Timing and risk factors for new brain metastasis formation in patients initially treated only with Gamma Knife surgery

Clinical article

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Object

Stereotactic radiosurgery has been shown to afford a reasonable chance of local tumor control. However, new brain metastasis can arise following successful local tumor control from radiosurgery. This study evaluates the timing, number, and risk factors for development of subsequent new brain metastasis in a group of patients treated with stereotactic radiosurgery alone.

Methods

One hundred seventeen patients with histologically confirmed metastatic cancer underwent Gamma Knife surgery (GKS) to treat all brain metastases demonstrable on MR imaging. Patients were followed clinically and radiologically at approximately 3-month intervals for a median of 14.4 months (range 0.37–51.8 months). Follow-up MR images were evaluated for evidence of new brain metastasis formation. Statistical analyses were performed to determine the timing, number, and risk factors for development of new brain metastases.

Results

The median time to development of a new brain metastasis was 8.8 months. Patients with 3 or more metastases at the time of initial radiosurgery or those with cancer histologies other than non–small cell lung carcinoma were found to be at increased risk for early formation of new brain metastasis (p < 0.05). The mean number of new metastases per patient was 1.6 (range 0–11). Those with a higher Karnofsky Performance Scale score at the time of initial GKS were significantly more likely to develop a greater number of brain metastases by the last follow-up evaluation.

Conclusions

The timing and number of new brain metastases developing in patients treated with GKS alone is not inconsequential. Those with 3 or more metastases at the time of radiosurgery and those with cancer histology other than non–small cell lung carcinoma were at greater risk of early formation of new brain metastasis. Frequent follow-up evaluations, such as at 3-month intervals, appears appropriate in this patient population, particularly in high-risk patients. When detected early, salvage treatments including repeat radiosurgery can be used to treat new brain metastasis.

Abbreviations used in this paper: GKS = Gamma Knife surgery; KPS = Karnofsky Performance Scale; NSCLC = non–small cell lung carcinoma; WBRT = whole-brain radiation therapy.

Article Information

Address correspondence to: Jason P. Sheehan, M.D., Ph.D., Department of Neurological Surgery, University of Virginia Health System, Box 800212, Charlottesville, Virginia 22908. email: jps2f@virginia.edu.

Please include this information when citing this paper: published online March 12, 2010; DOI: 10.3171/2010.2.JNS091539.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Kaplan-Meier plot of the time until development of a new brain metastasis after radiosurgery. Patients are stratified into groups of 2 or fewer brain metastases (≤ 2) or 3 or more (3+) brain metastases at the time of radiosurgery. Those with 3 or more brain metastases at the time of radiosurgery were significantly more likely (p < 0.05) to develop new brain metastasis earlier than those with 2 or fewer metastases at the time of radiosurgery.

  • View in gallery

    Kaplan-Meier plot of time to development of a new brain metastasis after radiosurgery. Patients are stratified into those with NSCLC (Lung CA) or those with other cancer histologies (Other). Patients with NSCLC developed new brain metastasis significantly later (p < 0.05) than those with other cancer histologies.

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