Thirty years' experience with Gamma Knife surgery for metastases to the brain

Clinical article

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Object

The aim of this study was to analyze factors influencing survival time and patterns of distant recurrences after Gamma Knife surgery (GKS) for metastases to the brain.

Methods

Information was available for 1855 of 1921 patients who underwent GKS for single or multiple cerebral metastases at 4 different institutions during different time periods between 1975 and 2007. The total number of Gamma Knife treatments administered was 2448, an average of 1.32 treatments per patient. The median survival time was analyzed, related to patient and treatment parameters, and compared with published data following conventional fractionated whole-brain irradiation.

Results

Twenty-five patients survived for longer than 10 years after GKS, and 23 are still alive. Age and primary tumor control were strongly related to survival time. Patients with single metastases had a longer survival than those with multiple metastases, but there was no difference in survival between patients with single and multiple metastases who had controlled primary disease. There were no significant differences in median survival time between patients with 2, 3–4, 5–8, or > 8 metastases. The 5-year survival rate was 6% for the whole patient population, and 9% for patients with controlled primary disease. New hematogenous spread was a more significant problem than micrometastases in patients with longer survival.

Conclusions

Patient age and primary tumor control are more important factors in predicting median survival time than number of metastases to the brain. Long-term survivors are more common than previously assumed.

Abbreviations used in this paper: GKS = Gamma Knife surgery; WBRT = whole-brain radiation therapy.

Article Information

Address correspondence to: Bengt Karlsson, M.D., Ph.D., Department of Neurosurgery, West Virginia University, Morgantown, West Virginia 26506. email: nykuttram@yahoo.se.

Please include this information when citing this paper: published online February 6, 2009; DOI: 10.3171/2008.10.JNS08214.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Graph of the relationship between number (nr) of brain metastases at first GKS and median survival time. The entire patient population is shown as is the subgroups with controlled and uncontrolled primary (P) tumors.

  • View in gallery

    Graphs of the relationship between number of brain metastases at first GKS and survival time. The survival time is significantly longer for single lesions, but there are no significant differences in survival between patients with 2, 3–4, 5–8, or > 8 metastases. Number of months is shown on the x axis.

  • View in gallery

    Two graphs compressed to 1. Patient ages are on the x axis. For the upper curve, the y axis is median months of survival, and for the lower curve, the y axis represents the mean number of brain lesions at the first GKS. The median survival is unrelated to age up to 60 years, after which it decreases.

  • View in gallery

    Magnetic resonance images obtained in a patient who underwent GKS for 9 metastatic lesions. The images in the upper row are from the first GKS treatment in 1994 (T1-weighted with contrast enhancement), and those in the lower row are FLAIR images from the most recent imaging follow-up in 2005. A high signal is shown in the area of an earlier tumor. No general white matter changes are seen, which would have been the case should significant radiation-induced changes have been present.

  • View in gallery

    Bar graph of the patient population grouped according to observation time in months (x axis). The percentages of patients treated with a second GKS is given for each group. The percentage of retreatments occurring within the first 6 months after GKS is illustrated. For comparison, the percentage of time at risk that the first 6 months constitutes (for example, 50% if time at risk is 1 year and 25% if time at risk is 2 years) is also illustrated. Note that repeated treatments are evenly distributed in time.

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