Stereotactic radiosurgery using the Leksell Gamma Knife Perfexion unit in the management of patients with 10 or more brain metastases

Grandhi, Ramesh; Kondziolka, Douglas; Panczykowski, David M.; Monaco, Edward A.; Kano, Hideyuki; Niranjan, Ajay; Flickinger, John C.; Lunsford, L. Dade

doi:10.3171/2012.4.jns11870

Cited by 111 publications

(89 citation statements)

References 24 publications

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“…29,35 The involvement of factors such as patient age, KPS score at SRS, and RPA class appear to have a larger impact on survival predictions than the number of metastases. 3,12,28 Tumor volume was a significant factor in patient survival, accounting for a 1-year survival increase of 14% after SRS. The clearest separation was demonstrated at < 5 cm 3 or ≥ 5 cm 3 with an increase in median survival of 4 months.…”

Section: Discussion Survivalmentioning

confidence: 99%

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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: 99%

“…A median of 2 metastases (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] were treated at each radiosurgical procedure. The median marginal dose was 18 Gy (range 10-22 Gy) and the maximum dose was 34 Gy (range 20-50 Gy).…”

Section: Radiosurgery Techniquementioning

confidence: 99%

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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“…8,10,11 The timing of publication of these studies coincides with an observed increase in the uptake of SRS. During our study period, multiple institutional SRS series were published, demonstrating promising efficacy for up to, and beyond, 10 intracranial lesions, [20][21][22] in elderly patients, 23 and in the postoperative setting, 24 indicating an increased practitioner comfort level with brain SRS for a number of clinical situations.…”

Section: Discussionmentioning

confidence: 99%

Radiosurgery for Brain Metastases: Changing Practice Patterns and Disparities in the United States

Kann¹,

Park²,

Johnson³

et al. 2017

J Natl Compr Canc Netw

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Background: Management of brain metastases typically includes radiotherapy (RT) with conventional fractionation and/or stereotactic radiosurgery (SRS). However, optimal indications and practice patterns for SRS remain unclear. We sought to evaluate national practice patterns for patients with metastatic disease receiving brain RT. Methods: We queried the National Cancer Data Base (NCDB) for patients diagnosed with metastatic non-small cell lung cancer, breast cancer, colorectal cancer, or melanoma from 2004 to 2014 who received upfront brain RT. Patients were divided into SRS and non-SRS cohorts. Patient and facility-level SRS predictors were analyzed with chi-square tests and logistic regression, and uptake trends were approximated with linear regression. Survival by diagnosis year was analyzed with the Kaplan-Meier method. Results: Of 75,953 patients, 12,250 (16.1%) received SRS and 63,703 (83.9%) received non-SRS. From 2004 to 2014, the proportion of patients receiving SRS annually increased (from 9.8% to 25.6%; P<.001), and the proportion of facilities using SRS annually increased (from 31.2% to 50.4%; P<.001). On multivariable analysis, nonwhite race, nonprivate insurance, and residence in lowerincome or less-educated regions predicted lower SRS use (P<.05 for each). During the study period, SRS use increased disproportionally among patients with private insurance or who resided in higher-income or higher-educated regions. From 2004 to 2013, 1-year actuarial survival improved from 24.1% to 49.6% for patients selected for SRS and from 21.0% to 26.3% for non-SRS patients (P<.001). Conclusions: This NCDB analysis demonstrates steadily increasing-although modest overall-brain SRS use for patients with metastatic disease in the United States and identifies several progressively widening sociodemographic disparities in the adoption of SRS. Further research is needed to determine the reasons for these worsening disparities and their clinical implications on intracranial control, neurocognitive toxicities, quality of life, and survival for patients with brain metastases.

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“…Stereotactic radiosurgery leads to tumor control in 70%-90% of metastatic brain tumors. 1,3,4,8,10 The clinical effectiveness of radiosurgery relates in part to the histological tumor source. Tumor control is adequate if serial imaging after radiosurgery reveals stable or reduced tumor volumes.…”

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Volumetric response to radiosurgery for brain metastasis varies by cell of origin

Iyer

Harrison

Kano³

et al. 2014

JNS

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T he imaging response of brain metastases after stereotactic radiosurgery is complex and dynamic. Stereotactic radiosurgery leads to tumor control in 70%-90% of metastatic brain tumors. 1,3,4,8,10 The clinical effectiveness of radiosurgery relates in part to the histological tumor source. Tumor control is adequate if serial imaging after radiosurgery reveals stable or reduced tumor volumes. A transient increase in tumor volume may not preclude the possibility of long-term tumor inactivation 5 and is inadequate to predict the eventual radiosurgical response at a single follow-up imaging time point. In an effort to better define the effect of radiosurgery on different tumor pathologies, we evaluated the quantitative volumetric response of lung, breast, and melanoma metastases in the brain following Gamma Knife radiosurgery (GKRS). We then correlated this response to patient survival. MethodsInstitutional review board approval was acquired at the University of Pittsburgh for data review and presentation. We conducted a retrospective review of patients who had undergone GKRS for brain metastases from nonsmall cell lung cancer (NSCLC), breast cancer, and melanoma between 2002 and 2010 at our institution. To be included in the study, patients had to have undergone follow-up imaging at our institution so that volumetric measurements could be made on the same imaging software. Object. The aim of this study was to evaluate the imaging response of brain metastases after radiosurgery and to correlate the response with tumor type and patient survival.Methods. The authors conducted a retrospective review of patients who had undergone Gamma Knife radiosurgery for brain metastases from non-small cell lung cancer (NSCLC), breast cancer, or melanoma. The imaging volumetric response by tumor type was plotted at 3-month intervals and classified as a sustained decrease in tumor volume (Type A), a transient decrease followed by a delayed increase in tumor volume (Type B), or a sustained increase in tumor volume (Type C). These imaging responses were then compared with patient survival and tumor type.Results. Two hundred thirty-three patients with metastases from NSCLC (96 patients), breast cancer (98 patients), and melanoma (39 patients) were eligible for inclusion in this study. The patients with NSCLC were most likely to exhibit a Type A response; those with breast cancer, a Type B response; and those with melanoma, a Type C response. Among patients with NSCLC, the median overall survival was 11.2 months for those with a Type A response (76 patients), 8.6 months for those with a Type B response (6 patients), and 10.5 months for those with a Type C response (14 patients). Among patients with breast cancer, the median overall survival was 16.6 months in those with a Type A response (65 patients), 18.1 months in those with a Type B response (20 patients), and 7.5 months in those with a Type C response (13 patients). For patients with melanoma, the median overall survival was 5.2 months in those with a Type A response (26 patients) an...

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Stereotactic radiosurgery using the Leksell Gamma Knife Perfexion unit in the management of patients with 10 or more brain metastases

Cited by 111 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

Radiosurgery for Brain Metastases: Changing Practice Patterns and Disparities in the United States

Volumetric response to radiosurgery for brain metastasis varies by cell of origin

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