Multisession gamma knife surgery for large brain metastases.

Area of Science:

• Neurosurgery
• Radiation Oncology
• Oncology

Background:

• Large brain metastases (≥10 cm³) pose treatment challenges.
• Surgical resection may not be suitable for all patients.
• Multisession Gamma Knife Surgery (GKS) is an emerging therapeutic option.

Purpose of the Study:

• To evaluate the safety and efficacy of multisession GKS for large brain metastases (≥10 cm³).
• To assess survival rates, progression-free survival, and symptomatic improvement.
• To compare multisession GKS with surgical resection as a treatment modality.

Main Methods:

• Retrospective analysis of 56 patients with 65 large brain metastases (≥10 cm³).
• Treatment involved 2- or 3-session GKS with doses of 10-13 Gy per session.
• Tumor volume, survival, progression, and clinical symptoms were monitored.

Main Results:

• Median tumor volume was 21 cm³, reducing to 5 cm³ post-treatment.
• Median survival was 7 months; 6-, 12-, and 18-month survival rates were 62%, 42%, and 31%.
• 74% of patients with pre-existing symptoms experienced improvement within 2 months.

Conclusions:

• Multisession GKS is a safe and effective treatment for large brain metastases (≥10 cm³).
• It offers a viable alternative to surgical resection, improving survival and neurological function.
• Further research is needed to clarify long-term outcomes and its palliative role.