Abstract
This study aimed to explore the safety and efficacy of multisession gamma knife surgery (GKS) for large brain metastases with a volume of 10 cm3 or larger. Fifty-six patients who had 65 brain metastases with a volume of at least 10 cm3 were treated with multisession GKS. Three-session GKS at a prescription dose of 10 Gy to the tumor margin per session with a 2-week interval between doses was performed in 3 patients. Other patients were treated with 2-session GKS at a prescription dose of 10–13 Gy to the tumor margin per session with an interval of 1–4 weeks. The median tumor volume was 21 cm3. The median survival was 7 months. The 6-, 12-, and 18-month survival rates were 62, 42, and 31%, respectively. The progression-free survival rates at 6, 12, and 18 months were 93, 80, and 74%, respectively. At the time of the first and last GKS sessions, the median tumor volumes were 21 and 15 cm3, respectively, which decreased to 5 cm3 with a median follow-up period of 6 months. Seventy-four percent of evaluated patients who had pre-GKS clinical symptoms obtained symptomatic improvement in a mean interval of 2 months. Multisession GKS was a safe and effective alternative to surgical resection for patients who had brain metastases with a tumor volume of 10 cm3 or larger. Although long-term results remain unclear, multisession GKS may be a suitable palliative treatment to preserve neurological function.
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References
Linskey ME, Andrews DW, Asher AL et al (2010) The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96:45–68
Kano H, Iyer A, Kondziolka D, Niranjan A, Flickinger JC, Lunsford LD (2011) Outcome predictors of gamma knife radiosurgery for renal cell carcinoma metastases. Neurosurgery 69:1232–1239
Bowden G, Kano H, Caparosa E, Park S-H, Niranjan A, Flickinger J, Lunsford LD (2015) Gamma Knife radiosurgery for the management of cerebral metastases from non–small cell lung cancer. J Neurosurg 122:1–7
Hasegawa T, Kondziolka D, Flickinger JC, Lunsford LD (2003) Stereotactic radiosurgery for brain metastases from gastrointestinal tract cancer. Surg Neurol 60:506-14-5
Matsunaga S, Shuto T, Kawahara N, Suenaga J, Inomori S, Fu**o H, Hospital YR (2010) Gamma Knife surgery for metastatic brain tumors from primary breast cancer: treatment indication based on number of tumors and breast cancer phenotype. J Neurosurg 113 Suppl:65–72
Matsunaga S, Shuto T, Kawahara N, Suenaga J, Inomori S, Fu**o H (2011) Gamma Knife surgery for brain metastases from colorectal cancer. Clinical article. J Neurosurg 114:782–789
Ryken TC, McDermott M, Robinson PD et al (2009) The role of steroids in the management of brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96:103–114
Kalkanis SN, Kondziolka D, Gaspar LE et al (2010) The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96:33–43
Gaspar LE, Mehta MP, Patchell RA et al (2009) The role of whole brain radiation therapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96:17–32
Mehta MP, Paleologos NA, Mikkelsen T et al (2010) The role of chemotherapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96:71–83
Tallet AV, Azria D, Barlesi F, Spano J-P, Carpentier AF, Gonçalves A, Metellus P (2012) Neurocognitive function impairment after whole brain radiotherapy for brain metastases: actual assessment. Radiat Oncol 7:77
Pinkham MB, Sanghera P, Wall GK, Dawson BD, Whitfield GA (2015) Neurocognitive effects following cranial irradiation for brain metastases. Clin Oncol (R Coll Radiol) 27:630–639
Yamamoto M, Serizawa T, Shuto T et al (2014) Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol 15:387–395
Gani C, Müller AC, Eckert F, Schroeder C, Bender B, Pantazis G, Bamberg M, Berger B (2012) Outcome after whole brain radiotherapy alone in intracranial leptomeningeal carcinomatosis from solid tumors. Strahlentherapie und Onkol Organ der Dtsch Röntgengesellschaft 188:148–53
Higuchi Y, Serizawa T, Nagano O, Matsuda S, Ono J, Sato M, Iwadate Y, Saeki N (2009) Three-staged stereotactic radiotherapy without whole brain irradiation for large metastatic brain tumors. Int J Radiat Oncol Biol Phys 74:1543–1548
Yomo S, Hayashi M, Nicholson C (2012) A prospective pilot study of two-session gamma knife surgery for large metastatic brain tumors. J Neurooncol 109:159–165
Yomo S, Hayashi M (2014) A minimally invasive treatment option for large metastatic brain tumors: long-term results of two-session gamma knife stereotactic radiosurgery. Radiat Oncol 9:132
Toma-Dasu I, Sandström H, Barsoum P, Dasu A (2014) To fractionate or not to fractionate? That is the question for the radiosurgery of hypoxic tumors. J Neurosurg 121 Suppl:110–5
Berger LA, Riesenberg H, Bokemeyer C, Atanackovic D (2013) CNS metastases in non-small-cell lung cancer: current role of EGFR-TKI therapy and future perspectives. Lung Cancer 80:242–248
Iuchi T, Shingyoji M, Sakaida T et al (2013) Phase II trial of gefitinib alone without radiation therapy for Japanese patients with brain metastases from EGFR-mutant lung adenocarcinoma. Lung Cancer 82:282–287
Gil-Gil MJ, Martinez-Garcia M, Sierra A, Conesa G, Del Barco S, González-Jimenez S, Villà S (2014) Breast cancer brain metastases: a review of the literature and a current multidisciplinary management guideline. Clin Transl Oncol 16:436–446
Lin NU, Diéras V, Paul D et al (2009) Multicenter phase II study of lapatinib in patients with brain metastases from HER2-positive breast cancer. Clin Cancer Res 15:1452–1459
Brufsky AM, Mayer M, Rugo HS et al (2011) Central nervous system metastases in patients with her2-positive metastatic breast cancer: incidence, treatment, and survival in patients from registHER. Clin Cancer Res 17:4834–4843
Kodack DP, Askoxylakis V, Ferraro GB, Fukumura D, Jain RK (2015) Emerging strategies for treating brain metastases from breast cancer. Cancer Cell 27:163–175
Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, Markesbery WR, Macdonald JS, Young B (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494–500
Minniti G, D’Angelillo RM, Scaringi C, Trodella LE, Clarke E, Matteucci P, Osti MF, Ramella S, Enrici RM, Trodella L (2014) Fractionated stereotactic radiosurgery for patients with brain metastases. J Neurooncol 117:295–301
Navarria P, Pessina F, Cozzi L et al (2016) Hypo-fractionated stereotactic radiotherapy alone using volumetric modulated arc therapy for patients with single, large brain metastases unsuitable for surgical resection. Radiat Oncol 11:76
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Hasegawa, T., Kato, T., Yamamoto, T. et al. Multisession gamma knife surgery for large brain metastases. J Neurooncol 131, 517–524 (2017). https://doi.org/10.1007/s11060-016-2317-4
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DOI: https://doi.org/10.1007/s11060-016-2317-4