Gamma Knife Surgery for Cerebral Metastases. Implications for Survival Based on 16 Years Experience

Kihlström, Lars; Karlsson, Bengt; Lindquist, C.

doi:10.1159/000100659

Cited by 159 publications

(63 citation statements)

References 10 publications

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“…The actuarial risk of regional progression was 81% in patients with multiple metastases (19% of RPFS) and 34% in patients with a single metastasis at 2 years (66% of RPFS), which was statistically significant (p = 0.03, log-rank test). A similar observation was reported by Kihlstrom, et al, 15 who treated brain metastases mainly with SRS without WBRT and demonstrated that, following SRS, new metastases in the brain were observed in 13% of patients with a single metastasis, 34% of those with two or three metastases, and 100% of those with four or five metastases. In the present study we included only patients in whom multiple metastases were demonstrated at the time of SRS, and the RPFS rate was 48% at 1 year and 18% at 2 years (Fig.…”

Section: Patterns Of Failure and Lpfs And Rpfssupporting

confidence: 86%

“…Nevertheless, a few retrospective studies including ours indicate that regional progression was more frequent in patients undergoing SRS alone than in those being treated with combined SRS/WBRT, although this did not result in an improvement of survival. 9,13,24 In contrast, Kihlstrom, et al, 15 found that in a subset of patients with a single metastasis, an 87% rate of intracranial tumor control was revealed following SRS without WBRT, and they concluded that elective WBRT is of no apparent value in this setting. In our subset analysis, median RPFS was longer in patients treated with combined SRS/WBRT than for those undergoing SRS alone (12 and 6 months, respectively), but the difference was not statistically significant (p = 0.36).…”

Section: Patterns Of Failure and Lpfs And Rpfsmentioning

confidence: 97%

“…1,2,12,14,15,[17][18][19] It is almost certain that local control with SRS is better than that for historical controls treated with WBRT alone, although no randomized study has ever been performed. Presently, there is an ongoing Radiation Therapy Oncology Group study in which WBRT is being compared with combined WBRT/SRS in patients with one to three unresected metastases.…”

Section: Patterns Of Failure and Lpfs And Rpfsmentioning

confidence: 99%

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The role of radiosurgery for multiple brain metastases

Cho¹,

Hall

Gerbi

et al. 2000

FOC

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Object The authors evaluated the role of stereotactic radiosurgery (SRS) in patients with multiple brain metastases by analyzing prognostic factors that predict survival. Methods Between March 1991 and January 1999, 83 patients with multiple brain metastases underwent SRS in which they used a 6 mV linear accelerator. The median radiation dose of 15 Gy (range 6–50 Gy) was delivered to the 40 to 90% (median 87%) isodose line encompassing the target. Actuarial overall survival was calculated from the date of SRS by using the Kaplan–Meier method. Univariate comparisons of survival between different groups were performed using a log-rank test. All 83 patients were included in the calculation of overall survival. Actuarial overall survival was 22% at 1 year and 13% at 2 years, and a median survival of 5.4 months (range, 0.3–28.8 months) was demonstrated. Variables that predicted survival were Karnofsky Performance Scale (KPS) score, extracranial disease status, and the number of intracranial metastases. Median survival in patients with a KPS score greater than as compared with less than 70 was 9.1 and 2.7 months, respectively (p = 0.002). Median survival when comparing absence and presence of extracranial disease was 9.9 and 4.1 months, respectively (p = 0.02). Median survival in patients harboring two, three, or four or more lesions was 6.6 months, 5.4 months, and 2.7 months, respectively (p = 0.02). In patients with a KPS score greater than or equal to 70 and with three or fewer lesions, median survival was 7 months or longer. In patients with four or more lesions median survival was 7.4 months for those with no extracranial disease and 2.4 months for those with extracranial disease. Other variables tested (sex, histological tumor type, previous resection, location of metastases, treatment modality, and tumor status) did not influence outcome. Conclusions The absence of extracranial disease, a KPS score greater than or equal to 70, and fewer number of metastases were shown to be significant predictors of longer survival. Stereotactic radiosurgery appears to be a reasonable therapeutic option in patients with up to three lesions when their KPS score is greater than or equal to 70, regardless of extracranial disease status. In those with four or more metastases, however, SRS should be limited to those with no extracranial disease.

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Section: Patterns Of Failure and Lpfs And Rpfssupporting

confidence: 86%

Section: Patterns Of Failure and Lpfs And Rpfsmentioning

confidence: 97%

Section: Patterns Of Failure and Lpfs And Rpfsmentioning

confidence: 99%

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The role of radiosurgery for multiple brain metastases

Cho¹,

Hall

Gerbi

et al. 2000

FOC

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“…High-dose IGRT of brain metastases is highly effective and safe for treating patients with small intracranial metastatic tumors, regardless of the site of origin or histology. 8,9 This suggests that patients with small extracranial malignancies may be cured with similar small-volume IGRT involving multiple fields and high doses.…”

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confidence: 99%

Small‐volume image‐guided radiotherapy using hypofractionated, coplanar, and noncoplanar multiple fields for patients with inoperable Stage I nonsmall cell lung carcinomas

Fukumoto

Shirato

Shimzu

et al. 2002

Cancer

122

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BACKGROUNDOccasionally, medically compromised and/or elderly patients with nonsmall cell lung carcinomas (NSCLCs) cannot be treated surgically. We investigated small‐volume hypofractionated image‐guided radiotherapy (IGRT) without the need for breath control in patients with inoperable Stage I NSCLCs.METHODSBetween September 1996 and September 1999, 22 patients with Stage I NSCLCs, including 19 males and 3 females, were treated with IGRT. Among these patients, there were 13 Stage IA and 9 Stage IB tumors. The tumors ranged in size from 14.2 to 58.5 mm, with a median size of 26.7 mm. Of the 22 patients, 19 were unfit for surgical treatment due to poor pulmonary function, complications, and/or advanced age and 3 refused surgery. Computed tomographic scans (CT) of the primary tumor were taken during three respiratory phases and they were analyzed to determine the planning target volume, which included only the primary tumor with allowances for respiratory movement. The radiation doses administered at the edge of the moving tumor during normal breathing were 80% of the prescribed dose, either 48 or 60 Gy given in eight fractions over 2 weeks. Clinical evaluation, chest CT scan, and pulmonary function tests were performed before irradiation and at regular intervals for the post‐IGRT follow‐up. The median follow‐up period was 24 months (range, 2–44 months; mean, 21.8 months) (at least 24 months for survivors).RESULTSOf 17 tumors assessed at the initial follow‐up 2–6 months after treatment (5 complete responses, 11 partial responses, and 1 progressive disease), 16 (94%) were controlled locally. One local recurrence was observed during the follow‐up. The lung carcinoma‐specific survival rate at 1 year was 94% and the 1‐year actuarial recurrence‐free survival rate was 71%. The lung carcinoma‐specific survival rate at 2 years was 73% and the 2‐year actuarial recurrence‐free survival rate was 67%. The treatment was well tolerated and no major side effects were observed. Localized radiation pneumonitis was observed in all patients who were examined by CT scan, but the patients were asymptomatic. Parameters of pulmonary function, including vital capacity, total lung capacity, and diffusion capacity for carbon monoxide, decreased very little or not at all, indicating that IGRT rarely deteriorated pulmonary functions.CONCLUSIONSSmall‐volume hypofractionated IGRT without breath control is a feasible and beneficial method for the curative treatment of patients with Stage I NSCLCs. It has the potential of a high local tumor control rate and low morbidity. Cancer 2002;95:1546–53. © 2002 American Cancer Society.DOI 10.1002/cncr.10853

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“…The results of these studies are very good, especially in patients with a solitary metastasis, where survival times of several years were observed (77,78 …”

Section: Brain Metastasesmentioning

confidence: 97%