Gamma knife treatment of brainstem metastases

The management of brainstem metastases is challenging. Surgical treatment is usually not an option, and chemotherapy is of limited utility. Stereotactic radiosurgery has emerged as a promising palliative treatment modality in these cases. The goal of this study is to assess our single institution ex...

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Bibliographic Details
Published in:International journal of molecular sciences 2014-05, Vol.15 (6), p.9748-9761
Main Authors: Peterson, Halloran E, Larson, Erik W, Fairbanks, Robert K, MacKay, Alexander R, Lamoreaux, Wayne T, Call, Jason A, Carlson, Jonathan D, Ling, Benjamin C, Demakas, John J, Cooke, Barton S, Peressini, Ben, Lee, Christopher M
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Brain cancer
Brain Neoplasms - pathology
Brain Neoplasms - secondary
Brain Neoplasms - surgery
Brain Neoplasms - therapy
Brain Stem - pathology
Brain Stem - surgery
Brain surgery
brainstem metastases
Female
Gamma Knife
Humans
Male
Metastasis
Middle Aged
Radiation therapy
Radiosurgery
Retrospective Studies
Survival Analysis
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Summary:The management of brainstem metastases is challenging. Surgical treatment is usually not an option, and chemotherapy is of limited utility. Stereotactic radiosurgery has emerged as a promising palliative treatment modality in these cases. The goal of this study is to assess our single institution experience treating brainstem metastases with Gamma Knife radiosurgery (GKRS). This retrospective chart review studied 41 patients with brainstem metastases treated with GKRS. The most common primary tumors were lung, breast, renal cell carcinoma, and melanoma. Median age at initial treatment was 59 years. Nineteen (46%) of the patients received whole brain radiation therapy (WBRT) prior to or concurrent with GKRS treatment. Thirty (73%) of the patients had a single brainstem metastasis. The average GKRS dose was 17 Gy. Post-GKRS overall survival at six months was 42%, at 12 months was 22%, and at 24 months was 13%. Local tumor control was achieved in 91% of patients, and there was one patient who had a fatal brain hemorrhage after treatment. Karnofsky performance score (KPS) >80 and the absence of prior WBRT were predictors for improved survival on multivariate analysis (HR 0.60 (p = 0.02), and HR 0.28 (p = 0.02), respectively). GKRS was an effective treatment for brainstem metastases, with excellent local tumor control.
ISSN:1422-0067
1661-6596
1422-0067
DOI:10.3390/ijms15069748