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Title: Gamma Knife Radiosurgery for the Treatment of Cystic Cerebral Metastases

Abstract

Purpose: To assess the role of Gamma Knife radiosurgery (GKRS) in the treatment of nonsurgical cystic brain metastasis, and to determine predictors of response to GKRS. Methods: We reviewed a prospectively maintained database of brain metastases patients treated at our institution between 2006 and 2010. All lesions with a cystic component were identified, and volumetric analysis was done to measure percentage of cystic volume on day of treatment and consecutive follow-up MRI scans. Clinical, radiologic, and dosimetry parameters were reviewed to establish the overall response of cystic metastases to GKRS as well as identify potential predictive factors of response. Results: A total of 111 lesions in 73 patients were analyzed; 57% of lesions received prior whole-brain radiation therapy (WBRT). Lung carcinoma was the primary cancer in 51% of patients, 10% breast, 10% colorectal, 4% melanoma, and 26% other. Fifty-seven percent of the patients were recursive partitioning analysis class 1, the remainder class 2. Mean target volume was 3.3 mL (range, 0.1-23 mL). Median prescription dose was 21 Gy (range, 15-24 Gy). Local control rates were 91%, 63%, and 37% at 6, 12, and 18 months, respectively. Local control was improved in lung primary and worse in patients with prior WBRTmore » (univariate). Only lung primary predicted local control in multivariate analysis, whereas age and tumor volume did not. Lesions with a large cystic component did not show a poorer response compared with those with a small cystic component. Conclusions: This study supports the use of GKRS in the management of nonsurgical cystic metastases, despite a traditionally perceived poorer response. Our local control rates are comparable to a matched cohort of noncystic brain metastases, and therefore the presence of a large cystic component should not deter the use of GKRS. Predictors of response included tumor subtype. Prior WBRT decreased effectiveness of SRS for local control rates.« less

Authors:
; ; ;  [1]; ;  [2]; ;  [3];  [1]
  1. Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario (Canada)
  2. Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario (Canada)
  3. Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario (Canada)
Publication Date:
OSTI Identifier:
22224361
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 85; Journal Issue: 3; Other Information: Copyright (c) 2013 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRAIN; DOSIMETRY; LUNGS; MELANOMAS; METASTASES; MULTIVARIATE ANALYSIS; NMR IMAGING; PATIENTS; RADIOTHERAPY; REVIEWS; SURGERY; VOLUMETRIC ANALYSIS

Citation Formats

Ebinu, Julius O., Lwu, Shelly, Monsalves, Eric, Arayee, Mandana, Chung, Caroline, Laperriere, Normand J., Kulkarni, Abhaya V., Goetz, Pablo, and Zadeh, Gelareh, E-mail: gelareh.zadeh@uhn.on.ca. Gamma Knife Radiosurgery for the Treatment of Cystic Cerebral Metastases. United States: N. p., 2013. Web. doi:10.1016/J.IJROBP.2012.06.043.
Ebinu, Julius O., Lwu, Shelly, Monsalves, Eric, Arayee, Mandana, Chung, Caroline, Laperriere, Normand J., Kulkarni, Abhaya V., Goetz, Pablo, & Zadeh, Gelareh, E-mail: gelareh.zadeh@uhn.on.ca. Gamma Knife Radiosurgery for the Treatment of Cystic Cerebral Metastases. United States. doi:10.1016/J.IJROBP.2012.06.043.
Ebinu, Julius O., Lwu, Shelly, Monsalves, Eric, Arayee, Mandana, Chung, Caroline, Laperriere, Normand J., Kulkarni, Abhaya V., Goetz, Pablo, and Zadeh, Gelareh, E-mail: gelareh.zadeh@uhn.on.ca. Fri . "Gamma Knife Radiosurgery for the Treatment of Cystic Cerebral Metastases". United States. doi:10.1016/J.IJROBP.2012.06.043.
@article{osti_22224361,
title = {Gamma Knife Radiosurgery for the Treatment of Cystic Cerebral Metastases},
author = {Ebinu, Julius O. and Lwu, Shelly and Monsalves, Eric and Arayee, Mandana and Chung, Caroline and Laperriere, Normand J. and Kulkarni, Abhaya V. and Goetz, Pablo and Zadeh, Gelareh, E-mail: gelareh.zadeh@uhn.on.ca},
abstractNote = {Purpose: To assess the role of Gamma Knife radiosurgery (GKRS) in the treatment of nonsurgical cystic brain metastasis, and to determine predictors of response to GKRS. Methods: We reviewed a prospectively maintained database of brain metastases patients treated at our institution between 2006 and 2010. All lesions with a cystic component were identified, and volumetric analysis was done to measure percentage of cystic volume on day of treatment and consecutive follow-up MRI scans. Clinical, radiologic, and dosimetry parameters were reviewed to establish the overall response of cystic metastases to GKRS as well as identify potential predictive factors of response. Results: A total of 111 lesions in 73 patients were analyzed; 57% of lesions received prior whole-brain radiation therapy (WBRT). Lung carcinoma was the primary cancer in 51% of patients, 10% breast, 10% colorectal, 4% melanoma, and 26% other. Fifty-seven percent of the patients were recursive partitioning analysis class 1, the remainder class 2. Mean target volume was 3.3 mL (range, 0.1-23 mL). Median prescription dose was 21 Gy (range, 15-24 Gy). Local control rates were 91%, 63%, and 37% at 6, 12, and 18 months, respectively. Local control was improved in lung primary and worse in patients with prior WBRT (univariate). Only lung primary predicted local control in multivariate analysis, whereas age and tumor volume did not. Lesions with a large cystic component did not show a poorer response compared with those with a small cystic component. Conclusions: This study supports the use of GKRS in the management of nonsurgical cystic metastases, despite a traditionally perceived poorer response. Our local control rates are comparable to a matched cohort of noncystic brain metastases, and therefore the presence of a large cystic component should not deter the use of GKRS. Predictors of response included tumor subtype. Prior WBRT decreased effectiveness of SRS for local control rates.},
doi = {10.1016/J.IJROBP.2012.06.043},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 85,
place = {United States},
year = {2013},
month = {3}
}