[Radiosurgery for brain metastases].

This article presents the state of art in radiosurgery as a new therapeutic strategy of brain metastases. Radiosurgery of brain metastases is ten years old and we propose to make an update of the literature. X-rays and gamma-rays are commonly used for radiosurgery and does not make a difference for dosimetry and precision. Selected patients for this treatment have usually good Karnofsky status and the mean size of their metastases is about 20 mm. Mean number of metastases treated in the same procedure is 2. Most frequent primary sites are lung and breast, but also kidney and skin (malignant melanoma) which are supposed to be radioresistant and so often untreatable by other techniques. Usual dose administrated ranges between 15 and 25 Grays in center of target with a 80% isodose in peripheral. Results are quite good for local control (80% to 100%) but survival does not seem to be improved (11 months). Radiation complication rate is 4% and sometimes hemorrhagic complications occur (1 to 2%). For local control, quality of life and cost/benefit ratio, there are strong arguments in favor of radiosurgery, especially for radioresistant metastases in spite of the lack of improvement of survival duration. Moreover published studies do not allow any comparison with efficacy of surgery and radiosurgery, whole brain radiosurgery and radiosurgery of the present metastases. Evaluations are still going on in several centers. Their results will allow more precise indications of this technique.