Browse > Article
http://dx.doi.org/10.3340/jkns.2011.50.4.299

Gamma Knife Radiosurgery for Brainstem Metastasis  

Yoo, Tae-Won (Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center)
Park, Eun-Suk (Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center)
Kwon, Do-Hoon (Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center)
Kim, Chang-Jin (Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center)
Publication Information
Journal of Korean Neurosurgical Society / v.50, no.4, 2011 , pp. 299-303 More about this Journal
Abstract
Objective : Brainstem metastases are rarely operable and generally unresponsive to conventional radiation therapy or chemotherapy. Recently, Gamma Knife Radiosurgery (GKRS) was used as feasible treatment option for brainstem metastasis. The present study evaluated our experience of brainstem metastasis which was treated with GKRS. Methods : Between November 1992 and June 2010, 32 patients (23 men and 9 women, mean age 56.1 years, range 39-73) were treated with GKRS for brainstem metastases. There were metastatic lesions in pons in 23, the midbrain in 6, and the medulla oblongata in 3 patients, respectively. The primary tumor site was lung in 21, breast in 3, kidney in 2 and other locations in 6 patients. The mean tumor volume was $1,517mm^3$ (range, 9-6,000), and the mean marginal dose was 15.9 Gy (range, 6-23). Magnetic Resonance Imaging (MRI) was obtained every 2-3 months following GKRS. Follow-up MRI was possible in 24 patients at a mean follow-up duration of 12.0 months (range, 1-45). Kaplan-Meier survival analysis was used to evaluate the prognostic factors. Results : Follow-up MRI showed tumor disappearance in 6, tumor shrinkage in 14, no change in tumor size in 1, and tumor growth in 3 patients, which translated into a local tumor control rate of 87.5% (21 of 24 tumors). The mean progression free survival was 12.2 months (range, 2-45) after GKRS. Nine patients were alive at the completion of the study, and the overall mean survival time after GKRS was 7.7 months (range, 1-22). One patient with metastatic melanoma experienced intratumoral hemorrhage during the follow-up period. Survival was found to be associated with score of more than 70 on Karnofsky performance status and low recursive partitioning analysis class (class 1 or 2), in terms of favorable prognostic factors. Conclusion : GKRS was found to be safe and effective for management of brainstem metastasis. The integral clinical status of patient seems to be important in determining the overall survival time.
Keywords
Brainstem tumor; Gamma knife radiosurgery; Metastasis; Stereotactic radiosurgery;
Citations & Related Records

Times Cited By Web Of Science : 2  (Related Records In Web of Science)
Times Cited By SCOPUS : 0
연도 인용수 순위
  • Reference
1 Alexander E 3rd, Moriarty TM, Davis RB, Wen PY, Fine HA, Black PM, et al. : Stereotactic radiosurgery for the definitive, noninvasive treatment of brain metastases. J Natl Cancer Inst 87 : 34-40, 1995   DOI   ScienceOn
2 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   DOI   ScienceOn
3 Aoyama H, Shirato H, Tago M, Nakagawa 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   DOI   ScienceOn
4 Auchter RM, Lamond JP, Alexander E, Buatti JM, Chappell R, Friedman WA, et al. : A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys 35 : 27-35, 1996   DOI   ScienceOn
5 Bindal AK, Bindal RK, Hess KR, Shiu A, Hassenbusch SJ, Shi WM, et al. : Surgery versus radiosurgery in the treatment of brain metastasis. J Neurosurg 84 : 748-754, 1996   DOI   ScienceOn
6 Cairncross JG, Kim JH, Posner JB : Radiation therapy for brain metastases. Ann Neurol 7 : 529-541, 1980   DOI   ScienceOn
7 Chason JL, Walker FB, Landers JW : Metastatic carcinoma in the central nervous system and dorsal root ganglia. A prospective autopsy study. Cancer 16 : 781-787, 1963   DOI   ScienceOn
8 Chidel MA, Suh JH, Reddy CA, Chao ST, Lundbeck MF, Barnett GH : Application of recursive partitioning analysis and evaluation of the use of whole brain radiation among patients treated with stereotactic radiosurgery for newly diagnosed brain metastases. Int J Radiat Oncol Biol Phys 47 : 993-999, 2000   DOI   ScienceOn
9 Flickinger JC, Kondziolka D, Lunsford LD, Coffey RJ, Goodman ML, Shaw EG, et al. : A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys 28 : 797-802, 1994   DOI   ScienceOn
10 Flickinger JC, Lunsford LD, Somaza S, Kondziolka D : Radiosurgery: its role in brain metastasis management. Neurosurg Clin N Am 7 : 497-504, 1996
11 Fuentes S, Delsanti C, Metellus P, Peragut JC, Grisoli F, Regis J : Brainstem metastases : management using gamma knife radiosurgery. Neurosurgery 58 : 37-42; discussion 37-42, 2006   DOI   ScienceOn
12 Adler JR, Cox RS, Kaplan I, Martin DP : Stereotactic radiosurgical treatment of brain metastases. J Neurosurg 76 : 444-449, 1992   DOI
13 Kased N, Huang K, Nakamura JL, Sahgal A, Larson DA, McDermott MW, et al. : Gamma knife radiosurgery for brainstem metastases : the UCSF experience. J Neurooncol 86 : 195-205, 2008   DOI   ScienceOn
14 Huang CF, Kondziolka D, Flickinger JC, Lunsford LD : Stereotactic radiosurgery for brainstem metastases. J Neurosurg 91 : 563-568, 1999   DOI   ScienceOn
15 Hussain A, Brown PD, Stafford SL, Pollock BE : Stereotactic radiosurgery for brainstem metastases : Survival, tumor control, and patient outcomes. Int J Radiat Oncol Biol Phys 67 : 521-524, 2007   DOI   ScienceOn
16 Johnson JD, Young B : Demographics of brain metastasis. Neurosurg Clin N Am 7 : 337-344, 1996
17 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
18 Lagerwaard FJ, Levendag PC, Nowak PJ, Eijkenboom WM, Hanssens PE, Schmitz PI : Identification of prognostic factors in patients with brain metastases : a review of 1292 patients. Int J Radiat Oncol Biol Phys 43 : 795-803, 1999   DOI   ScienceOn
19 Lang EF, Slater J : Metastatic brain tumours: results of surgical and nonsurgical treatment. Surg Clin North Am 44 : 865-872, 1964   DOI
20 Lorenzoni JG, Devriendt D, Massager N, Desmedt F, Simon S, Van Houtte P, et al. : Brain stem metastases treated with radiosurgery : prognostic factors of survival and life expectancy estimation. Surg Neurol 71 : 188-195; discussion 195, 195-196, 2009   DOI   ScienceOn
21 Markesbery WR, Brooks WH, Gupta GD, Young AB : Treatment for patients with cerebral metastases. Arch Neurol 35 : 754-756, 1978   DOI   ScienceOn
22 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 Engl J Med 322 : 494-500, 1990   DOI   ScienceOn
23 Valery CA, Boskos C, Boisserie G, Lamproglou I, Cornu P, Mazeron JJ, et al. : Minimized doses for linear accelerator radiosurgery of brainstem metastasis. Int J Radiat Oncol Biol Phys 80 : 362-368, 2011   DOI   ScienceOn
24 Vecht CJ, Haaxma-Reiche H, Noordijk EM, Padberg GW, Voormolen JH, Hoekstra FH, et al. : Treatment of single brain metastasis : radiotherapy alone or combined with neurosurgery? Ann Neurol 33 : 583-590, 1993   DOI   ScienceOn
25 Weltman E, Salvajoli JV, Brandt RA, de Morais Hanriot R, Prisco FE, Cruz JC, et al. : Radiosurgery for brain metastases : a score index for predicting prognosis. Int J Radiat Oncol Biol Phys 46 : 1155-1161, 2000   DOI   ScienceOn
26 Yen CP, Sheehan J, Patterson G, Steiner L : Gamma knife surgery for metastatic brainstem tumors. J Neurosurg 105 : 213-219, 2006   DOI   ScienceOn
27 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   DOI
28 Smalley SR, Laws ER Jr, O'Fallon JR, Shaw EG, Schray MF : Resection for solitary brain metastasis. Role of adjuvant radiation and prognostic variables in 229 patients. J Neurosurg 77 : 531-540, 1992   DOI
29 Shuto T, Fujino H, Asada H, Inomori S, Nagano H : Gamma knife radiosurgery for metastatic tumours in the brain stem. Acta Neurochir (Wien) 145 : 755-760, 2003   DOI   ScienceOn
30 Simonova G, Liscak R, Novotny J Jr, Novotny J : Solitary brain metastases treated with the Leksell gamma knife : prognostic factors for patients. Radiother Oncol 57 : 207-213, 2000   DOI   ScienceOn
31 Sneed PK, Lamborn KR, Forstner JM, McDermott MW, Chang S, Park E, et al. : Radiosurgery for brain metastases : is whole brain radiotherapy necessary? Int J Radiat Oncol Biol Phys 43 : 549-558, 1999   DOI   ScienceOn
32 Soffietti R, Ruda R, Mutani R : Management of brain metastases. J Neurol 249 : 1357-1369, 2002   DOI   ScienceOn
33 Tosoni A, Ermani M, Brandes AA : The pathogenesis and treatment of brain metastases : a comprehensive review. Crit Rev Oncol Hematol 52 : 199-215, 2004   DOI   ScienceOn
34 Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, et al. : Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37 : 745-751, 1997   DOI   ScienceOn
35 Goodman KA, Sneed PK, McDermott MW, Shiau CY, Lamborn KR, Chang S, et al. : Relationship between pattern of enhancement and local control of brain metastases after radiosurgery. Int J Radiat Oncol Biol Phys 50 : 139-146, 2001   DOI   ScienceOn