Gamma Knife surgery for brain metastases from colorectal cancer

Clinical article

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Object

The outcomes after Gamma Knife surgery (GKS) were retrospectively analyzed in patients with brain metastases from radioresistant primary colorectal cancer to evaluate the efficacy of GKS and the prognostic factors for local tumor control and overall survival.

Methods

The authors reviewed the medical records of 152 patients with 616 tumors. The group included 102 men and 50 women aged 35–85 years (mean age 64.4 years), who underwent GKS for metastatic brain tumors from colorectal cancer between April 1992 and September 2008 at Yokohama Rosai Hospital.

Results

The mean prescription dose to the tumor margin was 18.5 Gy (range 8–30 Gy). The mean tumor volume at GKS was 2.0 cm3 (range 0.004–10.0 cm3). The primary tumors were located in the colon in 88 patients and the rectum in 64. The median interval between the diagnosis of primary lesions and the diagnosis of brain metastases was 27 months (range 0–180 months). The median neuroradiological follow-up period after GKS was 3 months (mean 6.4 months, range 1–93 months). The local tumor growth control rate, based on MR imaging, was 91.2%. The significant factors for unfavorable local tumor growth control, based on multivariate analysis, were larger tumor volume (p = 0.001) and lower margin dose (p = 0.016). The median overall survival time was 6 months. Lower Karnofsky Performance Scale (KPS) score (p = 0.026) and the presence of extracranial metastases (p = 0.004) at first GKS were significantly correlated with poor overall survival period in multivariate analysis. The cause of death was systemic disease in 112 patients and neurological disease in 13 patients. Leptomeningeal carcinomatosis was significantly correlated with a shorter duration of neurological survival in multivariate analysis (p < 0.0001).

Conclusions

Gamma Knife surgery is effective for suppression of local tumor growth in patients with brain metastases from radioresistant colorectal primary cancer. Therefore, clinical and radiological screening of intracranial metastases for patients with lower KPS scores and/or the presence of extracranial metastases as well as follow-up examinations after GKS for brain metastases should be performed periodically in patients with colorectal cancer, because the neurological prognosis is improved by initial and repeat GKS for newly diagnosed or recurrent tumors leading to a prolonged high-quality survival period.

Abbreviations used in this paper: GKS = Gamma Knife surgery; KPS = Karnofsky Performance Scale; SRS = stereotactic radiosurgery; WBRT = whole-brain radiotherapy.

Article Information

Address correspondence to: Shigeo Matsunaga, M.D., Department of Neurosurgery, Yokohama Rosai Hospital, 3211 Kozukuecho, Kohoku-ku, Yokohama, Kanagawa, 222-0036, Japan. email: shigeo-m@mui.biglobe.ne.jp.

Please include this information when citing this paper: published online October 15, 2010; DOI: 10.3171/2010.9.JNS354.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Kaplan-Meier survival curve for the tumor progression–free period in 616 tumors after GKS treatment. The 6-month local tumor control rate was 95.0%.

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    Kaplan-Meier survival curve for 152 patients who underwent GKS treatment for brain metastases from colorectal cancer. The median survival time was 6.0 months.

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    Kaplan-Meier survival curves for 152 patients stratified by the adverse prognostic factors of KPS score < 70 and/or presence of extracranial metastases. There was a significant correlation between absence of these factors and favorable outcome (p = 0.0003, log-rank test).

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    Kaplan-Meier survival curves for 152 patients stratified by the adverse prognostic factors of multiple lesions of brain metastases and/or leptomeningeal carcinomatosis for overall survival. There was a significant correlation between absence of these factors and favorable outcome (p = 0.042, log-rank test).

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    Kaplan-Meier survival curves for the brain metastasis–free period after the diagnosis of primary lung, breast, and colorectal cancers. The intervals between the diagnosis of primary cancer and the diagnosis of brain metastases were significantly different in the 3 types of cancer (p < 0.0001, log-rank test).

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