ABSTRACT
The results of two prospective randomized studies 1, 2 indicate survival advantages for patients with single brain metastases treated with surgery and radiotherapy compared with radiotherapy alone. Radiosurgery - a minimally invasive technique that uses multiple convergent beams to deliver a high dose of radiation to a small volume precisely localized stereotactically - can serve as a surgical alternative. The biological and physical characteristics of metastases [radiographically discrete, small, spherical, non- invasive] render them ideal targets for radiosurgery, with the potential advantages of reduced morbidity, short hospitalization and reduced health care costs. At Mansoura we treated [10] patients with brain metastases, [7] had single lesions and [3] had multiple lesions [up to 5]. The age ranged between 51 and 68ys. The primary lesion was known in [8] cases. Each received a dose of 20 Gy to the tumor edge and a supplementary whole brain dose of 2000 cGy divided over 10 fractions. All patients, except one, tolerated the treatment well and were discharged from hospital within 3 days on average. One case who had five lesions developed hydrocephalus that was shunted, he died a few days later. Nine Patients showed subsequent radiological evidence of tumor shrinkage and central tumor necrosis. The peritumoural edema subsequently subsided and most patients became steroid independent within 3 months of radiosurgery .We acknowledge the small number of cases and short period of follow up that negate any statistical significance. However our limited experience shows that stereotactic radiosurgery is a safe alternative to open surgery, particularly for lesions in deep location, near eloquent cortex and for multiple lesions. Surgical resection would be more advantageous for metastatic lesion of size greater than 35 mm in diameter with significant edema and mass effect, particularly if there is significant mass effect on fourth ventricle