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. 2014 May 30;15(6):9748-61.
doi: 10.3390/ijms15069748.

Gamma knife treatment of brainstem metastases

Halloran E Peterson  1 , Erik W Larson  2 , Robert K Fairbanks  3 , Alexander R MacKay  4 , Wayne T Lamoreaux  5 , Jason A Call  6 , Jonathan D Carlson  6 , Benjamin C Ling  7 , John J Demakas  8 , Barton S Cooke  9 , Ben Peressini  10 , Christopher M Lee  11
Affiliations

Gamma knife treatment of brainstem metastases

Halloran E Peterson et al. Int J Mol Sci. .

Abstract

The management of brainstem metastases is challenging. Surgical treatment is usually not an option, and chemotherapy is of limited utility. Stereotactic radiosurgery has emerged as a promising palliative treatment modality in these cases. The goal of this study is to assess our single institution experience treating brainstem metastases with Gamma Knife radiosurgery (GKRS). This retrospective chart review studied 41 patients with brainstem metastases treated with GKRS. The most common primary tumors were lung, breast, renal cell carcinoma, and melanoma. Median age at initial treatment was 59 years. Nineteen (46%) of the patients received whole brain radiation therapy (WBRT) prior to or concurrent with GKRS treatment. Thirty (73%) of the patients had a single brainstem metastasis. The average GKRS dose was 17 Gy. Post-GKRS overall survival at six months was 42%, at 12 months was 22%, and at 24 months was 13%. Local tumor control was achieved in 91% of patients, and there was one patient who had a fatal brain hemorrhage after treatment. Karnofsky performance score (KPS) >80 and the absence of prior WBRT were predictors for improved survival on multivariate analysis (HR 0.60 (p = 0.02), and HR 0.28 (p = 0.02), respectively). GKRS was an effective treatment for brainstem metastases, with excellent local tumor control.

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Figures

Figure 1
Figure 1
Overall survival of all patients with brainstem metastasis treated with Gamma Knife radiosurgery (GKRS) (n = 41).
Figure 2
Figure 2
Survival curves subdivided by primary tumor histology. There was no statistical difference among these groups. See Table 1 for sample size.
Figure 3
Figure 3
Survival curves based on age.
Figure 4
Figure 4
Survival curve comparing patients with whole brain radiation therapy (WBRT). There was a statistically significant reduced survival in patients with prior or concurrent WBRT in the multivariate analysis (p = 0.019). This finding was likely due to increased overall brain tumor load.
Figure 5
Figure 5
Survival curve considering the number of metastasis. There was no statistically significant difference between these two groups.
Figure 6
Figure 6
Survival curve considering Karnofsky performance score (KPS). There was a statistically significant difference with better survival in patients with KPS ≥ 80 (p = 0.019) after multivariate analysis.
Figure 7
Figure 7
Survival curve comparing Gamma Knife (GK) radiotherapy dose or brainstem metastasis (<16 Gy vs. ≥16 Gy). There was no statistically significant difference among these groups.
Figure 8
Figure 8
Survival curve comparing tumor volume (<0.5 cc vs. ≥1.0 cc). There was no statistically significant difference among these groups.
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