title: Therapeutic effect of gamma knife radiosurgery for multiple brain metastases.
abstract: OBJECTIVE
  The aim of this study is to evaluate the therapeutic effects of gamma knife radiosurgery (GKRS) in patients with multiple brain metastases and to investigate prognostic factors related to treatment outcome.
  
  
  METHODS
  We retrospectively reviewed clinico-radiological and dosimetric data of 36 patients with 4-14 brain metastases who underwent GKRS for 264 lesions between August 2008 and April 2011. The most common primary tumor site was the lung (n=22), followed by breast (n=7). At GKRS, the median Karnofsky performance scale score was 90 and the mean tumor volume was 1.2 cc (0.002-12.6). The mean prescription dose of 17.8 Gy was delivered to the mean 61.1% isodose line. Among 264 metastases, 175 lesions were assessed for treatment response by at least one imaging follow-up.
  
  
  RESULTS
  The overall median survival after GKRS was 9.1±1.7 months. Among various factors, primary tumor control was a significant prognostic factor (11.1±1.3 months vs. 3.3±2.4 months, p=0.031). The calculated local tumor control rate at 6 and 9 months after GKRS were 87.9% and 84.2%, respectively. Paddick's conformity index (>0.75) was significantly related to local tumor control. The actuarial peritumoral edema reduction rate was 22.4% at 6 months.
  
  
  CONCLUSIONS
  According to our results, GKRS can provide beneficial effect for the patients with multiple (4 or more) brain metastases, when systemic cancer is controlled. And, careful dosimetry is essential for local tumor control. Therefore, GKRS can be considered as one of the treatment modalities for multiple brain metastase.
authors: Department of Neurosurgery, Gamma Knife Center, Ajou University School of Medicine, Suwon, Korea.
authors: Chul-Kyu
authors: CK
authors: Lee
authors: Sang Ryul
authors: SR
authors: Lee
authors: Jin Mo
authors: JM
authors: Cho
authors: Kyung Ah
authors: KA
authors: Yang
authors: Se-Hyuk
authors: SH
authors: Kim