Alternative Treatment of Stereotactic Cyst Aspiration and Radiosurgery for Cystic Brain Metastases

Jung, Tae‐Young; Kim, In-Young; Jung, Shin; Jang, Won Young; Moon, Kyung‐Sub; Park, Seungjin; Lim, Sang Chul

doi:10.1159/000362935

Cited by 26 publications

(16 citation statements)

References 16 publications

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“…Tumor control is an important aspect of this treatment. The overall local tumor control of the aspirated cystic lesions after GKRS was 60.9%, which is within the range of other studies reporting a tumor control of 54.2-91.7% [2,3,5,9,15,19,20]. The local tumor progression was 39.1% which is in line with others reporting a local tumor progression of 8.3-41.4% [2,3,5,9,15,19,20].…”

Section: Discussionsupporting

confidence: 87%

“…The mean volumetric decrease was 56.5% after SCA which is within the range of other studies reporting a mean volumetric decrease of 47.8-77.9% [2,3,5,15] after SCA. A great advantage of cyst aspiration is acute symptomatic relief due to mass reduction.…”

Section: Discussionsupporting

confidence: 85%

“…The overall median survival in this study was 12 months. Others reported similar median overall survival rates ranging from 6.8-19.5 months [2,3,5,9,15,19,20]. Tendulkar et al reported a median survival of 8.7 months in those undergoing subtotal resection for single brain metastasis and 10.6 months after gross total resection (GTR) [18].…”

Section: Discussionmentioning

confidence: 93%

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Stereotactic cyst aspiration directly followed by Gamma Knife radiosurgery for large cystic brain metastases

et al. 2020

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Background Gamma Knife radiosurgery (GKRS) has been proven to be a successful primary treatment for metastatic brain tumors (BM). BM can come in cystic lesions and are often too large for GKRS. An alternative approach to treat cystic BM is stereotactic cyst aspiration (SCA) for volume reduction, making it suitable for GKRS afterwards. Objective Our objective is evaluation of volumetric reduction after SCA, tumor control, and complications after SCA directly followed by GKRS. Methods We performed a retrospective analysis of all patients who underwent SCA directly followed by GKRS at the Gamma Knife Center of the Elisabeth-Tweesteden Hospital in Tilburg between 2002 and 2015. In total, 54 patients had undergone this combined approach. Two patients were excluded because of prior intracranial treatment. The other 52 patients were included for analysis. Results SCA resulted in a mean volumetric reduction of 56.5% (range 5.50-87.00%). In 83.6% of the tumors (46 tumors), SCA led to sufficient volumetric reduction making GKRS possible. The overall local tumor control (OLTC) of the aspirated lesions post-GKRS was 60.9% (28 out of 46 tumors). Median progression-free survival (PFS) and overall survival (OS) for all patients were 3 (range 5 days-14 months) and 12 months (range 5 days-58 months), respectively. Leptomeningeal disease was reported in 5 (9.6%) cases. Conclusion SCA directly followed by GKRS is an effective and time-efficient treatment for large cystic BM in selected patients in which surgery is contraindicated and those with deeply located lesions.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 85%

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Stereotactic cyst aspiration directly followed by Gamma Knife radiosurgery for large cystic brain metastases

et al. 2020

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“…However, Franzin et al (6) found that no acute complications were observed and that only 7.6% of patients underwent radionecrosis following treatment with GKRS combined with stereotactic aspiration for cystic brain metastases. Jung et al (22) reported that stereotactic cyst aspiration and radiosurgery for cystic brain metastases resulted in a local control rate of 58.6%; this type of treatment is safe, but the efficiency is not high. In the present study, 10 cases of phosphorus-32 radiotherapy patients without radioactive brain necrosis were also recorded.…”

Section: Discussionmentioning

confidence: 99%

Gamma Knife radiosurgery combined with stereotactic aspiration as an effective treatment method for large cystic brain metastases

Wang

Dou

et al. 2016

Oncology Letters

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Abstract. In the present study, the efficacy and clinical outcomes of stereotactic aspiration combined with the Gamma Knife radiosurgery (GKRS) method were evaluated retrospectively for patients with large cystic brain metastases. This combined method aims to decrease the tumor weight (volume) and increase the possible radiation dose. The present study involved 48 patients who were diagnosed with cystic metastatic brain tumors between January 2008 and December 2012 in the Department of Neurosurgery of Nanfang Hospital Southern Medical University (Guangzhou, China). Every patient underwent Leksell stereotactic frame, 1.5T magnetic resonance imaging (MRI)-guided stereotactic cyst aspiration and Leksell GKRS. Subsequent to the therapy, MRI was performed every 3 months. The results indicated that 48 cases were followed up for 24-72 months, with a mean follow-up duration of 36.2 months. Following treatment, 44 patients (91.7%) exhibited tumor control and 4 patients (8.3%) experienced progression of the local tumor. During this period, 35 patients (72.9%) succumbed, but only 2 (4.2%) of these succumbed to the brain metastases. The total local control rate was 91.7% and the median overall survival time of all patients was 19.5 months. The 1-year overall survival rate was 70.8% and the 2-year overall survival rate was 26.2%. In conclusion, these results indicated that the method of stereotactic cyst aspiration combined with GKRS was safe and effective for patients with large cystic brain metastases. This method is effective for patients whose condition is too weak for general anesthesia and in whom the tumors are positioned at eloquent areas. This method enables patients to avoid a craniotomy, and provides a good tumor control rate, survival time and quality of life. IntroductionIn the clinical setting, metastatic tumors that translocate from the primary tumor site to the central nervous system are the most frequently occurring intracranial tumors (1). Three methods, including stereotactic radiosurgery, general surgery and whole-brain radiation therapy (WBRT), are normally clinically used and are relatively effective for treating brain metastases (1). However, for a long time, none of these methods was assigned as the standard therapy in clinical practice. The median survival time of affected patients is 1-3 months without therapy (1). The median survival time increases to ~6 months after WBRT (2) and to 10 months subsequent to using the Gamma Knife radiosurgery (GKRS) method (3). The survival time has been recorded as 12 months in patients who underwent surgery (prior method) and WBRT (4). With each of the latter methods, the patients only suffered from single brain metastasis, however, when using the GKRS and WBRT combined method for multiple brain metastases, a survival time of >1 year can also be obtained (5). Recently, the radiosurgery method has become a focal topic in the area of brain tumor metastases, and more advantages have been demonstrated when compared to tumor resection. Radiosurgery has been applied in m...

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“…Histologically, most of these lesions derived from lung cancer and these had the highest incidence of BM and the most cystic BM patients published [8, 9, 15]. Patients with non-small-cell lung cancer (NSCLC) harboring anaplastic lymphoma kinase (ALK)-rearrangements that were treated with crizotinib have also presented with cystic BM [16–19].…”

Section: Discussionmentioning

confidence: 99%

Cystic brain metastasis is associated with poor prognosis in patients with advanced breast cancer

Sun

Huang

et al. 2016

Oncotarget

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PurposeBrain metastasis (BM) with a cystic component from breast cancer is rare and largely uncharacterized. The purpose of this study was to identify the characteristics of cystic BM in a large cohort of breast cancer patients.ResultsA total of 35 eligible patients with cystic BM and 255 patients with solid BM were analyzed. Three factors were significantly associated with an increased probability of developing cystic lesions: age at diagnosis ≤ 40 years, age at BM ≤ 45 years, and poor histological grade (p < 0.05). Patients with cystic metastasis were also characterized by a larger metastasis volume, a shorter progression-free survival (PFS) following their first treatment for BM, and poor overall survival after BM (p < 0.05). Multivariate analysis further demonstrated that local control of cystic BM was only potentially achieved for HER2-negative primary tumors (p = 0.084).MethodsBreast cancer patients with parenchymal BM were reviewed from consecutive cases treated at our institution. Cystic BM was defined when the volume of a cystic lesion was greater than 50% of the aggregated volume of all lesions present. Clinicopathologic and radiographic variables were correlated with development of cystic lesions and with prognosis of cystic BM.ConclusionsThis study shows that cystic BM from breast cancer, a special morphological type of BM, had worse prognosis than the more commonly observed solid BM. Younger age and low tumor grade were associated with the development of cystic lesions. Further comprehensive research and management of cystic BM are warranted to improve its poor prognosis.

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Alternative Treatment of Stereotactic Cyst Aspiration and Radiosurgery for Cystic Brain Metastases

Cited by 26 publications

References 16 publications

Stereotactic cyst aspiration directly followed by Gamma Knife radiosurgery for large cystic brain metastases

Stereotactic cyst aspiration directly followed by Gamma Knife radiosurgery for large cystic brain metastases

Gamma Knife radiosurgery combined with stereotactic aspiration as an effective treatment method for large cystic brain metastases

Cystic brain metastasis is associated with poor prognosis in patients with advanced breast cancer

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