Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Gamma Knife Radiosurgery after Stereotactic Aspiration for Large Cystic Brain Metastases

  • Park, Won-Hyoung (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jang, In-Seok (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Chang-Jin (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kwon, Do-Hoon (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Published : 2009.10.28
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Abstract

Objective : Several treatment options have proven effective for metastatic brain tumors, including surgery and stereotactic radiosurgery. Tumors with cystic components, however, are difficult to treat using a single method. We retrospectively assessed the outcome and efficacy of gamma knife radiosurgery (GKRS) for cystic brain metastases after stereotactic aspiration of cystic components to decrease the tumor volume. Methods : The study population consisted of 24 patients (13 males, 11 females; mean age, 58.3 years) with cystic metastatic brain tumors treated from January 2002 to August 2008. Non-small cell lung cancer was the most common primary origin. After Leksell stereotactic frame was positioned on each patient, magnetic resonance images (MRI)-guided stereotactic cyst aspiration and GKRS were performed (mean prescription dose : 20.2 Gy). After treatment, patients were evaluated by MRI every 3 or 4 months. Results : After treatment, 13 patients (54.2%) demonstrated tumor control, 5 patients (20.8%) showed local tumor progression, and 6 patients (25.0%) showed remote progression. Mean follow-up duration was 13.1 months. During this period, 10 patients (41.7%) died, but only 1 patient (4.2%) died from brain metastases. The overall median survival after these procedures was 17.8 months. Conclusion : These results support the usefulness of GKRS after stereotactic cyst aspiration in patients with large cystic brain metastases. This method is especially effective for the patients whose general condition is very poor for general anesthesia and those with metastatic brain tumors located in eloquent areas.

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References

  1. Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, et al. : Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases : phase III results of the RTGO 9585 randomized trial. Lancet 363 : 1665-1672, 2004 https://doi.org/10.1016/S0140-6736(04)16250-8
  2. Arnold SM, Patchell RA : Diagnosis and management of brain metastases. Hemato Oncol Clin North Am 15 : 1085-1107, 2001 https://doi.org/10.1016/S0889-8588(05)70269-0
  3. Bernstein M, Parrent A : Complication of CT guided stereotactic biopsy of intra-axial brain lesions. J Neurosurg 81 : 165-168, 1994 https://doi.org/10.3171/jns.1994.81.2.0165
  4. Borgelt B, Gelber R, Kramer S, Brady LW, Chang CH, Davis LW, et al. : The palliation of brain metastases : final results of the first two studies by the Radiation Therapy Oncology Group. Int J Radiat Oncol Bio Phys 6 : 1-9, 1980 https://doi.org/10.1016/0360-3016(80)90195-9
  5. Coffey RJ : Stereotactic radiosurgical treatment of brain metastases in Cohen AR, Haines SJ (eds) : Minimally invasive Techniques in Neurosurgery. Baltimore : Williams & Wilkins, 1995, pp139-143
  6. Cumings JN : The chemistry of cerebral cysts. Brain 73 : 244-250, 1950 https://doi.org/10.1093/brain/73.2.244
  7. Diener-West M, Dobbins TW, Phillips TL, Nelson DF : Identification of an optimal subgroup for treatment evaluation of patients with brain metastases using RTGO study 7916. Int J Radiat Oncol Bio Phys 16 : 669-673, 1989 https://doi.org/10.1016/0360-3016(89)90483-5
  8. Flickiner JC : Radiotherapy and radiosurgical management of brain metastases. Curr Oncol Rep 3 : 484-489, 2001 https://doi.org/10.1007/s11912-001-0069-5
  9. Franzin A, Vimercati A, Picozzi P, Serra C, Snider S, Gioia L, et al. : Stereotactic drainage and Gamma Knife radiosurgery of cystic brain metastasis. J Neurosurg 109 : 259-267, 2008 https://doi.org/10.3171/JNS/2008/109/8/0259
  10. Gardner WJ, Collis JS, Lewis LA : Cystic brain tumors and the blood-brain barrier. Comparision of protein fractions in cyst fluids and sera. Arch Neurol 8 : 291-298, 1963 https://doi.org/10.1001/archneur.1963.00460030075007
  11. Kim MS, Lee SL, Sim SH : Brain tumors with cyst treated with Gamma Knife Radiosurgery : Is Microsurgery Indicated? Stereotact Funct Neurosurg 72 (Suppl 1) : 38-44, 1999
  12. Kondziolka D, Firlik AD, Lunsford LD : Complications of stereotactic brain surgery. Neurol Clin 16 : 35-54, 1998 https://doi.org/10.1016/S0733-8619(05)70366-2
  13. Lohr F, Pirzkall A, Hof H, Fleckenstein K, Debus J : Adjuvant treatment of brain metastases. Semin Surg Oncol 20 : 50-56, 2001 https://doi.org/10.1002/ssu.1016
  14. Lunsford LD, Martines AJ : Streotactic exploration of the brain in the era of computed tomography. Surg Neurol 22 : 222-230, 1984 https://doi.org/10.1016/0090-3019(84)90003-X
  15. Mandell L, Hilaris B, Sullvian M, Sundaresan N, Nori D, Kim JH, et al. : The treatment of single brain metastasis from non-oat cell lung carcinoma : surgery and radiation versus radiation therapy alone. Cancer 58 : 641-649, 1986
  16. Mingione V, Oliveira M, Prasar D, Steiner M, Steiner L : Gamma surgery for melanoma metastases in the brain. J Neurosurg 96 : 544-551, 2002 https://doi.org/10.3171/jns.2002.96.3.0544
  17. Muacevic A, Kreth FW, Horstmann GA, Schmid-Elsaesser R, Wowra B, Steiger HJ, et al. : Surgery and radiotherapy compared with gamma knife radiosurgery in the treatment of solitary cerebral metastases of small diameter. J Neurosurg 91 : 35-43, 1999 https://doi.org/10.3171/jns.1999.91.1.0035
  18. Pan HC, Sheehan J, Stroila M, Steiner M, Steiner L : Gamma knife radiosurgery for brain metastases from lung cancer. J Neurosurg 102 : 128-133, 2005 https://doi.org/10.3171/jns.2005.102.s_supplement.0128
  19. Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, et al. : A randomized trial of surgery in the treatment of single metastases to the brain. N England J Med 322 : 494-500, 1990 https://doi.org/10.1056/NEJM199002223220802
  20. Pullicino P, Thompson EJ, Moseley IF, Zilkha E, Shortman RC : Cystic intracranial tumors. Cyst fluid, biochemical changes and computerized tomographic findings. J Neurol Sci 44 : 77-85, 1979 https://doi.org/10.1016/0022-510X(79)90225-9
  21. Tendulkar RD, Liu SW, Barnett GH, Vogelbaum MA, Toms SA, Jin T, et al. : RPA classification has prognostic significance for surgically resected single brain metastasis. Int J Radiat Oncol Biol Phys 66 : 810-817, 2006 https://doi.org/10.1016/j.ijrobp.2006.06.003
  22. Sansur CA, Chin LS, Ames JW, Banegura AT, Aggarwal S, Ballesteros M, et al. : Gamma knife radiosurgery for the treatment of brain metastases. Stereotact Funct Neurosurg 74 : 37-51, 2000 https://doi.org/10.1159/000056462
  23. Stem K : Chemical study of fluids obtained from cerebral cysts : report on 56 cases. Brain 62 : 88, 1939 https://doi.org/10.1093/brain/62.1.88
  24. Weissman DE : Glucocorticoid treatment for brain metastases and epidural spinal cord compression : a review. J Clin Oncol 6 : 543-551, 1988
  25. Werner-Wasik M, Rudoler S, Preston PE, Hauck WW, Downes BM, Leeper D, et al. : Immediate side effects of stereotactic radiotherapy and radiosurgery. Int J Radiat Oncol Biol Phys 43 : 299-304,1999 https://doi.org/10.1016/S0360-3016(98)00410-6
  26. Yoshida S, Morii K : The role of surgery in the treatment of brain metastasis : a retrospective review. Acta Neurochir (Wien) 146 : 767-770, 2004

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