RATIONALE: Stereotactic radiation therapy may be able to deliver x-rays directly to the
tumor and cause less damage to normal tissue.
PURPOSE: Phase II trial to study the effectiveness of stereotactic radiation therapy in
treating patients who have brain metastases.
OBJECTIVES: I. Determine the efficacy of stereotactic radiosurgery without whole brain
radiotherapy in elderly patients or patients with poor performance status who have brain
metastases. II. Determine the neurologic function in these patients after receiving this
treatment regimen. III. Determine the quality of life in these patients with this treatment
OUTLINE: Patients undergo stereotactic head frame placement, followed by stereotactic
radiosurgery using Gamma Knife, on day 1. Quality of life is assessed one week prior to and
one week after treatment, and then at 2, 4, 6, 8, 10, and 12 months. Patients are followed
at one week, at 2, 4, 6, 8, 10, and 12 months, every 4 months for one year, and then every 6
months for 3 years.
PROJECTED ACCRUAL: Approximately 52 patients will be accrued for this study within 2 years.
DISEASE CHARACTERISTICS: Patients with 1-4 sites of brain metastases Confirmed by MRI with
gadolinium texaphyrin scan within two weeks of study If solitary metastases, diameter must
be 40 mm or less If multiple metastases, one site may be greater than 30 mm, while all
others must be less than 30 mm No metastases in the brainstem or within 5 mm of optic
nerves or chiasm Prior surgical resection of metastases allowed if radiographically
visible residual disease No prior cranial radiotherapy Patients must be over 65 years of
age OR Over 18 years of age with Karnofsky performance status 40-60% All primary
histologies allowed except the following: Lymphomas Leukemia Multiple myeloma Small cell
lung cancer Germ cell tumors Extracranial disease allowed
PATIENT CHARACTERISTICS: Age: See Disease Characteristics Performance status: See Disease
Characteristics Life expectancy: Not specified Hematopoietic: Hemoglobin greater than 8
g/dL Absolute neutrophil count greater than 1,000/mm3 Platelet count greater than
50,000/mm3 Hepatic: Not specified Renal: Not specified
PRIOR CONCURRENT THERAPY: Biologic therapy: Not specified Chemotherapy: Prior chemotherapy
allowed Endocrine therapy: Not specified Radiotherapy: See Disease Characteristics Prior
or concurrent radiotherapy to noncranial sites allowed Surgery: See Disease
Donald C. Shina, MD
Ireland Cancer Center at University Hospitals Case Medical Center, Case Comprehensive Cancer Center