameter that may be used as a performance evaluation tool to compare these 2 treatment modalities. Patient selection, methodology, and results provide data on the efficacy of both methods comparatively. MATERIALS AND METHODS Patients This study is a retrospective review of 67 patients treated with WBI and 53 patients treated with GKRS, for BRM in a single institution. At LSU Health Sciences Center- Shreveport (LSUHSC-S), the patients with BRM were tradi- tionally treated with WBI using a LINAC (Varian Clinac 6/100). In January 2000, Leksell Gamma Knife was installed and patients eligible for stereotactic radiosurgery (SRS) (ie, metastatic lesion volume less than 30 mL and number of lesions less than 4), were treated with GKRS. During 2000 and 2001, 190 patients were treated by GKRS, out of which 53 patients were treated for BRM. At this point, a decision was made to do a retrospective review of these BRM patients From the *Departments of Radiology/Radiation Oncology, †Neurosurgery, and ‡Medicine, LSU Health Sciences Center-Shreveport, Shreveport, LA. Reprints: Dr. Ratna Datta, Department of Radiology/Radiation Oncology, LSU Health Sciences Center, 1501 Kings Highway, PO Box 33932, Shreveport, LA 71130. E-mail: rdatta@lsuhsc.edu Copyright © 2004 by Lippincott Williams & Wilkins ISSN: 0277-3732/04/2704-0420 DOI: 10.1097/01.coc.0000128863.75360.a5 American Journal of Clinical Oncology • Volume 27, Number 4, August 2004 420