title: Gamma knife surgery for metastatic brainstem tumors.
abstract: OBJECTIVE
  The authors review imaging and clinical outcomes in patients with metastatic brainstem tumors treated using Gamma Knife surgery (GKS).
  
  
  METHODS
  Between March 1989 and March 2005, 53 patients (24 men and 29 women) with metastatic brainstem lesions underwent GKS. The metastatic deposits were located in the midbrain in eight patients, the pons in 42, and the medulla oblongata in three. Lung cancer was the most common primary malignancy, followed by breast cancer, melanoma, and renal cell carcinoma. The mean volume of the metastatic deposits at the time of treatment was 2.8 cm3 (range 0.05-21 cm3). The prescription doses varied from 9 to 25 Gy (mean 17.6 Gy). Imaging follow-up studies were not completed in 16 patients, because of the short-term survival in 11 and patient refusal in five. Of the remaining 37 patients, who underwent an imaging follow-up evaluation at a mean of 9.8 months (range 1-25 months), the tumors disappeared in seven, shrank in 22, remained unchanged in three, and grew in five. All but one of 18 patients with asymptomatic brainstem deposits remained free of symptoms. In 35 patients with symptomatic brainstem deposits, neurological symptoms improved in 21, remained stable in 11, and worsened in three. At the time of this study, 10 patients were alive, and their survival ranged from 3 to 52 months after treatment. Thirty-four patients died of extracranial disease, three of the progressing metastatic brainstem lesion, and six of additional progressing intracranial deposits in other parts of the brain. The overall median survival period was 11 months after GKS. In terms of survival, the absence of active extracranial disease was the only favorable prognostic factor. Neither previous whole-brain radiation therapy nor a single brainstem metastasis was statistically related to the duration of survival.
  
  
  CONCLUSIONS
  Compared with allowing a metastatic brainstem lesion to take its natural course, GKS prolongs survival. The risks associated with such treatment are low. The severity of systemic diseases largely determines the prognosis of metastases to the brainstem.
authors.affiliation: Lars Leksell Center for Gamma Surgery, Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA. ls9e@virginia.edu
authors.forename: Chun Po
authors.initials: CP
authors.lastname: Yen
authors.forename: Jason
authors.initials: J
authors.lastname: Sheehan
authors.forename: Greg
authors.initials: G
authors.lastname: Patterson
authors.forename: Ladislau
authors.initials: L
authors.lastname: Steiner
mesh_terms: D000328:Adult; D000368:Aged; D020295:Brain Stem Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011379:Prognosis; D016634:Radiosurgery; D012878:Skin Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome