Fractionated Stereotactic Gamma Knife Radiosurgery for Large Brain Metastases: A Retrospective, Single Center Study.
OBJECTIVE
Stereotactic radiosurgery (SRS) is widely used for brain metastases but has been relatively contraindicated for large lesions (>3 cm). In the present study, we analyzed the efficacy and toxicity of hypofractionated Gamma Knife radiosurgery to treat metastatic brain tumors for which surgical resection were not considered as the primary treatment option.


METHODS
Thirty-six patients, forty cases were treated with Gamma Knife-based fractionated SRS for three to four consecutive days with the same Leksell frame on their heads. The mean gross tumor volume was 18.3 cm³, and the median dose was 8 Gy at 50% isodose line with 3 fractions for three consecutive days (range, 5 to 11 Gy and 2 to 4 fractions for 2 to 4 consecutive days). Survival rates and prognostic factors were analyzed.


RESULTS
The overall survival rate at one and two years was 66.7 and 33.1%, respectively. The median survival time was 16.2 months, and the local control rate was 90%. RTOG toxicity grade 1 was observed in 3 (8.3%) patients, grade 2 in 1 (2.7%) patient and grade 3 in 1 (2.7%) patient respectively. Radiation necrosis was developed in 1 (2.7%) patient. KPS scores and control of primary disease resulted in significant differences in survival.


CONCLUSIONS
Our findings suggest that consecutive hypofractionated Gamma Knife SRS could be applied to large metastatic brain tumors with effective tumor control and low toxicity rates.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.|Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Joo Whan
http://orcid.org/0000-0003-2286-3301
JW
Kim
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.|Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Hye Ran
HR
Park
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.|Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Jae Meen
JM
Lee
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.|Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Jin Wook
JW
Kim
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.|Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Hyun-Tai
HT
Chung
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.|Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Dong Gyu
DG
Kim
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.|Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Hee-Won
HW
Jung
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.|Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Sun Ha
http://orcid.org/0000-0003-3007-8653
SH
Paek
Neurosurgery. 2003 May;52(5):1066-73; discussion 1073-4
12699548
Int J Radiat Oncol Biol Phys. 2014 Jan 1;88(1):130-6
24331659
BMC Cancer. 2014 Jan 14;14:21
24422871
Int J Radiat Oncol Biol Phys. 2000 Jul 15;47(5):1379-84
10889393
Neurosurgery. 2011 Mar;68(3):682-90; discussion 690
21311296
J Neurosurg. 2014 Dec;121 Suppl:75-83
25434940
Arch Neurol. 1978 Nov;35(11):754-6
718475
Clin Oncol (R Coll Radiol). 2001;13(2):71-81
11373882
Int J Radiat Oncol Biol Phys. 2013 Jul 15;86(4):623-9
23683828
Am J Public Health Nations Health. 1965 Sep;55:1334-5
14334755
Eur J Neurol. 2006 Jul;13(7):674-81
16834697
Int J Radiat Oncol Biol Phys. 1994 Jul 1;29(4):711-7
8040016
Radiother Oncol. 2006 Oct;81(1):18-24
16978720
Radiat Oncol. 2011 May 15;6:48
21575163
Br J Radiol. 1989 Aug;62(740):679-94
2670032
Int J Radiat Oncol Biol Phys. 2000 May 1;47(2):291-8
10802351
Cancer. 1965 Mar;18:298-306
14264031
Strahlenther Onkol. 2007 Nov;183(11):625-30
17960338
Am J Roentgenol Radium Ther Nucl Med. 1971 Feb;111(2):334-6
5541678
Ann Neurol. 1980 Jun;7(6):529-41
7436358
J Neurooncol. 2012 Aug;109(1):159-65
22544651
Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):113-20
22019247
Int J Radiat Oncol Biol Phys. 2011 Oct 1;81(2):483-9
20800386
J Radiat Res. 2014 Mar 1;55(2):334-42
24187332
Int J Radiat Oncol Biol Phys. 2012 Nov 1;84(3):688-93
22445007
Int J Radiat Oncol Biol Phys. 2008 Mar 1;70(3):847-52
18262098
J Neurosurg. 2014 Jan;120(1):52-9
24160478
Radiother Oncol. 2011 Mar;98(3):292-7
21316787
Stereotact Funct Neurosurg. 2007;85(2-3):82-7
17167236
J Neurosurg. 2002 Dec;97(5 Suppl):515-24
12507088
Acta Chir Scand. 1951 Dec 13;102(4):316-9
14914373
Neurologist. 2003 Jul;9(4):180-8
12864928
J Radiat Res. 2012;53(1):1-9
21997195
Neurosurgery. 2005 May;56(5):1021-34; discussion 1021-34
15854250
J Neurosurg. 2002 Dec;97(6):1276-81
12507123
Ann Neurol. 1980 Apr;7(4):385-7
6155101
J Neurosurg. 2010 Dec;113 Suppl:199-206
21222296
J Neurosurg. 2006 Jun;104(6):907-12
16776334
Int J Radiat Oncol Biol Phys. 2009 Aug 1;74(5):1543-8
19135317
Cancer Treat Rev. 2003 Dec;29(6):533-40
14585263
Int J Radiat Oncol Biol Phys. 2006 Mar 1;64(3):898-903
16338097
Radiat Oncol. 2014 Jun 10;9:132
24917309
N Engl J Med. 1990 Feb 22;322(8):494-500
2405271
Int J Radiat Oncol Biol Phys. 1994 Jan 15;28(2):523-6
8276670
Br J Radiol. 1985 Jun;58(690):515-28
4063711