Gamma knife surgery for brain metastases from lung cancer

Pan, Hung-Chuan; Sheehan, Jason P.; Stroila, Matei; Steiner, Melita; Steiner, Ladislau

doi:10.3171/jns.2005.102.s_supplement.0128

Cited by 70 publications

(64 citation statements)

References 24 publications

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“…8,33 Recent publications have indicated that WBRT has no survival benefit, no improvement in functional independence, and a negative impact on quality of life. 5,16,26,32 In our study, the survival from the time of SRS was shorter by longer than 2 months in the WBRT-treated group. However, the statistical significance was neutralized when the survival from diagnosis of brain metastasis was analyzed.…”

Section: Discussion Survivalmentioning

confidence: 71%

Gamma Knife radiosurgery for the management of cerebral metastases from non–small cell lung cancer

Bowden

Kano

Caparosa

et al. 2015

JNS

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L ung cancer is the most common malignancy in the world, accounting for 13% of all documented cancer cases, of which 85% are non-small cell lung cancer (NSCLC). NSCLC is often diagnosed at an advanced stage, as 56% of patients present with distant metastases. 31The 5-year survival for NSCLC is 19.3% overall but decreases to 4.1% with distant metastases. 15Intracranial metastases occur in an estimated 30%-40% of patients with NSCLC and are often identifiable at the time of primary diagnosis. 6,18,23 The presence of intracranial metastases is invariably associated with a decrease in median survival across all cancer types. 10 The median survival for a patient with NSCLC and intracranial metastases who forgoes treatment is reportedly less than 2 months. The addition of fractionated whole-brain radiation therapy (WBRT) increases survival to only 3-6 months. 4,6 Gamma Knife radiosurgery (GKRS) has proven to be a low risk and effective treatment strategy for a wide variety of patients with brain metastases. The local tumor control after SRS in NSCLC patients consistently exceeds 80% in the literature. 24,30 The utilization of SRS for NSCLC metastases has increased significantly and appropriately abbreviatioNs GKRS = Gamma Knife radiosurgery; KPS = Karnofsky Performance Scale; NSCLC = non-small cell lung cancer; RPA = recursive partitioning analysis; RTOG = Radiation Therapy Oncology Group; SRS = stereotactic radiosurgery; WBRT = whole-brain radiotherapy. obJect Non-small cell lung cancer (NSCLC) is the most frequent cancer that metastasizes to brain. Stereotactic radiosurgery (SRS) has become the management of choice for most patients with such metastatic tumors. Therefore, the authors endeavored to elucidate the survival and SRS outcomes for patients with NSCLC metastasis at their center. methods In this single-institution retrospective analysis, the authors reviewed their experience with NSCLC metastasis during a 10-year period from 2001 to 2010. Seven hundred twenty patients underwent Gamma Knife radiosurgery. A total of 1004 SRS procedures were performed, and 3143 tumors were treated. The NSCLC subtype was adenocarcinoma in 386 patients, squamous cell carcinoma in 111 patients, and large cell carcinoma in 34 patients. The median aggregate tumor volume was 4.5 cm 3 (range 0.1-88 cm 3 ). results The median survival time after diagnosis of brain metastasis from NSCLC was 12.6 months, and the median survival after SRS was 8.5 months. The 1-, 2-, and 5-year survival rates after SRS were 39%, 21%, and 10%, respectively. Postradiosurgery survival was decreased in patients treated with prior whole-brain radiation therapy compared with SRS alone (p = 0.003). Aggregate tumor volume was inversely related to survival after SRS (p < 0.001), and the histological subgroups demonstrated significant survival differences (p = 0.023). The overall local tumor control rate in the entire group was 92.8%. One hundred seventy-four patients (24%) underwent repeat SRS for new or resistant metastatic deposits. coNclusioNs Stereotactic radio...

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Section: Discussion Survivalmentioning

confidence: 71%

Gamma Knife radiosurgery for the management of cerebral metastases from non–small cell lung cancer

Bowden

Kano

Caparosa

et al. 2015

JNS

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“…Radiosurgery is not always applicable for large cystic brain metastases. Pan et al (17) reported that GKRS alone could not control the large cystic components (>10 ml) effectively. When applied to the solid component of the tumor, the combination of stereotactic cyst aspiration and GKRS resulted in a good outcome, with a 1-year survival rate of 60%.…”

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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“…Positive influence of controlled primary site has been reported in multivariate study (Sneed, 2002) and in univariate studies (Lorenzoni, 2004;Jawahar, 2004;Pan, 2005;Kased, 2009). Some studies did not find significant influence (Chidel, 2000;Hernández, 2002;Golden, 2008).…”

Section: Control Of the Primary Tumormentioning

confidence: 98%

“…After a Gamma Knife treatment for brain metastases, along the time new metastases can develop, in such situations a new Gamma Knife treatment can be offered to these patients, Pan (Pan, 2005) found a positive influence on survival the realization of a new treatments in multivariate analysis. Vesagas (Vesagas, 2002) and Yu (Yu, 2005) found benefice in univariate studies.…”

Section: Multiple Lgk Treatmentsmentioning

confidence: 99%

Gamma Knife Treatment for Patient Harboring Brain Metastases: How to Estimate Patient Eligibility and Survival?

Lorenzoni¹,

Zarate²,

Ramón³

et al. 2011

Gamma Knife Radiosurgery

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Gamma knife surgery for brain metastases from lung cancer

Abstract: The risk-benefit ratio of GKS in this series was satisfactory. There was no difference in response rates of the two tumor types, and WBRT did not improve the duration of survival.

Cited by 70 publications

References 24 publications

Gamma Knife radiosurgery for the management of cerebral metastases from non–small cell lung cancer

Gamma Knife radiosurgery for the management of cerebral metastases from non–small cell lung cancer

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

Gamma Knife Treatment for Patient Harboring Brain Metastases: How to Estimate Patient Eligibility and Survival?

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