PURPOSE: To evaluate the outcomes after a single stereotactic radiosurgery procedure for the care of patients with 4 or more intracranial metastases. METHODS AND MATERIALS: Two hundred five patients with primary malignancies, including non-small-cell lung carcinoma (42%), breast carcinoma (23%), melanoma (17%), renal cell carcinoma (6%), colon cancer (3%), and others (10%) underwent gamma knife radiosurgery for 4 or more intracranial metastases at one time. The median number of brain metastases was 5 (range, 4-18) with a median total treatment volume of 6.8 cc (range, 0.6-51.0 cc). Radiosurgery was used as sole management (17% of patients), or in combination with whole brain radiotherapy (46%) or after failure of whole brain radiotherapy (38%). The median marginal radiosurgery dose was 16 Gy (range, 12-20 Gy). The mean follow-up was 8 months. RESULTS: The median overall survival after radiosurgery for all patients was 8 months. The 1-year local control rate was 71%, and the median time to progressive/new brain metastases was 9 months. Using the Radiation Therapy Oncology Group recursive partitioning analysis (RPA) classification system, the median overall survivals for RPA classes I, II, and III were 18, 9, and 3 months, respectively (p < 0.00001). Multivariate analysis revealed total treatment volume, age, RPA classification, and marginal dose as significant prognostic factors. The number of metastases was not statistically significant (p = 0.333). CONCLUSION: Radiosurgery seems to provide survival benefit for patients with 4 or more intracranial metastases. Because total treatment volume was the most significant predictor of survival, the total volume of brain metastases, rather than the number of metastases, should be considered in identifying appropriate radiosurgery candidates.
PURPOSE: To evaluate the outcomes after a single stereotactic radiosurgery procedure for the care of patients with 4 or more intracranial metastases. METHODS AND MATERIALS: Two hundred five patients with primary malignancies, including non-small-cell lung carcinoma (42%), breast carcinoma (23%), melanoma (17%), renal cell carcinoma (6%), colon cancer (3%), and others (10%) underwent gamma knife radiosurgery for 4 or more intracranial metastases at one time. The median number of brain metastases was 5 (range, 4-18) with a median total treatment volume of 6.8 cc (range, 0.6-51.0 cc). Radiosurgery was used as sole management (17% of patients), or in combination with whole brain radiotherapy (46%) or after failure of whole brain radiotherapy (38%). The median marginal radiosurgery dose was 16 Gy (range, 12-20 Gy). The mean follow-up was 8 months. RESULTS: The median overall survival after radiosurgery for all patients was 8 months. The 1-year local control rate was 71%, and the median time to progressive/new brain metastases was 9 months. Using the Radiation Therapy Oncology Group recursive partitioning analysis (RPA) classification system, the median overall survivals for RPA classes I, II, and III were 18, 9, and 3 months, respectively (p < 0.00001). Multivariate analysis revealed total treatment volume, age, RPA classification, and marginal dose as significant prognostic factors. The number of metastases was not statistically significant (p = 0.333). CONCLUSION: Radiosurgery seems to provide survival benefit for patients with 4 or more intracranial metastases. Because total treatment volume was the most significant predictor of survival, the total volume of brain metastases, rather than the number of metastases, should be considered in identifying appropriate radiosurgery candidates.
Authors: Louis Burt Nabors; Jana Portnow; Mario Ammirati; Henry Brem; Paul Brown; Nicholas Butowski; Marc C Chamberlain; Lisa M DeAngelis; Robert A Fenstermaker; Allan Friedman; Mark R Gilbert; Jona Hattangadi-Gluth; Deneen Hesser; Matthias Holdhoff; Larry Junck; Ronald Lawson; Jay S Loeffler; Paul L Moots; Maciej M Mrugala; Herbert B Newton; Jeffrey J Raizer; Lawrence Recht; Nicole Shonka; Dennis C Shrieve; Allen K Sills; Lode J Swinnen; David Tran; Nam Tran; Frank D Vrionis; Patrick Yung Wen; Nicole R McMillian; Maria Ho Journal: J Natl Compr Canc Netw Date: 2014-11 Impact factor: 11.908
Authors: Louis Burt Nabors; Mario Ammirati; Philip J Bierman; Henry Brem; Nicholas Butowski; Marc C Chamberlain; Lisa M DeAngelis; Robert A Fenstermaker; Allan Friedman; Mark R Gilbert; Deneen Hesser; Matthias Holdhoff; Larry Junck; Ronald Lawson; Jay S Loeffler; Moshe H Maor; Paul L Moots; Tara Morrison; Maciej M Mrugala; Herbert B Newton; Jana Portnow; Jeffrey J Raizer; Lawrence Recht; Dennis C Shrieve; Allen K Sills; David Tran; Nam Tran; Frank D Vrionis; Patrick Y Wen; Nicole McMillian; Maria Ho Journal: J Natl Compr Canc Netw Date: 2013-09-01 Impact factor: 11.908
Authors: Anthony L Asher; Mohammed Ali Alvi; Mohamad Bydon; Nader Pouratian; Ronald E Warnick; James McInerney; Inga S Grills; Jason Sheehan Journal: J Neurooncol Date: 2021-01-22 Impact factor: 4.130
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Authors: Douglas Kondziolka; Samuel M Shin; Andrew Brunswick; Irene Kim; Joshua S Silverman Journal: Neuro Oncol Date: 2014-09-28 Impact factor: 12.300
Authors: Sameer K Nath; Joshua D Lawson; Jia-Zhu Wang; Daniel R Simpson; C Benjamin Newman; John F Alksne; Arno J Mundt; Kevin T Murphy Journal: J Neurooncol Date: 2009-08-23 Impact factor: 4.130