A single institutional outcome analysis of Gamma Knife radiosurgery for single or multiple brain metastases

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Abstract

Although Gamma Knife stereotactic radiosurgery (SRS) is widely used for metastatic brain tumors, optimal patient selection and treatment strategy continue to be investigated. The aim of this study was to provide treatment results with Gamma Knife SRS and to establish prognostic factors. Of the 54 patients treated from 1990 to 1997, 51 patients were evaluable. There were 28 males and 23 females, with a median age of 60 years. Median Karnofsky Index was 80. There were 19 non-small cell lung cancers, eight colon cancers, six renal cell cancers, five ovarian cancers, four gastric cancers, three breast cancers, and six others. Primary tumors were controlled in 33 patients, and extracranial tumors were absent in 25 patients. Sixty-eight metastatic brain tumors in 37 patients underwent SRS as an initial treatment for the brain metastasis. Brain metastasis was solitary in 32 patients. Conventional radiation was combined with SRS in 29 patients, 24 of whom received whole brain radiotherapy. Eight patients had some form of surgical resection. Median survival time was 7.4 months. Five-year actuarial survival and local control rates were 16 and 52%, respectively. Median duration time of keeping pretreatment quality of life was 6.9 months. On a multivariate analysis, uncontrolled primary tumor, combined conventional radiotherapy, and performance status were statistically significant prognostic factors. Four patients who underwent whole brain radiation developed low grade dementia.

Introduction

Over the past several decades, whole brain radiation therapy has emerged as the standard treatment of choice for single or multiple brain metastases. However, for the solitary brain metastasis, surgery plus whole brain radiation has been proven to deliver superior local control and survival rates as compared with whole brain radiation alone [1], [2]. More recently, stereotactic radiosurgery (SRS) has been established as a potentially superior alternative to surgical resection by virtue of its lower morbidity [3], [4], [5]. Although SRS is being used with increasing frequency for the treatment of brain metastases, optimal patient selection and treatment factors continue to be investigated. The aim of this study was to provide outcome data from a single institutional, retrospective experience with Gamma Knife SRS and to identify prognostic factors for the proper selection and treatment of patients.

Section snippets

Materials and methods

From July 1990 to April 1997, 54 patients with solitary or multiple brain metastases were treated using Gamma Knife SRS. Of the 54, we analyzed 51 patients whose treatment results were evaluated properly with CT and/or MRI. Follow-up period ranged 1.5–84.4 months with a median of 23.4 months. There were 28 males and 23 females, with a median age of 60 years (range: 33–88, mean 59.4 years). Karnofsky Index (KI) was 50 in one, 60 in five, 70 in 14, 80 in 12, 90 in 18, and 100 in one patient with

Results

Initial local response and its relationship to local control rate are shown in Table 4. Local control was achieved in 47 tumors (69%). In the patients with local recurrence, time to the recurrence ranged from 1 to 20 months with an average of 4.6 and median of 3 months. The actuarial 1-year, 2-year, 3-year, and 5-year survival rates were 44.2, 22.0, 21.0, and 15.8%. The median survival period were 7.4 months. The actuarial 1-year, 3-year, and 5-year local control rates were 62.3, 51.9, 51.9,

Discussion

Combined surgical resection and whole brain radiotherapy have been a mainstay of the treatment of cerebral metastases. This approach results in a median survival of approximately 10 months [1], [2]. Recent publications have suggested that similar results can be achieved with SRS for the solitary brain metastasis [3], [4], [5]. The overall conclusion of previous publications appears to be that the median survival for the patients with cerebral metastases ranges 7–10 months regardless of

Acknowledgements

This work was supported in part by a grant from the Ministry of Education of Japan.

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This work was done at the University of Tokyo Hospital.

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