Gamma Knife surgery for brain metastases from gastrointestinal cancer

Clinical article

Arnaldo Neves Da Silva M.D., Kazuki Nagayama M.D., Ph.D., David J. Schlesinger Ph.D., and Jason P. Sheehan M.D., Ph.D.
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  • The Lars Leksell Gamma Knife Center, Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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Object

Brain metastases from gastrointestinal cancers are rare. However, the incidence is increasing because patients with gastrointestinal carcinoma tend to live longer due to earlier diagnosis and more effective treatment of systemic disease. The purpose of this study was to evaluate the efficacy of Gamma Knife surgery (GKS) for the treatment of brain metastases from gastrointestinal cancers.

Methods

The authors performed a retrospective review of 40 patients (18 women and 22 men) who had undergone GKS to treat a total of 118 metastases from gastrointestinal cancers between January 1996 and December 2006. The mean patient age was 58.7 years, and the mean Karnofsky Performance Scale (KPS) score was 70. There were 7 patients with esophageal cancer, 25 with colon cancer, 5 with rectal cancer, 2 with pancreatic cancer, and 1 with gastric cancer. Nineteen patients were treated with whole-brain radiotherapy and/or local brain radiotherapy before GKS. Twenty-four patients had extracranial metastases, and 3 had an additional primary cancer. The mean metastatic brain tumor volume was 4.3 cm3, and the mean maximum tumor dose varied from 17.1 to 76.7 Gy (mean 41.8 Gy).

Results

Follow-up imaging studies were available in 25 patients with a total of 90 treated metastases. The results demonstrate a tumor control rate of 91%. The median survival time was 6.7 months, and the 6-month and 1-year survival rates were 55 and 25%, respectively. A univariate analysis revealed that the KPS score (≤ 70 vs ≥ 80) was significant (p = 0.018) for improved survival.

Conclusions

Results in this series suggest that GKS can be an effective tool for the treatment of brain metastases from gastrointestinal cancer.

Abbreviations used in this paper:

GKS = Gamma Knife surgery; IMRT = intensity-modulated radiation therapy; KPS = Karnofsky Performance Scale; RPA = recursive partitioning analysis; SIR = Score Index for Radiosurgery; SRS = stereotactic radiosurgery; WBRT = whole-brain radiotherapy.

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Contributor Notes

Address correspondence to: Jason P. Sheehan, M.D., Ph.D., Box 800-212, Department of Neurological Surgery, Health Sciences Center, Charlottesville, Virginia 22908. email: jps2f@virginia.edu.

Please include this information when citing this paper: published online January 16, 2009; DOI: 10.3171/JNS.2008.9.JNS08281.

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