Tumor volume as a predictor of survival and local control in patients with brain metastases treated with Gamma Knife surgery

Baschnagel, Andrew M.; Meyer, K.; Chen, Peter Y.; Krauss, Daniel; Olson, Rick E.; Pieper, Daniel R.; Maitz, Ann; Ye, Hong; Grills, I.S.

doi:10.3171/2013.7.jns13431

Cited by 166 publications

(94 citation statements)

References 17 publications

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“…The statistical significance of tumor volume and its negative impact on overall survival has been indicated in the literature. 2,25 The aggregate tumor volume was not a factor in tumor control in this paper. However, the rate of tumor control in larger metastases based on published data remains well in excess of 85% for tumors larger than 6 cm 3 .…”

Section: Discussion Survivalmentioning

confidence: 84%

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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: 84%

“…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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“…Radiosurgery gives the advantages of minimal invasiveness, with substantial reduction of hospitalization time and costs and excellent local control rate [7,8]. The local control rate is related to tumor volume and radiation dosage [9,10,11]. Radiologically, a homogeneous pattern of contrast enhancement indicates longer freedom from progression compared to heterogeneous and ring-enhancing patterns after radiosurgery [10].…”

Section: Introductionmentioning

confidence: 99%

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

Jung¹,

Kim²,

Jung³

et al. 2014

Stereotact Funct Neurosurg

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Background: Surgical removal is the first choice of treatment for large cystic brain metastases. However, some patients cannot undergo surgical resection due to their general condition and/or the tumor location. Aims: In this study, we investigated the feasibility and safety of stereotactic cyst aspiration and gamma knife radiosurgery (GKR) as an alternative treatment for these lesions and followed the volumetric changes in cystic and solid portions. Methods: Between February 2005 and March 2012, a total of 24 patients underwent GKR after cyst aspiration for 29 cystic metastatic brain tumors. The median age was 60 years (range, 18-81). The number of male patients was 18 and that of female patients 6. Most of the patients were in class II (87.5%) based on the data of the Radiation Therapy Oncology Group using recursive partitioning analysis. We analyzed the changes in tumor volume, the local control rate, intracranial progression-free survival (PFS) and overall survival (OS). Results: Before aspiration, the mean total tumor volume was 32.7 cm³ (range, 12.1-103.3) and cystic volume was 18.6 cm³ (range, 8-72.3). The mean duration of cyst drainage was 1 day (range, 1-2). The mean amount of aspiration was 16.8 cm³ (range, 6-67.4). After aspiration, the total mean volume was 12.4 cm³ (range, 3.7-38.1) and cystic volume was 2.0 cm³ (range, 0.1-9.5). The nature of the cyst was serous in 18, serous and hemorrhagic in 3, and serous and necrotic in 8. The median prescription dose was 16 Gy (range, 14-20). There was no treatment-related complication. The local control rate was 58.6% (17/29). The median survival to local recurrence was 6.0 (±1.42) months. During the follow-up period, an Ommaya reservoir was placed in 3 patients. Insertion of an Ommaya reservoir and whole-brain radiotherapy (WBRT) or GKR were done in 2 patients, WBRT in 2, GKR in 1 and operation in 1. The median intracranial PFS and OS after intracranial metastasis was 5.2 (±0.42) and 6.8 (±0.38) months. Conclusions: Cyst aspiration and GKR were feasible and safe but not very efficient, which could be an alternative option for large cystic metastases in patients who could not expect longer survival time.

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“…Baschnagel et al (2013) attempted to answer this question in their publication, assessing outcomes of 251 patients. The HR of total BM volume (continuous variable) on multivariate cox regression analysis was 1.04 (1.00-1.08, P = 0.046).…”

Section: Does Number Really Matter?mentioning

confidence: 99%

Brain Metastases

Vellayappan¹,

Sahgal²,

Redmond³

et al. 2017

Medical Radiology

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Tumor volume as a predictor of survival and local control in patients with brain metastases treated with Gamma Knife surgery

Cited by 166 publications

References 17 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

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

Brain Metastases

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