Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Therapeutic Effect of Gamma Knife Radiosurgery for Multiple Brain Metastases

  • Lee, Chul-Kyu (Department of Neurosurgery, Gamma Knife Center, Ajou University School of Medicine) ;
  • Lee, Sang-Ryul (Department of Neurosurgery, Gamma Knife Center, Ajou University School of Medicine) ;
  • Cho, Jin-Mo (Department of Neurosurgery, Gamma Knife Center, Ajou University School of Medicine) ;
  • Yang, Kyung-Ah (Department of Neurosurgery, Gamma Knife Center, Ajou University School of Medicine) ;
  • Kim, Se-Hyuk (Department of Neurosurgery, Gamma Knife Center, Ajou University School of Medicine)
  • Received : 2011.06.08
  • Accepted : 2011.09.08
  • Published : 2011.09.28
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Abstract

Objective : The aim of this study is to evaluate the therapeutic effects of gamma knife radiosurgery (GKRS) in patients with multiple brain metastases and to investigate prognostic factors related to treatment outcome. Methods : We retrospectively reviewed clinico-radiological and dosimetric data of 36 patients with 4-14 brain metastases who underwent GKRS for 264 lesions between August 2008 and April 2011. The most common primary tumor site was the lung (n=22), followed by breast (n=7). At GKRS, the median Karnofsky performance scale score was 90 and the mean tumor volume was 1.2 cc (0.002-12.6). The mean prescription dose of 17.8 Gy was delivered to the mean 61.1% isodose line. Among 264 metastases, 175 lesions were assessed for treatment response by at least one imaging follow-up. Results : The overall median survival after GKRS was $9.1{\pm}1.7$ months. Among various factors, primary tumor control was a significant prognostic factor ($11.1{\pm}$1.3 months vs. $3.3{\pm}2.4$ months, p=0.031). The calculated local tumor control rate at 6 and 9 months after GKRS were 87.9% and 84.2%, respectively. Paddick's conformity index (>0.75) was significantly related to local tumor control. The actuarial peritumoral edema reduction rate was 22.4% at 6 months. Conclusion : According to our results, GKRS can provide beneficial effect for the patients with multiple (4 or more) brain metastases, when systemic cancer is controlled. And, careful dosimetry is essential for local tumor control. Therefore, GKRS can be considered as one of the treatment modalities for multiple brain metastase.

Keywords

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 RTOG 9508 randomised trial. Lancet 363 : 1665-1672, 2004 https://doi.org/10.1016/S0140-6736(04)16250-8
  2. Aoyama H, Shirato H, Tago M, Nakaga K, Toyoda T, Hatano K, et al. : Stereotactic radiosurgery plus whole-brain radiation therapy vs. stereotactic radiosurgery alone for treatment of brain metastases : a randomized controlled trial. JAMA 295 : 2483-2491, 2006 https://doi.org/10.1001/jama.295.21.2483
  3. Chiou SM : Validity of the graded prognostic assessment-derived index to predict brain-metastatic patients' survival after Gamma Knife radiosurgery. Int J Radiat Oncol Biol Phys 78 : 1156-1162, 2010 https://doi.org/10.1016/j.ijrobp.2009.09.028
  4. DiStefano A, Yong Yap Y, Hortobagyi GN, Blumenschein GR : The natural history of breast cancer patients with brain metastases. Cancer 44 : 1913-1918, 1979 https://doi.org/10.1002/1097-0142(197911)44:5<1913::AID-CNCR2820440554>3.0.CO;2-D
  5. Gaspar LE, Scott C, Murray K, Curran W : Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys 47 : 1001-1006, 2000 https://doi.org/10.1016/S0360-3016(00)00547-2
  6. Grosshans DR, Meyers CA, Allen PK, Davenport SD, Komaki R : Neurocognitive function in patients with small cell lung cancer : effect of prophylactic cranial irradiation. Cancer 112 : 589-595, 2008 https://doi.org/10.1002/cncr.23222
  7. Henson JW, Ulmer S, Harris GJ : Brain tumor imaging in clinical trials. AJNR Am J Neuroradiol 29 : 419-424, 2008 https://doi.org/10.3174/ajnr.A0963
  8. Kim CH, Im YS, Nam DH, Park K, Kim JH, Lee JI : Gamma knife radiosurgery for ten or more brain metastases. J Korean Neurosurg Soc 44 : 358-363, 2008 https://doi.org/10.3340/jkns.2008.44.6.358
  9. Kondziolka D, Patel A, Lunsford LD, Kassam A, Flickinger JC : Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases. Int J Radiat Oncol Biol Phys 45 : 427-434, 1999
  10. Molenaar R, Wiggenraad R, Verbeek-de Kanter A, Walchenbach R, Vecht C : Relationship between volume, dose and local control in stereotactic radiosurgery of brain metastasis. Br J Neurosurg 23 : 170-178, 2009 https://doi.org/10.1080/02688690902755613
  11. Paddick I : A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg 93 Suppl 3 : 219-222, 2000
  12. Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, et al. : Postoperative radiotherapy in the treatment of single metastases to the brain : a randomized trial. JAMA 280 : 1485-1489, 1998 https://doi.org/10.1001/jama.280.17.1485
  13. Patil CG, Pricola K, Garg SK, Bryant A, Black KL : Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases. Cochrane Database Syst Rev : CD006121, 2010
  14. Ricard D, Taillia H, Renard JL : Brain damage from anticancer treatments in adults. Curr Opin Oncol 21 : 559-565, 2009 https://doi.org/10.1097/CCO.0b013e328330c669
  15. Serizawa T, Iuchi T, Ono J, Saeki N, Osato K, Odaki M, et al. : Gamma knife treatment for multiple metastatic brain tumors compared with whole-brain radiation therapy. J Neurosurg 93 Suppl 3 : 32-36, 2000
  16. Smith ML, Lee JY : Stereotactic radiosurgery in the management of brain metastasis. Neurosurg Focus 22 : E5, 2007
  17. Vogelbaum MA, Asher AL, Kondziolka D, Boulis NM, Selden NR, Hoh BL, et al. : Modern treatment of cerebral metastases : Integrated Medical Learning (SM) at CNS 2007. J Neurooncol 93 : 89-105, 2009 https://doi.org/10.1007/s11060-009-9833-4
  18. Welzel G, Fleckenstein K, Schaefer J, Hermann B, Kraus-Tiefenbacher U, Mai SK, et al. : Memory function before and after whole brain radiotherapy in patients with and without brain metastases. Int J Radiat Oncol Biol Phys 72 : 1311-1318, 2008 https://doi.org/10.1016/j.ijrobp.2008.03.009
  19. Woo HJ, Hwang SK, Park SH, Hwang JH, Hamm IS : Factors related to the local treatment failure of gamma knife surgery for metastatic brain tumors. Acta Neurochir (Wien) 152 : 1909-1914, 2010 https://doi.org/10.1007/s00701-010-0805-4

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