title: Relevance of gamma knife radiosurgery alone for the treatment of non-small cell lung cancer brain metastases.
abstract: OBJECTIVE
  Stereotactic radiosurgery (SRS) followed by close follow-up is becoming a popular strategy for the management of brain metastases as cancer patients live longer and late adverse effects of whole brain radiotherapy (WBRT) are increasingly reported. The authors report their experience in consecutively treated patients with limited brain metastases from non-small cell lung cancer (NSCLC), who underwent SRS alone followed by a close follow-up.
  
  
  METHODS
  This study is the retrospective analysis of prospectively collected data. We included of 89 consecutive patients (80 men; mean age 59.7 years) with a KPS score of 60 or greater, who underwent Gamma Knife SRS for 1-4 metastases, at Lille University Hospital between January 2004 and December 2010. The mean radiation dose was 23.41Gy (range 18-26Gy) and the mean tumour volume was 2.47cm(3) (range 0.3-6.7cm(3)). After treatment, clinical and radiological (MRI) monitoring was scheduled at 2, 4, 8 and 12 months in the first year and at 4-month intervals thereafter.
  
  
  RESULTS
  Overall survival was 70.8% at 1 year and 50% at 2 years. The actuarial local control rate was 91.5% at 1 year and 85.5% at 2 years. Ten of 89 patients experienced a local failure, which required a salvage treatment. The distant brain control rate was 79.2% at 1 year, and 67.1% at 2 years. A total of 25 patients developed new metastases, 10 patients were treated with a new radiosurgical procedure, 12 patients underwent a WBRT while 3 patients developed a leptomeningeal disease. We reported an overall complication rate of 10.1% per patient and 7.8% per treated tumour; all complications were classified grade 1 or 2.
  
  
  CONCLUSIONS
  In patients with limited brain metastases from NSCLC, SRS is an effective treatment associated with high local control rate with low morbidity. When performed in isolation, close follow-up is mandatory and radiosurgery can be renewed as salvage treatment for distant brain progression, limiting the use of WBRT.
authors.affiliation: Department of Neurosurgery, Lille University Hospital, Lille, France. Electronic address: fahed.zairi@gmail.com.
authors.forename: Fahed
authors.initials: F
authors.lastname: Zairi
authors.affiliation: Department of Neurosurgery, Lille University Hospital, Lille, France.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Ouammou
authors.affiliation: Department of Neurosurgery, Lille University Hospital, Lille, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Le Rhun
authors.affiliation: Department of Neurosurgery, Lille University Hospital, Lille, France.
authors.forename: Rabih
authors.initials: R
authors.lastname: Aboukais
authors.affiliation: Department of Neurosurgery, Lille University Hospital, Lille, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Blond
authors.affiliation: Department of Physics, Lille University Hospital, Lille, France.
authors.forename: Maximillien
authors.initials: M
authors.lastname: Vermandel
authors.affiliation: Department of Biostatistics, Lille University Hospital, Lille, France.
authors.forename: Valerie
authors.initials: V
authors.lastname: Deken
authors.affiliation: Department of Biostatistics, Lille University Hospital, Lille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Devos
authors.affiliation: Department of Neurosurgery, Lille University Hospital, Lille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Reyns
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000556:secondary / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000556:secondary / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; D016371:Cranial Irradiation / Q000379:methods; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Brain metastases; Lung cancer; Neurocognitive function; Radiosurgery; WBRT