Gamma knife radiosurgery for metastatic tumours in the brain stem

Shuto, Takashi; Fujino, Hiroyuki; Asada, Hiroyuki; Inomori, Shigeo; Nagano, Hisato

doi:10.1007/s00701-003-0034-1

Cited by 53 publications

(42 citation statements)

References 24 publications

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“…This potential for morbitiy coupled with a concern regarding possible increased radiosensitivity of brainstem tissue this has led to the exclusion of brainstem metastases from various radiosurgery clinical trials [3][4][5]. Data on the safety and efficacy of stereotactic radiosurgery in the management of brainstem metastases is lacking therefore, and relies on retrospective reports from single institutions [6][7][8][9][10][11][12][13][14]. Nine previous reports have been published.…”

Section: Introductionmentioning

confidence: 96%

Linear accelerator-based stereotactic radiosurgery for brainstem metastases: the Dana-Farber/Brigham and Women’s Cancer Center experience

Kelly

Lin

et al. 2011

J Neurooncol

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To review the safety and efficacy of linear accelerator-based stereotactic radiosurgery (SRS) for brainstem metastases. We reviewed all patients with brain metastases treated with SRS at DF/BWCC from 2001 to 2009 to identify patients who had SRS to a single brainstem metastasis. Overall survival and freedom-from-local failure rates were calculated from the date of SRS using the Kaplan-Meier method. Prognostic factors were evaluated using the log-rank test and Cox proportional hazards model. A total of 24 consecutive patients with brainstem metastases had SRS. At the time of SRS, 21/24 had metastatic lesions elsewhere within the brain. 23/24 had undergone prior WBRT. Primary diagnoses included eight NSCLC, eight breast cancer, three melanoma, three renal cell carcinoma and two others. Median dose was 13 Gy (range, 8-16). One patient had fractionated SRS 5 Gy ×5. Median target volume was 0.2 cc (range, 0.02-2.39). The median age was 57 years (range, 42-92). Follow-up information was available in 22/24 cases. At the time of analysis, 18/22 patients (82%) had died. The median overall survival time was 5.3 months (range, 0.8-21.1 months). The only prognostic factor that trended toward statistical significance for overall survival was the absence of synchronous brain metastasis at the time of SRS; 1-year overall survival was 31% with versus 67% without synchronous brain metastasis (log rank P = 0.11). Non-significant factors included primary tumor histology and status of extracranial disease (progressing vs. stable/absent). Local failure occurred in 4/22 cases (18%). Actuarial freedom from local failure for all cases was 78.6% at 1 year. RTOG grade 3 toxicities were recorded in two patients (ataxia, confusion). Linac-based SRS for small volume brainstem metastases using a median dose of 13 Gy is associated with acceptable local control and low morbidity.

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Section: Introductionmentioning

confidence: 96%

Linear accelerator-based stereotactic radiosurgery for brainstem metastases: the Dana-Farber/Brigham and Women’s Cancer Center experience

Kelly

Lin

et al. 2011

J Neurooncol

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“…

MATERIALS AND METHODS

Patient characteristics

From November 1992 to June 2010, a total of 32 patients underwent GKRS for local control of brainstem metastasis at our institute.

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confidence: 99%

Gamma Knife Radiosurgery for Brainstem Metastasis

Yoo

Park

Kwon

et al. 2011

J Korean Neurosurg Soc

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small case series for the management of brainstem metastases using Gamma Knife Radiosurgery (GKRS) 12,16,18,22,26,35) . The present study assessed outcomes following our use of GKRS for the management of brainstem metastasis, and we investigated the effect of treatment on tumor size and survival time. MATERIALS AND METHODS Patient characteristicsFrom November 1992 to June 2010, a total of 32 patients underwent GKRS for local control of brainstem metastasis at our institute. The clinical characteristics of the 32 patients are summarized in Table 1. The study population consisted of 23 men and 9 women, with a mean age of 56.1 years (range, 39-73). The primary malignancy was lung cancer in 21 patients, breast cancer in 3, renal cell cancer in 2, prostate cancer in 2, and hepatocellular carcinoma, colorectal cancer in 1, gastric cancer in 1, and melanoma in 1. Fourteen patients had score of more than 70 on the Karnofsky performance status (KPS), and 18 had scores of less than 70. Lesions were located in the pons in 23 patients, the midbrain in 6 and the medulla oblongata in 3 patients. Fifteen patients presented with brainstem signs which INTRODUCTIONMetastasis to the brain is a frequent complication of malignant tumors of the lung, breast, kidney, and of malignant melanoma 2) . Metastatic brain lesions are estimated to eventually develop in 15 to 40% of patients with cancer 31) , and autopsy studies show brain metastases in 24% of cancer patients. However, brainstem metastases are uncommon, and account for only 3 to 5% of all brain metastases 8,17,30) . Brainstem metastases are generally not treated surgically due to the risk of causing neurological damage. Whole brain radiation therapy (WBRT) and stereotactic radiosurgery have been reported to provide benefits in brain metastases patients 3,4,9,10,14,19,29) . However, the benefits of such treatment in brainstem metastasis patients remain unclear.Since the first report of Huang et al. series 15) , there were some Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaObjective : 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 1,517 mm 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 durat...

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“…16,17 All of these studies have shown that SRS is a safe, reliable, and efficient treatment method for brainstem metastases. [3][4][5][6][13][14][15][16][17] This study differs from others in reporting treatment results of not only metastases in the brainstem but also those that are adjacent to brainstem (≤5 mm) and using CyberKnife as an FSRT/ SRS system. The CyberKnife SRT system has certain improved features of utility compared to the Gamma Knife radiosurgery system.…”

Section: Discussionmentioning

confidence: 82%

“…In the current literature, most of the studies have used Gamma Knife for the treatment of brainstem metastases using stereotactic radiosurgery. 3,5,6,[13][14][15] In addition, there are other studies in which linac-based systems were used as a means of SRS. 16,17 All of these studies have shown that SRS is a safe, reliable, and efficient treatment method for brainstem metastases.…”

Section: Discussionmentioning

confidence: 99%

“…Dose range for different SRS series using Gamma Knife or a linac for the treatment of brainstem metastases were between 1,300 and 2,000 cGy, in one fraction. [3][4][5][6]13,16 In the final report of RTOG protocol 90-05, patients with cerebral or cerebellar solitary non-brainstem tumors with a maximum diameter of 40 mm were evaluated. Of 156 patients, 36% had recurrent primary brain tumors (prior median dose 60 Gy) and 64% had recurrent brain metastases (prior median dose 30 Gy).…”

Section: Discussionmentioning

confidence: 99%

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Cyberknife® Radiosurgery and Fractionated Stereotactic Radiotherapy For Brainstem or Adjacent-to-Brainstem Metastases

Güney¹,

Ozseker²,

İnan³

et al. 2013

Turkiye Klinikleri J Med Sci

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Gamma knife radiosurgery for metastatic tumours in the brain stem

Abstract: GKS for brain stem metastases using a marginal dose of 15 Gy or less is effective and relatively safe. Accurate targeting of the tumour and safe dose planning are essential to obtain satisfactory results with GKS for brain stem metastases.

Cited by 53 publications

References 24 publications

Linear accelerator-based stereotactic radiosurgery for brainstem metastases: the Dana-Farber/Brigham and Women’s Cancer Center experience

Linear accelerator-based stereotactic radiosurgery for brainstem metastases: the Dana-Farber/Brigham and Women’s Cancer Center experience

Gamma Knife Radiosurgery for Brainstem Metastasis

Cyberknife® Radiosurgery and Fractionated Stereotactic Radiotherapy For Brainstem or Adjacent-to-Brainstem Metastases

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