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Title: Gamma Knife Radiosurgery as a Therapeutic Strategy for Intracranial Sarcomatous Metastases

Abstract

Purpose: To determine the indication and outcomes for Gamma Knife stereotactic radiosurgery (GKSRS) in the care of patients with intracranial sarcomatous metastases. Methods and Materials: Data from 21 patients who underwent radiosurgery for 60 sarcomatous intracranial metastases (54 parenchymal and 6 dural-based) were studied. Nine patients had radiosurgery for solitary tumors and 12 for multiple tumors. The primary pathology was metastatic leiomyosarcoma (4 patients), osteosarcoma (3 patients), soft-tissue sarcoma (5 patients), chondrosarcoma (2 patients), alveolar soft part sarcoma (2 patients), and rhabdomyosarcoma, Ewing's sarcoma, liposarcoma, neurofibrosarcoma, and synovial sarcoma (1 patient each). Twenty patients received multimodality management for their primary tumor, and 1 patient had no evidence of systemic disease. The mean tumor volume was 6.2 cm{sup 3} (range, 0.07-40.9 cm{sup 3}), and a median margin dose of 16 Gy was administered. Three patients had progressive intracranial disease despite fractionated whole-brain radiotherapy before SRS. Results: A local tumor control rate of 88% was achieved (including patients receiving boost, up-front, and salvage SRS). New remote brain metastases developed in 7 patients (33%). The median survival after diagnosis of intracranial metastasis was 16 months, and the 1-year survival rate was 61%. Conclusions: Gamma Knife radiosurgery was a well-tolerated and initially effective therapymore » in the management of patients with sarcomatous intracranial metastases. However, many patients, including those who also received fractionated whole-brain radiotherapy, developed progressive new brain disease.« less

Authors:
 [1];  [2];  [3]; ; ; ;  [1];  [2];  [4];  [1];  [2];  [1];  [2]
  1. Department of Neurological Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA (United States)
  2. (United States)
  3. (United Kingdom)
  4. Department of Neuropathology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA (United States)
Publication Date:
OSTI Identifier:
21372068
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 76; Journal Issue: 2; Other Information: DOI: 10.1016/j.ijrobp.2009.02.007; PII: S0360-3016(09)00223-5; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRAIN; METASTASES; NEOPLASMS; RADIOTHERAPY; SURGERY; BODY; CENTRAL NERVOUS SYSTEM; DISEASES; MEDICINE; NERVOUS SYSTEM; NUCLEAR MEDICINE; ORGANS; RADIOLOGY; THERAPY

Citation Formats

Flannery, Thomas, Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA, Department of Neurosurgery, Royal Hospitals Trust, Belfast, Northern Ireland, Kano, Hideyuki, Niranjan, Ajay M.Ch., Monaco, Edward A., Flickinger, John C., Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA, Kofler, Julia, Lunsford, L. Dade, Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA, Kondziolka, Douglas, E-mail: kondziolkads@upmc.ed, and Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA. Gamma Knife Radiosurgery as a Therapeutic Strategy for Intracranial Sarcomatous Metastases. United States: N. p., 2010. Web. doi:10.1016/j.ijrobp.2009.02.007.
Flannery, Thomas, Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA, Department of Neurosurgery, Royal Hospitals Trust, Belfast, Northern Ireland, Kano, Hideyuki, Niranjan, Ajay M.Ch., Monaco, Edward A., Flickinger, John C., Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA, Kofler, Julia, Lunsford, L. Dade, Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA, Kondziolka, Douglas, E-mail: kondziolkads@upmc.ed, & Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA. Gamma Knife Radiosurgery as a Therapeutic Strategy for Intracranial Sarcomatous Metastases. United States. doi:10.1016/j.ijrobp.2009.02.007.
Flannery, Thomas, Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA, Department of Neurosurgery, Royal Hospitals Trust, Belfast, Northern Ireland, Kano, Hideyuki, Niranjan, Ajay M.Ch., Monaco, Edward A., Flickinger, John C., Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA, Kofler, Julia, Lunsford, L. Dade, Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA, Kondziolka, Douglas, E-mail: kondziolkads@upmc.ed, and Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA. Mon . "Gamma Knife Radiosurgery as a Therapeutic Strategy for Intracranial Sarcomatous Metastases". United States. doi:10.1016/j.ijrobp.2009.02.007.
@article{osti_21372068,
title = {Gamma Knife Radiosurgery as a Therapeutic Strategy for Intracranial Sarcomatous Metastases},
author = {Flannery, Thomas and Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA and Department of Neurosurgery, Royal Hospitals Trust, Belfast, Northern Ireland and Kano, Hideyuki and Niranjan, Ajay M.Ch. and Monaco, Edward A. and Flickinger, John C. and Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA and Kofler, Julia and Lunsford, L. Dade and Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA and Kondziolka, Douglas, E-mail: kondziolkads@upmc.ed and Department of Radiation Oncology, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA},
abstractNote = {Purpose: To determine the indication and outcomes for Gamma Knife stereotactic radiosurgery (GKSRS) in the care of patients with intracranial sarcomatous metastases. Methods and Materials: Data from 21 patients who underwent radiosurgery for 60 sarcomatous intracranial metastases (54 parenchymal and 6 dural-based) were studied. Nine patients had radiosurgery for solitary tumors and 12 for multiple tumors. The primary pathology was metastatic leiomyosarcoma (4 patients), osteosarcoma (3 patients), soft-tissue sarcoma (5 patients), chondrosarcoma (2 patients), alveolar soft part sarcoma (2 patients), and rhabdomyosarcoma, Ewing's sarcoma, liposarcoma, neurofibrosarcoma, and synovial sarcoma (1 patient each). Twenty patients received multimodality management for their primary tumor, and 1 patient had no evidence of systemic disease. The mean tumor volume was 6.2 cm{sup 3} (range, 0.07-40.9 cm{sup 3}), and a median margin dose of 16 Gy was administered. Three patients had progressive intracranial disease despite fractionated whole-brain radiotherapy before SRS. Results: A local tumor control rate of 88% was achieved (including patients receiving boost, up-front, and salvage SRS). New remote brain metastases developed in 7 patients (33%). The median survival after diagnosis of intracranial metastasis was 16 months, and the 1-year survival rate was 61%. Conclusions: Gamma Knife radiosurgery was a well-tolerated and initially effective therapy in the management of patients with sarcomatous intracranial metastases. However, many patients, including those who also received fractionated whole-brain radiotherapy, developed progressive new brain disease.},
doi = {10.1016/j.ijrobp.2009.02.007},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 76,
place = {United States},
year = {2010},
month = {2}
}