Gamma Knife radiosurgery in the management of brainstem metastases

被引:22
作者
Jung, Edward W. [1 ]
Rakowski, Joseph T. [1 ]
Delly, Fadi [2 ]
Jagannathan, Jayant [3 ]
Konski, Andre A. [1 ]
Guthikonda, Murali [3 ]
Kim, Harold [1 ]
Mittal, Sandeep [3 ]
机构
[1] Wayne State Univ, Dept Radiat Oncol, Karmanos Canc Inst, Sch Med, Detroit, MI 48201 USA
[2] Wayne State Univ, Karmanos Canc Inst, Dept Neurol, Sch Med, Detroit, MI 48201 USA
[3] Wayne State Univ, Karmanos Canc Inst, Dept Neurosurg, Sch Med, Detroit, MI 48201 USA
关键词
Brain; Brainstem; Gamma Knife; Metastases; Stereotactic radiosurgery; STEREOTACTIC RADIOSURGERY; PROGNOSTIC-FACTORS; TRIGEMINAL NEURALGIA; SURGERY; EXPERIENCE; TOLERANCE; SURVIVAL; OUTCOMES; THERAPY; SYSTEM;
D O I
10.1016/j.clineuro.2013.06.012
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Metastases to the brainstem portend a poor prognosis and present a challenge in clinical management. Surgical resection is rarely a viable option. Methods: Post-treatment MRI scans of patients with brainstem metastases treated with radiosurgery were used to determine local control and disease progression. Median survival was calculated using Kaplan-Meier analysis. Univariate and multivariate analyses were performed using log-rank test and Cox proportional hazards model, respectively. Results: Thirty-two consecutive patients with brainstem metastasis underwent Gamma Knife radiosurgery. Median age was 50 years. Median tumor volume was 0.71 cm(3) and median tumor margin dose was 13 Gy. Seventeen of 32 patients received WBRT prior to stereotactic radiosurgery. Median survival was 5.2 months. There was a statistically significant difference in survival based on RTOG recursive partition analysis (RPA) class. Median survival of patients categorized as RPA class I was 19.2 months, RPA class II was 8.4 months, and RPA class III was 1.9 months. The overall local tumor control rate was 87.5%. There were no acute complications following stereotactic radiosurgery and no evidence of radiation necrosis noted on post-treatment MRI scans. Conclusion: Stereotactic radiosurgery is an effective treatment for brainstem metastases and should be considered especially for patients with good performance status. (C) 2013 Elsevier B.V. All rights reserved.
引用
收藏
页码:2023 / 2028
页数:6
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