A phase I/II study of salvage radiosurgery in the treatment of recurrent brain metastases.

Radiosurgery has been advocated as a salvage treatment for relapsed patients with brain metastases. This report describes a phase I/II study of salvage radiosurgery for patients previously treated with whole brain irradiation. The study was opened in March 1989 and the last patient was treated in July 1992. All patients have been followed to recurrence at the radiosurgically treated site or to death. Twenty progressing metastases in 12 patients were treated using 14 radiosurgical procedures. The radiation dose was always 25 Gy with the 90% isodose volume encompassing all enhancing tumour. Nineteen metastases were evaluable at +4 weeks. There were no instances of progressive disease; there were three complete responses, six partial responses, and 10 metastases remained unchanged. Median survival from the date of radiosurgery was 6 months. Nine of 12 patients eventually failed at the radiosurgically treated site (two remain alive). Radiosurgery at the time of relapse provides temporary control of recurrent brain metastases with acceptable toxicity.