title: Gamma Knife surgery for brain metastases from gastrointestinal cancer.
abstract: OBJECTIVE
  Brain metastases from gastrointestinal cancers are rare. However, the incidence is increasing because patients with gastrointestinal carcinoma tend to live longer due to earlier diagnosis and more effective treatment of systemic disease. The purpose of this study was to evaluate the efficacy of Gamma Knife surgery (GKS) for the treatment of brain metastases from gastrointestinal cancers.
  
  
  METHODS
  The authors performed a retrospective review of 40 patients (18 women and 22 men) who had undergone GKS to treat a total of 118 metastases from gastrointestinal cancers between January 1996 and December 2006. The mean patient age was 58.7 years, and the mean Karnofsky Performance Scale (KPS) score was 70. There were 7 patients with esophageal cancer, 25 with colon cancer, 5 with rectal cancer, 2 with pancreatic cancer, and 1 with gastric cancer. Nineteen patients were treated with whole-brain radiotherapy and/or local brain radiotherapy before GKS. Twenty-four patients had extracranial metastases, and 3 had an additional primary cancer. The mean metastatic brain tumor volume was 4.3 cm3, and the mean maximum tumor dose varied from 17.1 to 76.7 Gy (mean 41.8 Gy).
  
  
  RESULTS
  Follow-up imaging studies were available in 25 patients with a total of 90 treated metastases. The results demonstrate a tumor control rate of 91%. The median survival time was 6.7 months, and the 6-month and 1-year survival rates were 55 and 25%, respectively. A univariate analysis revealed that the KPS score (<or=70 vs >or=80) was significant (p=0.018) for improved survival.
  
  
  CONCLUSIONS
  Results in this series suggest that GKS can be an effective tool for the treatment of brain metastases from gastrointestinal cancer.
authors.affiliation: The Lars Leksell Gamma Knife Center, Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
authors.forename: Arnaldo Neves
authors.initials: AN
authors.lastname: Da Silva
authors.forename: Kazuki
authors.initials: K
authors.lastname: Nagayama
authors.forename: David J
authors.initials: DJ
authors.lastname: Schlesinger
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sheehan
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D003110:Colonic Neoplasms / Q000473:pathology; D004938:Esophageal Neoplasms / Q000473:pathology; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology; D016634:Radiosurgery; D012004:Rectal Neoplasms / Q000473:pathology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology