Multisession gamma knife surgery for large brain metastases.
This study aimed to explore the safety and efficacy of multisession gamma knife surgery (GKS) for large brain metastases with a volume of 10 cm3or larger. Fifty-six patients who had 65 brain metastases with a volume of at least 10 cm3were treated with multisession GKS. Three-session GKS at a prescription dose of 10 Gy to the tumor margin per session with a 2-week interval between doses was performed in 3 patients. Other patients were treated with 2-session GKS at a prescription dose of 10-13 Gy to the tumor margin per session with an interval of 1-4 weeks. The median tumor volume was 21 cm3. The median survival was 7 months. The 6-, 12-, and 18-month survival rates were 62, 42, and 31%, respectively. The progression-free survival rates at 6, 12, and 18 months were 93, 80, and 74%, respectively. At the time of the first and last GKS sessions, the median tumor volumes were 21 and 15 cm3, respectively, which decreased to 5 cm3with a median follow-up period of 6 months. Seventy-four percent of evaluated patients who had pre-GKS clinical symptoms obtained symptomatic improvement in a mean interval of 2 months. Multisession GKS was a safe and effective alternative to surgical resection for patients who had brain metastases with a tumor volume of 10 cm3or larger. Although long-term results remain unclear, multisession GKS may be a suitable palliative treatment to preserve neurological function.
Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi Prefecture, 485-8520, Japan. h-toshi@komakihp.gr.jp.
Toshinori
T
Hasegawa
Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi Prefecture, 485-8520, Japan.
Takenori
T
Kato
Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi Prefecture, 485-8520, Japan.
Takashi
T
Yamamoto
Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi Prefecture, 485-8520, Japan.
Hiroshi
H
Iizuka
Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi Prefecture, 485-8520, Japan.
Tomohide
T
Nishikawa
Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi Prefecture, 485-8520, Japan.
Hiroshi
H
Ito
Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi Prefecture, 485-8520, Japan.
Naoki
N
Kato
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
Functional outcomes; Gamma knife; Large brain metastasis; Multisession; Stereotactic radiosurgery; Tumor control