Stereotactic radiosurgery for brain metastases.

The authors discuss the results of Gamma Knife (Elekta AB, Stockholm, Sweden) radiosurgery (GKS) for brain metastases based on their retrospective review of 2645 cases. All patients were treated according to the same protocol, with the tumors being irradiated with GKS without up-front whole-brain radiation therapy at the initial treatment. New distant lesions, detected by gadolinium-enhanced magnetic resonance imaging (MRI) performed every 2 to 3 months, were treated primarily with GKS. New distant lesions are generally well controlled with GKS salvage treatment. However, careful observation with enhanced MRI and appropriate salvage treatments are needed to prevent neurologic death and maintain activities of daily life.