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The usefulness of stereotactic radiosurgery for radioresistant brain metastases
Hyool Kim1, Tae-Young Jung, In-Young Kim
1Department of Neurosurgery, Chonnam National University Hwasun Hospital & Medical School, Gwangju, Korea.
Objective:
We investigated the effectiveness of stereotactic gamma knife Radiosurgery (GKR) for radioresistant brain metastases with the impact upon histology.
Methods:
Between April 2004 and May 2011, a total of 23 patients underwent GKR for 67 metastatic brain tumors from 12 renal cell cancers, 5 sarcomas and 6 melanomas. The mean age was 56 years (range, 18 to 79 years). Most of the patients were classified as the Radiation Therapy Oncology Group recursive partitioning analysis class II (91.3%). The synchronous metastasis was found in 6 patients (26.1%) and metachronous metastasis in 17 patients (73.9%). We analyzed the local control rate, intracranial progression-free survival (PFS) and overall survival (OS).
Results:
The mean tumor volume for GKR was 2.24 cc and the mean prescription dose was 19.4 Gy (range, 10 to 24) to the tumor margin. Out of metachronous metastases, the median duration to intracranial metastasis was 3.3 years in renal cell cancer (RCC), 2.4 years in melanoma and 1.1 years in sarcoma (p=0.012). The total local control rate was 89.6% during the mean 12.4 months follow-up. The six-month and one-year local control rate was 90.2% and 83% respectively. Depending on the pathology, the control rate of RCC was 95.7%, sarcoma 91.3% and melanoma 80.5% during the follow-up. The common cause of local failure was the tumor bleeding in melanoma. The median PFS and OS were 5.2 and 8.4 months in RCC patients, 6.5 and 9.8 months in sarcoma, and 3.8 and 5.1 months in melanoma.
Conclusion:
The GKR can be one of the effective management options for the intracranial metastatic tumors from the radioresistant tumors. The melanoma showed a poor local control rate compared to other pathologies because of the hemorrhage.
Insights
Stereotactic gamma knife radiosurgery (GKR) effectively treats radioresistant brain metastases. Melanoma showed poorer local control due to bleeding, unlike renal cell cancer and sarcoma.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Oncology
Background:
- Brain metastases from radioresistant tumors pose a significant clinical challenge.
- Stereotactic radiosurgery is a targeted treatment modality for intracranial lesions.
Purpose of the Study:
- To evaluate the efficacy of stereotactic gamma knife radiosurgery (GKR) for radioresistant brain metastases.
- To analyze the impact of histology on treatment outcomes.
Main Methods:
- A retrospective analysis of 23 patients with 67 metastatic brain tumors treated with GKR between 2004 and 2011.
- Tumors originated from renal cell cancer, sarcoma, and melanoma.
- Outcomes assessed included local control rate, intracranial progression-free survival (PFS), and overall survival (OS).
Main Results:
- The overall local control rate was 89.6% at a mean follow-up of 12.4 months.
- Renal cell cancer (95.7%) and sarcoma (91.3%) showed higher local control rates than melanoma (80.5%).
- Hemorrhage was identified as a common cause of local failure in melanoma metastases.
Conclusions:
- Stereotactic gamma knife radiosurgery (GKR) is an effective treatment option for intracranial metastases from radioresistant primary tumors.
- Histological differences, particularly the tendency for hemorrhage in melanoma, influence treatment outcomes.
