title: Effectiveness of Postoperative Gamma Knife Radiosurgery to the Tumor Bed After Resection of Brain Metastases.
abstract: OBJECTIVE
  The role of Gamma knife radiosurgery (GKS) after the resection of brain metastases remains undefined. We evaluated the outcomes of postoperative GKS to the tumor bed after the resection of brain metastasis compared with GKS alone without resection in the same patients.
  
  
  METHODS
  We performed a retrospective review of 24 patients who underwent GKS to the tumor bed after the resection of brain metastases. In this cohort, 25 metastatic lesions were treated with postoperative GKS, and 37 brain metastatic lesions were simultaneously managed with GKS alone without resection.
  
  
  RESULTS
  The median target volume and marginal dose of GKS to the surgical bed were 10.5 cm(3) and 15.0 Gy, respectively. The median target volume and marginal dose of GKS alone for the metastatic lesions were 0.5 cm(3) and 21.0 Gy, respectively. The actuarial 1-year and 2-year overall survival of the patients were 43.1% and 28.7%, respectively. The median overall survival of all patients was 11 months. The actuarial 6-month and 12-month local progression-free survival of GKS alone for metastatic lesions without resection were 92.6% and 84.9%; however, the actuarial 6-month and 12-month local progression-free survival of GKS to the surgical bed were 82% and 71%, respectively.
  
  
  CONCLUSIONS
  For patients with brain metastases treated with surgical resection, postoperative GKS to the resection area is an effective and safe treatment option. Particularly, concurrent postoperative GKS to the surgical cavity with GKS alone for multiple small metastatic lesions is a feasible treatment strategy for multiple brain metastases.
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jung Won
authors.initials: JW
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yong-Seok
authors.initials: YS
authors.lastname: Im
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea.
authors.forename: Doo-Sik
authors.initials: DS
authors.lastname: Kong
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea.
authors.forename: Ho Jun
authors.initials: HJ
authors.lastname: Seol
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea.
authors.forename: Do-Hyun
authors.initials: DH
authors.lastname: Nam
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea. Electronic address: jilee@skku.edu.
authors.forename: Jung-Il
authors.initials: JI
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000556:secondary; D003071:Cognition / Q000528:radiation effects; D060825:Cognitive Dysfunction / Q000209:etiology* / Q000517:prevention & control*; D016371:Cranial Irradiation / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Gamma knife surgery; Metastasis; Postoperative; Radiosurgery; Surgical bed; Tumor bed