| Gamma Knife Radiosurgery for Ten or More Brain Metastases. |
| Chang Hyun Kim, Yong Seok Im, Do Hyun Nam, Kwan Park, Jong Hyun Kim, Jung Il Lee |
| Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jilee@skku.edu |
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| ABSTRACT |
OBJECTIVE
This study was performed to assess the efficacy of GKS in patients with ten or more brain metastases.
METHODS
From Aug 2002 to Dec 2007, twenty-six patients (13 men and 13 women) with ten or more cerebral metastatic lesions underwent GKS. The mean age was 55 years (32-80).
All patients had Karnofsky performance status (KPS) score of 70 or better. According to recursive partitioning analysis (RPA) classification, 3 patients belonged to class I and 23 to class II. The location of primary tumor was lung (21), breast (3) and unknown (2). The mean number of the lesions per patient was 16.6 (10-37). The mean cumulated volume was 10.9 cc (1.0-42.2). The median marginal dose was 15 Gy (9-23). Overall survival and the prognostic factors for the survival were retrospectively analyzed by using Kaplan Meier method and univariate analysis. RESULTS: Overall median survival from GKS was 34 weeks (8-199). Local control was possible for 79.5% of the lesions and control of all the lesions was possible in at least 14 patients (53.8%) until 6 months after GKS. New lesions appeared in 7 (26.9%) patients during the same period. At the last follow-up, 18 patients died; 6 (33.3%) from systemic causes, 10 (55.6%) from neurological causes, and 2 (11.1%) from unknown causes.
Synchronous onset in non-small cell lung cancer (p=0.007), high KPS score (> or =80, p=0.029), and controlled primary disease (p=0.020) were favorable prognostic factors in univariate analysis. CONCLUSION: In carefully selected patients, GKS may be a treatment option for ten or more brain metastases. |
| Key Words:
Multiple; Brain metastases; Gamma knife radiosurgery; Prognostic factor |
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