Advertisement

Journal of Neuro-Oncology

, Volume 113, Issue 1, pp 33–38 | Cite as

Treatment of brainstem metastases with gamma-knife radiosurgery

  • Meriç Şengöz
  • İpek Arslan Kabalay
  • Evrim Tezcanlı
  • Selçuk Peker
  • Necmettin Pamir
Clinical Study

Abstract

The aim was to investigate the efficacy and safety of gamma-knife stereotactic radiosurgery (SRS) for treating brainstem metastases. The cases of 44 patients who underwent SRS as treatment for 46 brainstem metastases were retrospectively evaluated. The median age was 57 years (range 42–82 years) and the median Karnofsky performance score (KPS) was 80 (range 60–90). The primary tumor was lung carcinoma in 28 cases, breast carcinoma in 7 cases, colon carcinoma in 3 cases, renal cell carcinoma in 3 cases, malignant melanoma in 1 case, and unknown origin in 2 cases. Of the 46 metastases, 30 were in the pons, 14 were in the mesencephalon, and 2 were in the medulla oblongata. The median volume of the 46 metastases was 0.6 cc (range 0.34–7.3 cc). The median marginal dose of radiation was 16 Gy (range 10–20 Gy). Twenty-three patients (52 %) received whole brain radiotherapy prior to SRS, and 6 (14 %) received this therapy after SRS. In the remaining 15 cases (34 %), SRS was applied as the only treatment. Recursive partitioning analysis, graded prognostic assessment, and basic score for brain metastases were used to predict survival time. Local control was achieved for all but two of the 46 metastases (96 %). The overall survival time after SRS was 8 months. Female gender, KPS >70, mesencephalon tumor location, and response to treatment were associated with longer survival. Basic score for brain metastases class I and recursive partitioning analysis classification were associated with better prognosis. Peri-tumoral changes were detected radiologically at 2 (4 %) of the metastatic lesion sites but neither of these patients exhibited symptoms. Gamma-knife radiosurgery is effective for treating brainstem metastases without a higher risk for radiation necrosis.

Keywords

Brainstem metastases Gamma-knife Radiosurgery 

References

  1. 1.
    Chason JL, Walker FB, Landers JW (1963) Metastatic carcinoma in the central nervous system and dorsal root ganglia. A prospective autopsy study. Cancer 16:781–787PubMedCrossRefGoogle Scholar
  2. 2.
    Delattre JY, Krol G, Thaler HT, Posner JB (1988) Distribution of brain metastases. Arch Neurol 45:741–744PubMedCrossRefGoogle Scholar
  3. 3.
    Andrews DW, Scott CB, Sperduto PW et al (2004) 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 363:1665–1672PubMedCrossRefGoogle Scholar
  4. 4.
    Shaw E, Scott C, Souhami L et al (2000) Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90–05. Int J Radiat Oncol Biol Phys 47:291–298PubMedCrossRefGoogle Scholar
  5. 5.
    Emami B, Lyman J, Brown A et al (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21:109–122PubMedCrossRefGoogle Scholar
  6. 6.
    Koyfman SA, Tendulkar RD, Chao ST et al (2010) Stereotactic radiosurgery for single brainstem metastases: the Cleveland Clinic experience. Int J Radiat Oncol Biol Phys 78(2):409–414PubMedCrossRefGoogle Scholar
  7. 7.
    Huang CF, Kondziolka D, Flickinger JC, Lunsford LD (1999) Stereotactic radiosurgery for brain stem metastases. J Neurosurg 91:563–568PubMedCrossRefGoogle Scholar
  8. 8.
    Lorenzoni JG, Devriendt D, Massager N et al (2009) Brain stem metastases treated with radiosurgery: prognostic factors of survival and life expectancy estimation. Surg Neurol 71:188–195PubMedCrossRefGoogle Scholar
  9. 9.
    Kased N, Huang K, Nakamura JL et al (2008) Gamma knife radiosurgery for brain stem metastases: the UCSF experience. J Neurooncol 86:195–205PubMedCrossRefGoogle Scholar
  10. 10.
    Hussain A, Brown PD, Stafford SL, Pollock BE (2007) Stereotactic radiosurgery for brain stem metastases: survival, tumor control, and patient outcomes. Int J Radiat Oncol Biol Phys 67:521–524PubMedCrossRefGoogle Scholar
  11. 11.
    Fuentes S, Delsanti C, Metellus P, Peragut JC, Grisoli F, Regis J (2006) Brain stem metastases: management using gamma knife radiosurgery. Neurosurgery 58:37–42PubMedCrossRefGoogle Scholar
  12. 12.
    Yen CP, Sheehan J, Patterson G, Steiner L (2006) Gamma knife surgery for metastatic brain stem tumors. J Neurosurg 105:213–219PubMedCrossRefGoogle Scholar
  13. 13.
    Shuto T, Fujino H, Asada H, Inomori Si Nagano H (2003) Gamma knife radiosurgery for metastatic tumours in the brain stem. Acta Neurochir (Wien) 145:755–760CrossRefGoogle Scholar
  14. 14.
    Valery CA, Boskos C, Boisserie G et al (2011) Minimized doses for linear accelerator radiosurgery of brainstem metastasis. Int J Radiat Oncol Biol Phys 80(2):362–368PubMedCrossRefGoogle Scholar
  15. 15.
    Kelly PJ, Lin YB, Yu AY et al (2011) Linear accelerator-based stereotactic radiosurgery for brainstem metastases: the Dana-Farber/Brigham and Women’s Cancer Center experience. J Neurooncol 104(2):553–557PubMedCrossRefGoogle Scholar
  16. 16.
    Gaspar L, Scott C, Rotman M et al (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751PubMedCrossRefGoogle Scholar
  17. 17.
    Weltman E, Salvajoli JV, Brandt RA et al (2000) Radiosurgery for brain metastases: a score index for predicting prognosis. Int J Radiat Oncol Biol Phys 46:1155–1161PubMedCrossRefGoogle Scholar
  18. 18.
    Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W (2008) A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys 70:510–514PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Meriç Şengöz
    • 1
  • İpek Arslan Kabalay
    • 2
  • Evrim Tezcanlı
    • 1
  • Selçuk Peker
    • 3
  • Necmettin Pamir
    • 3
  1. 1.Department of Radiation OncologyAcıbadem Kozyatağı Hospital, Acıbadem UniversityKozyatağı, IstanbulTurkey
  2. 2.Department of Radiation OncologyMarmara UniversityIstanbulTurkey
  3. 3.Department of NeurosurgeryAcıbadem UniversityIstanbulTurkey

Personalised recommendations