Staged radiosurgery in the managment of patients with brain metastases

Abstract

The study objective is to present the results of the treatment of metastatic brain patients by the staged radiosurgery with the Gamma Knife.Materials and methods. The retrospective analysis included 31 patients (13 men and 18 women) with brain metastases, whose radiosurgery treatment was carried out in 2 sessions. The operation was contraindicated in all patients due to the risk of neurological deficits or due to the high anesthesiological risk.Results. Local control of metastases growth was achieved in 31 (96.9 %) of 32 foci 3 months after treatment, and in 92.5 and 83.8 %, after 6 and 12 months, respectively. The age <50 years were associated with higher progression-free survival respectively. The median time of grade I–II radiation complications was 3.0 months, complications were observed in 11 (45.8 %) of 24 patients. Radiation complications of grade II (perifocal edema) were observed in 8 (33.3 %) patients, grade III (radionecrosis) – in 2 (8.3 %) patients. Overall survival at 6 and 12 months was 55.6 and 40.8 %, respectively (median 6.9 months), in patients receiving antitumor drug treatment – 80.0 and 56.8 %, respectively. All patients who did not received antitumor drug therapy died within 6 months.Conclusion. Two-stage radiosurgery, carried out in 2 sessions with an interval of 2–4 weeks, provides satisfactory local control with an acceptable level of post-radiation complications. This method of treatment can be used in patients with large brain metastases who are not subject to surgical treatment.