title: Stereotactic radiosurgical treatment of brain metastases to the choroid plexus.
abstract: OBJECTIVE
  Choroid plexus metastases (CPM) are uncommon lesions. Consequently, optimal management of CPM is uncertain. We summarize our experience with stereotactic radiosurgery (SRS) of CPM.
  
  
  METHODS
  Sixteen consecutive patients with presumed CPM treated with SRS between 1997 and 2007 were examined. Twelve were men with a median age at diagnosis of CPM of 61.9 ± 9.9 years; 14 had metastases from renal cell carcinoma (RCC). All patients had controlled primary disease at the time of treatment for CPM. Four patients with RCC and 1 with non-small-cell lung cancer had undergone whole-brain radiotherapy (WBRT) previously and 2 had received SRS to other brain metastases. The disease-free interval from the primary diagnosis to CPM diagnosis averaged 39.3 ± 46.2 months (range, 1.0-156.3). Five patients were asymptomatic; of the remaining 11, none had symptoms related to CPM. All presented with a single CPM.
  
  
  RESULTS
  Average maximum diameter of the CPMs was 2.0 ± 1.0 cm (range, 0.9-4.1 cm); mean volume was 2.4 ± 2.6 cm(3) (range, 0.2-9.3). Median SRS dose was 24 Gy to the 53% isodose line (range, 14-24 Gy). Survival after SRS to the CPM was 25.3 ± 23.4 months (range, 3.2-101.6). Patients in Recursive Partitioning Analysis (RPA) class I (n = 10) had improved survival compared to those in class II (n = 6), as did those with better GPA scores. There were no local failures. After SRS, 1 patient underwent WBRT, 3 patients had one, and another had two subsequent SRS treatments to other brain lesions. Of the 14 patients who have died, 11 succumbed to systemic disease progression, 2 to progressive, multifocal central nervous system disease, and 1 to systemic disease with concurrent, stable central nervous system disease. There were no complications related to SRS.
  
  
  CONCLUSIONS
  Most CPMs are associated with RCC. SRS represents a safe and viable treatment option as primary modality for these metastases, with excellent outcomes.
authors.affiliation: Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Siomin
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Lin
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: Marko
authors.forename: Gene H
authors.initials: GH
authors.lastname: Barnett
authors.forename: Steven A
authors.initials: SA
authors.lastname: Toms
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Chao
authors.forename: Lilyana
authors.initials: L
authors.lastname: Angelov
authors.forename: Michael A
authors.initials: MA
authors.lastname: Vogelbaum
authors.forename: Kapila
authors.initials: K
authors.lastname: Navaratne
authors.forename: John H
authors.initials: JH
authors.lastname: Suh
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weil
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000556:secondary / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D016545:Choroid Plexus Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D004938:Esophageal Neoplasms; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms; D008175:Lung Neoplasms; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D047368:Tumor Burden