Radiosurgery: Its Role in Brain Metastasis Management

Jc, Flickinger; Ld, Lunsford; Somaza, Salvador; Kondziolka, Douglas

doi:10.1016/s1042-3680(18)30375-9

Cited by 59 publications

(26 citation statements)

References 23 publications

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“…Stereotactic radiosurgery has been reported to be as effective as open surgery in local tumor control 24,27) . GKRS is reported to result in local control rates of 83 to 94%, and median survival times ranging from 7 to 12 months 1,5,6,10,11,15) . The advantages of GKRS are that it is minimally invasive and suitable for lesions inaccessible via surgery.…”

Section: Radiosurgery Techniquementioning

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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Section: Radiosurgery Techniquementioning

confidence: 99%

Gamma Knife Radiosurgery for Brainstem Metastasis

Yoo

Park

Kwon

et al. 2011

J Korean Neurosurg Soc

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“…26,37 Radiosurgery has emerged as a key method of providing definitive local control for brain metastases in addition to surgery and WBRT. 13 Radiosurgery with WBRT has been consistently shown to improve overall local control in comparison with WBRT alone. 2,20 In addition, in comparison to WBRT alone, the combination of WBRT and SRS appears to improve survival in patients with a single brain metastasis and improve functional independence in patients with 3 or fewer metastases.…”

Section: Role Of Radiosurgery In Management Of Brain Metastasesmentioning

confidence: 99%

Control of brain metastases using frameless image-guided radiosurgery

Chen

Bugoci

Girvigian

et al. 2009

FOC

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Object Radiosurgery is an important and well-accepted method in the management of brain metastases. Using conventional frame-based techniques, high lesional control rates are expected. The introduction of image-guided techniques allows for improved patient comfort and workflow. Some controversy exists as to the accuracy of imageguided techniques and consequently the impact they might have on control of brain metastases (as opposed to the level of control achieved with frame-based methods). The authors describe their initial 15-month experience with image-guided radiosurgery (IGRS) using Novalis with ExacTrac for management of brain metastases. Methods The authors reviewed the cases of brain metastasis treated by means of IGRS in their tertiary regional radiation oncology service over a 15-month period. During the study period 54 patients (median age 57.9 years) harboring 108 metastases were treated with IGRS. The median time from cancer diagnosis to development of brain metastasis was 12 months (range 0–144 months). The median tumor volume was 0.98 cm3 (range 0.03–19.07 cm3). The median prescribed dose was 18 Gy to the 80% isodose line (range 14–20 Gy). Lesions were followed with postradiosurgery MR imaging every 2–3 months following treatment. Results The median follow-up period was 9 months (range 0–20 months). Median actuarial survival was 8.6 months following IGRS. Eight patients with 18 lesions died within the first 2 months after the procedure, before scheduled follow-up imaging. Thus 90 lesions (in 46 patients) were followed up with imaging studies. Lesions that were unchanged or reduced in size were considered to be under control. The 6-month actuarial lesion control rate was 88%. Smaller lesions (< 1 cm3) had a statistically improved likelihood of complete imaging response (loss of all contrast-enhancement p = 0.01). Conclusions Image-guided radiosurgical treatment of brain metastases resulted in high rates of tumor control comparable to control rates reported for frame-based methods. High control rates were seen for small lesions in which spatial precision in dose delivery is critical. These data suggests that in regard to lesion control, IGRS using Novalis with ExacTrac is equivalent to frame-based radiosurgery methods.

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“…Multiple studies examining the efficacy of SRS have shown generally positive results. For all types of metastatic histologies, the local control rate after treatment with SRS ranges between 85 and 90 percent at one year [101][102][103]. For metastatic melanoma to the brain, the local control rate was shown to be approximately 90 to 97 percent [103][104][105].…”

Section: Stereotactic Radiosurgerymentioning

confidence: 99%