A prospective pilot study of two-session Gamma Knife surgery for large metastatic brain tumors

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• 作者：Shoji Yomo (12) yomoshoji@gmail.com
  Motohiro Hayashi (12)
  Claire Nicholson (3)
• 关键词：Gamma Knife surgery &#8211 ; Stereotactic radiotherapy &#8211 ; Brain metastases
• 刊名：Journal of Neuro-Oncology
• 出版年：2012
• 出版时间：August 2012
• 年：2012
• 卷：109
• 期：1
• 页码：159-165
• 全文大小：283.9 KB
• 参考文献：1. Adler JR, Cox RS, Kaplan I, Martin DP (1992) Stereotactic radiosurgical treatment of brain metastases. J Neurosurg 76:444–449
  2. Alexander E 3rd, Moriarty TM, Davis RB, Wen PY, Fine HA, Black PM, Kooy HM, Loeffler JS (1995) Stereotactic radiosurgery for the definitive, noninvasive treatment of brain metastases. J Natl Cancer Inst 87:34–40
  3. Flickinger JC, Kondziolka D, Lunsford LD, Coffey RJ, Goodman ML, Shaw EG, Hudgins WR, Weiner R, Harsh GRt, Sneed PK et al (1994) A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys 28:797–802
  4. Serizawa T, Saeki N, Higuchi Y, Ono J, Iuchi T, Nagano O, Yamaura A (2005) Gamma knife surgery for brain metastases: indications for and limitations of a local treatment protocol. Acta Neurochir (Wien) 147:721–726 (discussion 726)
  5. Shiau CY, Sneed PK, Shu HK, Lamborn KR, McDermott MW, Chang S, Nowak P, Petti PL, Smith V, Verhey LJ, Ho M, Park E, Wara WM, Gutin PH, Larson DA (1997) Radiosurgery for brain metastases: relationship of dose and pattern of enhancement to local control. Int J Radiat Oncol Biol Phys 37:375–383
  6. Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, Markesbery WR, Foon KA, Young B (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280:1485–1489
  7. Armstrong JG, Wronski M, Galicich J, Arbit E, Leibel SA, Burt M (1994) Postoperative radiation for lung cancer metastatic to the brain. J Clin Oncol 12:2340–2344
  8. Jagannathan J, Yen CP, Ray DK, Schlesinger D, Oskouian RJ, Pouratian N, Shaffrey ME, Larner J, Sheehan JP (2009) Gamma knife radiosurgery to the surgical cavity following resection of brain metastases. J Neurosurg 111:431–438
  9. Ernst-Stecken A, Ganslandt O, Lambrecht U, Sauer R, Grabenbauer G (2006) Phase II trial of hypofractionated stereotactic radiotherapy for brain metastases: results and toxicity. Radiother Oncol 81:18–24
  10. Manning MA, Cardinale RM, Benedict SH, Kavanagh BD, Zwicker RD, Amir C, Broaddus WC (2000) Hypofractionated stereotactic radiotherapy as an alternative to radiosurgery for the treatment of patients with brain metastases. Int J Radiat Oncol Biol Phys 47:603–608
  11. Kwon AK, Dibiase SJ, Wang B, Hughes SL, Milcarek B, Zhu Y (2009) Hypofractionated stereotactic radiotherapy for the treatment of brain metastases. Cancer 115:890–898
  12. Higuchi Y, Serizawa T, Nagano O, Matsuda S, Ono J, Sato M, Iwadate Y, Saeki N (2009) Three-staged stereotactic radiotherapy without whole brain irradiation for large metastatic brain tumors. Int J Radiat Oncol Biol Phys 74:1543–1548
  13. Brenner DJ, Martel MK, Hall EJ (1991) Fractionated regimens for stereotactic radiotherapy of recurrent tumors in the brain. Int J Radiat Oncol Biol Phys 21:819–824
  14. Kano H, Kondziolka D, Lobato-Polo J, Zorro O, Flickinger JC, Lunsford LD (2010) T1/T2 matching to differentiate tumor growth from radiation effects after stereotactic radiosurgery. Neurosurgery 66:486–491 (discussion 491–482)
  15. Barajas RF, Chang JS, Sneed PK, Segal MR, McDermott MW, Cha S (2009) Distinguishing recurrent intra-axial metastatic tumor from radiation necrosis following gamma knife radiosurgery using dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. AJNR Am J Neuroradiol 30:367–372
  16. Ohguri T, Imada H, Kohshi K, Kakeda S, Ohnari N, Morioka T, Nakano K, Konda N, Korogi Y (2007) Effect of prophylactic hyperbaric oxygen treatment for radiation-induced brain injury after stereotactic radiosurgery of brain metastases. Int J Radiat Oncol Biol Phys 67:248–255
  17. Aoyama H, Shirato H, Onimaru R, Kagei K, Ikeda J, Ishii N, Sawamura Y, Miyasaka K (2003) Hypofractionated stereotactic radiotherapy alone without whole-brain irradiation for patients with solitary and oligo brain metastasis using noninvasive fixation of the skull. Int J Radiat Oncol Biol Phys 56:793–800
  18. Hopewell JW, Millar WT, Ang KK (2007) Toward improving the therapeutic ratio in stereotactic radiosurgery: selective modulation of the radiation responses of both normal tissues and tumor. J Neurosurg 107:84–93
  19. Han JH, Kim DG, Chung HT, Paek SH, Park CK, Jung HW (2011) Radiosurgery for large brain metastases. Int J Radiat Oncol Biol Phys
  20. Hasegawa T, Kondziolka D, Flickinger JC, Germanwala A, Lunsford LD (2003) Brain metastases treated with radiosurgery alone: an alternative to whole brain radiotherapy? Neurosurgery 52:1318–1326 (discussion 1326)
  21. Serizawa T, Higuchi Y, Ono J, Matsuda S, Nagano O, Iwadate Y, Saeki N (2006) Gamma knife surgery for metastatic brain tumors without prophylactic whole-brain radiotherapy: results in 1000 consecutive cases. J Neurosurg 105(Suppl):86–90
  22. Varlotto JM, Flickinger JC, Niranjan A, Bhatnagar AK, Kondziolka D, Lunsford LD (2003) Analysis of tumor control and toxicity in patients who have survived at least one year after radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys 57:452–464
  23. Nishizaki T, Saito K, Jimi Y, Harada N, Kajiwara K, Nomura S, Ishihara H, Yoshikawa K, Yoneda H, Suzuki M, Gibbs IC (2006) The role of cyberknife radiosurgery/radiotherapy for brain metastases of multiple or large-size tumors. Minim Invasive Neurosurg 49:203–209
  24. Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751
  25. Sneed PK, Suh JH, Goetsch SJ, Sanghavi SN, Chappell R, Buatti JM, Regine WF, Weltman E, King VJ, Breneman JC, Sperduto PW, Mehta MP (2002) A multi-institutional review of radiosurgery alone vs. radiosurgery with whole brain radiotherapy as the initial management of brain metastases. Int J Radiat Oncol Biol Phys 53:519–526
  26. Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W (2008) A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys 70:510–514
• 作者单位：1. Saitama Gamma Knife Center, San-ai Hospital, 4-35-17 Tajima Sakura-ku, Saitama, 338-0837 Japan2. Department of Neurosurgery, Tokyo Women鈥檚 Medical University, Tokyo, Japan3. Regional Neurosciences Centre, Newcastle upon Tyne, UK
• ISSN：1573-7373

文摘

The purpose of this prospective study is to evaluate the efficacy and limitations of two-session Gamma Knife radiosurgery (GKS) alone for large metastatic brain tumors. Inclusion criteria were as follows: (i) patients with large metastatic brain tumors (volume >15 cm3 in the supratentorial region or >10 cm3 in the infratentorial region), and (ii) tumors not causing clinical signs of impending cerebral herniation. Twenty-eight lesions in 27 consecutive patients (18 men and 9 women, age range 32 to 88 years, median age 65 years) were included in this study. The radiosurgical protocol was as follows: 20&#8211;30 Gy given in two fractions 3&#8211;4 weeks apart. The local tumor control rate and the overall survival rate were calculated by using the Kaplan&#8211;Meier method. Median tumor volumes were 17.8 cm3 at first GKS and 9.7 cm3 at second GKS. Median follow-up time was 8.9 months. The local control rate was 85 % at 6 months and 61 % at 12 months. The overall survival rate after GKS was 63 % at 6 months and 45 % at 12 months. The 1-year rate of prevention of neurological death was maintained at 78 %. Mean Karnofsky performance status (KPS) improved from 61 [95 % confidence interval (CI), 57&#8211;71] at first GKS to 80 (95 % CI, 74&#8211;85) at second GKS; the best follow-up mean KPS was 85 (95 % CI, 78&#8211;91) (p < 0.001). Local tumor recurrence necessitated craniotomy in two patients and repeat GKS in three patients. Seventeen patients died, and the causes of death were as follows: 3 from local progression, 2 from meningeal carcinomatosis, and 12 from progression of the primary tumor. Delayed symptomatic perilesional edema developed in one patient and eventually resolved with conservative treatment. Two-session GKS for large brain metastases appears to be an effective treatment in terms of both local tumor control and neurological palliation with minimal treatment-related morbidity. These data suggest that two-session GKS could be used as an alternative to surgical resection of large tumors in patients with significant comorbidity and/or at an advanced age. The optimum regimen for dose and fraction schedule remains to be established.