Journal of Korean Neurosurgical Society

  • 제61권5호
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  • Pages.592-599
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  • 2018
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Gamma Knife Radiosurgery for Metastatic Brain Tumors with Exophytic Hemorrhage

  • Park, Eun Suk (Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Lee, Eun Jung (Department of Neurosurgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University) ;
  • Yun, Jung-Ho (Department of Neurosurgery, Dankook University College of Medicine) ;
  • Cho, Young Hyun (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jeong Hoon (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)
  • 투고 : 2017.03.15
  • 심사 : 2017.10.23
  • 발행 : 2018.09.01
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초록

Objective : Metastatic brain tumors (MBTs) often present with intracerebral hemorrhage. Although Gamma Knife surgery (GKS) is a valid treatment option for hemorrhagic MBTs, its efficacy is unclear. To achieve oncologic control and reduce radiation toxicity, we used a radiosurgical targeting technique that confines the tumor core within the hematoma when performing GKS in patients with such tumors. We reviewed our experience in this endeavor, focusing on local tumor control and treatment-associated morbidities. Methods : From 2007 to 2014, 13 patients with hemorrhagic MBTs were treated via GKS using our targeting technique. The median marginal dose prescribed was 23 Gy (range, 20-25). GKS was performed approximately 2 weeks after tumor bleeding to allow the patient's condition to stabilize. Results : The primary sites of the MBTs included the liver (n=7), lung (n=2), kidney (n=1), and stomach (n=1); in two cases, the primary tumor was a melanoma. The mean tumor volume was $4.00cm^3$ (range, 0.74-11.0). The mean overall survival duration after GKS was 12.5 months (range, 3-29), and three patients are still alive at the time of the review. The local tumor control rate was 92% (tumor disappearance 23%, tumor regression 46%, and stable disease 23%). There was one (8%) instance of local recurrence, which occurred 11 months after GKS in the solid portion of the tumor. No GKS-related complications were observed. Conclusion : Our experience shows that GKS performed in conjunction with our targeting technique safely and effectively treats hemorrhagic MBTs. The success of this technique may reflect the presence of scattered metastatic tumor cells in the hematoma that do not proliferate owing to the inadequate microenvironment of the hematoma. We suggest that GKS can be a useful treatment option for patients with hemorrhagic MBTs that are not amenable to surgery.

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참고문헌

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