Stereotactic drainage and Gamma Knife radiosurgery of cystic brain metastasis.
OBJECTIVE
Treatment options for patients with brain metastasis include tumor resection, whole-brain radiation therapy, and radiosurgery. A single treatment is not useful in cases of multiple tumors, of which at least 1 is a cystic tumor. The purpose of this study was to assess the role of stereotactic drainage and Gamma Knife surgery (GKS) in the treatment of cystic brain metastasis.


METHODS
Between January 2001 and November 2005, 680 consecutive patients with brain metastases underwent GKS at our hospital, 30 of whom were included in this study (18 males and 12 females, mean age 60.6 +/- 11 years, range 38-75 years). Inclusion criteria were: 1) no prior whole-brain radiation therapy or resection procedure; 2) a maximum of 4 lesions on preoperative MR imaging; 3) at least 1 cystic lesion; 4) a Karnofsky Performance Scale score >or= 70; and 5) histological diagnosis of a malignant tumor.


RESULTS
Non-small cell lung carcinoma was the primary cancer in most patients (19 patients [63.3%]). A single metastasis was present in 13 patients (43.3%). There was a total of 81 tumors, 33 of which were cystic. Ten patients (33.3%) were in recursive partitioning analysis Class I, and 20 (66.6%) were in Class II. Before drainage the mean tumor volume was 21.8 ml (range 3.8-68 ml); before GKS the mean tumor volume was 10.1 ml (range 1.2-32 ml). The mean prescription dose to the tumor margin was 19.5 Gy (range 12-25 Gy). Overall median patient survival was 15 months. The 1- and 2-year survival rates were 54.7% (95% confidence interval 45.3-64.1%) and 34.2% (95% confidence interval 23.1-45.3%). Local tumor control was achieved in 91.3% of the patients.


CONCLUSIONS
The results of this study support the use of a multiple stereotactic approach in cases of multiple and cystic brain metastasis.
Franzin
Alberto
A
Gamma Knife Unit, Department of Neurosurgery, IRCCS San Raffaele, University Vita-Salute, Milan, Italy. franzin.alberto@hsr.it
Vimercati
Alberto
A
Picozzi
Piero
P
Serra
Carlo
C
Snider
Silvia
S
Gioia
Lorenzo
L
Ferrari da Passano
Camillo
C
Bolognesi
Angelo
A
Giovanelli
Massimo
M
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D003131:Combined Modality Therapy; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D016634:Radiosurgery; D016879:Salvage Therapy; D013238:Stereotaxic Techniques; D016019:Survival Analysis