title: Gamma Knife radiosurgery for cystic brain metastases.
abstract: OBJECTIVE
  The goal of this study was to investigate the treatment results of Gamma Knife radiosurgery (GKRS) for cystic brain metastases and relevant factors associated with local tumor control.
  
  
  METHODS
  We retrospectively reviewed the clinical, radiological, and dosimetry data of 37 cystic brain metastases of 28 patients who were treated with GKRS. Cyst drainage was performed in 8 large lesions before GKRS to decrease the target volume. The mean target volume was 4.8 (range, 0.3-15.8) cc at the time of GKRS, and the mean prescription dose was 16.6 (range, 13-22) Gy.
  
  
  RESULTS
  The actuarial median survival time was 17.7 ± 10.2 months, and the primary tumor status was a significant prognostic factor for survival. The actuarial local tumor control rate at 6 and 12 months was 93.1 and 82.3%, respectively. Among the various factors, only prescription dose (>15 Gy) was a significant factor related to local tumor control after multivariate analysis (p = 0.049). Cyst volume or cyst/total tumor volume ratio did not influence local control after GKRS, when the target volume was reduced to about 15 cc after cyst drainage.
  
  
  CONCLUSIONS
  According to our results, we suggest that stereotactic radiosurgery should be considered as one of the treatment options for cystic brain metastases, when large tumor volume can be reduced by surgical drainage before radiosurgery, especially for patients with a controlled primary tumor.
authors.affiliation: a Gamma Knife Center, Department of Neurosurgery , Ajou University School of Medicine , Suwon , Korea.
authors.forename: Sang Ryul
authors.initials: SR
authors.lastname: Lee
authors.affiliation: a Gamma Knife Center, Department of Neurosurgery , Ajou University School of Medicine , Suwon , Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Oh
authors.affiliation: a Gamma Knife Center, Department of Neurosurgery , Ajou University School of Medicine , Suwon , Korea.
authors.forename: Se-Hyuk
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000556:secondary / Q000601:surgery*; D003560:Cysts / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D016634:Radiosurgery / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden / Q000502:physiology
keywords: Gamma Knife radiosurgery; cyst; drainage; edema; metastases