title: Gamma Knife radiosurgery in the management of brainstem metastases.
abstract: BACKGROUND
  Metastases to the brainstem portend a poor prognosis and present a challenge in clinical management. Surgical resection is rarely a viable option.
  
  
  METHODS
  Post-treatment MRI scans of patients with brainstem metastases treated with radiosurgery were used to determine local control and disease progression. Median survival was calculated using Kaplan-Meier analysis. Univariate and multivariate analyses were performed using log-rank test and Cox proportional hazards model, respectively.
  
  
  RESULTS
  Thirty-two consecutive patients with brainstem metastasis underwent Gamma Knife radiosurgery. Median age was 50 years. Median tumor volume was 0.71 cm3 and median tumor margin dose was 13 Gy. Seventeen of 32 patients received WBRT prior to stereotactic radiosurgery. Median survival was 5.2 months. There was a statistically significant difference in survival based on RTOG recursive partition analysis (RPA) class. Median survival of patients categorized as RPA class I was 19.2 months, RPA class II was 8.4 months, and RPA class III was 1.9 months. The overall local tumor control rate was 87.5%. There were no acute complications following stereotactic radiosurgery and no evidence of radiation necrosis noted on post-treatment MRI scans.
  
  
  CONCLUSIONS
  Stereotactic radiosurgery is an effective treatment for brainstem metastases and should be considered especially for patients with good performance status.
authors.affiliation: Department of Radiation Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, USA.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Jung
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Rakowski
authors.forename: Fadi
authors.initials: F
authors.lastname: Delly
authors.forename: Jayant
authors.initials: J
authors.lastname: Jagannathan
authors.forename: Andre A
authors.initials: AA
authors.lastname: Konski
authors.forename: Murali
authors.initials: M
authors.lastname: Guthikonda
authors.forename: Harold
authors.initials: H
authors.lastname: Kim
authors.forename: Sandeep
authors.initials: S
authors.lastname: Mittal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D020295:Brain Stem Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D014916:Whole-Body Irradiation
keywords: Brain; Brainstem; Gamma Knife; Metastases; Stereotactic radiosurgery