Toru Serizawa1, Yoshinori Higuchi2, Masaaki Yamamoto3, Shigeo Matsunaga4, Osamu Nagano5, Yasunori Sato6, Kyoko Aoyagi5, Shoji Yomo7, Takao Koiso3, Toshinori Hasegawa8, Kiyoshi Nakazaki9, Akihito Moriki10, Takeshi Kondoh11, Yasushi Nagatomo12, Hisayo Okamoto13, Yukihiko Kohda14, Hideya Kawai15, Satoka Shidoh16, Toru Shibazaki17, Shinji Onoue18, Hiroyuki Kenai19, Akira Inoue20, Hisae Mori21. 1. 1Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo. 2. Departments of2Neurological Surgery and. 3. 3Katsuta Hospital Mito GammaHouse, Hitachi-naka. 4. 4Stereotactic Radiotherapy Center, Yokohama Rosai Hospital, Yokohama. 5. 5Gamma Knife House, Chiba Cerebral and Cardiovascular Center, Ichihara. 6. 6Global Clinical Research, Chiba University Graduate School of Medicine, Chiba. 7. 7Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto. 8. 8Department of Neurosurgery, Komaki City Hospital, Komaki. 9. 9Department of Neurosurgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama. 10. 10Kochi Gamma Knife Center, Mominoki Hospital, Kochi. 11. 11Department of Neurosurgery, Shinsuma General Hospital, Kobe. 12. 12Department of Neurosurgery, Kouseikai Takai Hospital, Tokyo. 13. 13Department of Neurosurgery, Takashima Hospital, Yonago. 14. 14Department of Neurosurgery, Asanogawa General Hospital, Kanazawa. 15. 15Department of Surgical Neurology, Research Institute for Brain and Blood Vessels, Akita. 16. 16Department of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki. 17. 17Department of Neurosurgery, Hidaka Hospital, Takasaki. 18. 18Department of Neurosurgery, Ehime Prefectural Central Hospital, Matsuyama. 19. 19Department of Neurosurgery, Nagatomi Neurosurgical Hospital, Oita. 20. 20Department of Neurosurgery, Yamagata Prefectural Central Hospital, Yamagata; and. 21. 21Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
Abstract
OBJECTIVE: In order to obtain better local tumor control for large (i.e., > 3 cm in diameter or > 10 cm3 in volume) brain metastases (BMs), 3-stage and 2-stage Gamma Knife surgery (GKS) procedures, rather than a palliative dose of stereotactic radiosurgery, have been proposed. Here, authors conducted a retrospective multi-institutional study to compare treatment results between 3-stage and 2-stage GKS for large BMs. METHODS: This retrospective multi-institutional study involved 335 patients from 19 Gamma Knife facilities in Japan. Major inclusion criteria were 1) newly diagnosed BMs, 2) largest tumor volume of 10.0-33.5 cm3, 3) cumulative intracranial tumor volume ≤ 50 cm3, 4) no leptomeningeal dissemination, 5) no more than 10 tumors, and 6) Karnofsky Performance Status 70% or better. Prescription doses were restricted to between 9.0 and 11.0 Gy in 3-stage GKS and between 11.8 and 14.2 Gy in 2-stage GKS. The total treatment interval had to be within 6 weeks, with at least 12 days between procedures. There were 114 cases in the 3-stage group and 221 in the 2-stage group. Because of the disproportion in patient numbers and the pre-GKS clinical factors between these two GKS groups, a case-matched study was performed using the propensity score matching method. Ultimately, 212 patients (106 from each group) were selected for the case-matched study. Overall survival, tumor progression, neurological death, and radiation-related adverse events were analyzed. RESULTS: In the case-matched cohort, post-GKS median survival time tended to be longer in the 3-stage group (15.9 months) than in the 2-stage group (11.7 months), but the difference was not statistically significant (p = 0.65). The cumulative incidences of tumor progression (21.6% vs 16.7% at 1 year, p = 0.31), neurological death (5.1% vs 6.0% at 1 year, p = 0.58), or serious radiation-related adverse events (3.0% vs 4.0% at 1 year, p = 0.49) did not differ significantly. CONCLUSIONS: This retrospective multi-institutional study showed no differences between 3-stage and 2-stage GKS in terms of overall survival, tumor progression, neurological death, and radiation-related adverse events. Both 3-stage and 2-stage GKS performed according to the aforementioned protocols are good treatment options in selected patients with large BMs.
OBJECTIVE: In order to obtain better local tumor control for large (i.e., > 3 cm in diameter or > 10 cm3 in volume) brain metastases (BMs), 3-stage and 2-stage Gamma Knife surgery (GKS) procedures, rather than a palliative dose of stereotactic radiosurgery, have been proposed. Here, authors conducted a retrospective multi-institutional study to compare treatment results between 3-stage and 2-stage GKS for large BMs. METHODS: This retrospective multi-institutional study involved 335 patients from 19 Gamma Knife facilities in Japan. Major inclusion criteria were 1) newly diagnosed BMs, 2) largest tumor volume of 10.0-33.5 cm3, 3) cumulative intracranial tumor volume ≤ 50 cm3, 4) no leptomeningeal dissemination, 5) no more than 10 tumors, and 6) Karnofsky Performance Status 70% or better. Prescription doses were restricted to between 9.0 and 11.0 Gy in 3-stage GKS and between 11.8 and 14.2 Gy in 2-stage GKS. The total treatment interval had to be within 6 weeks, with at least 12 days between procedures. There were 114 cases in the 3-stage group and 221 in the 2-stage group. Because of the disproportion in patient numbers and the pre-GKS clinical factors between these two GKS groups, a case-matched study was performed using the propensity score matching method. Ultimately, 212 patients (106 from each group) were selected for the case-matched study. Overall survival, tumor progression, neurological death, and radiation-related adverse events were analyzed. RESULTS: In the case-matched cohort, post-GKS median survival time tended to be longer in the 3-stage group (15.9 months) than in the 2-stage group (11.7 months), but the difference was not statistically significant (p = 0.65). The cumulative incidences of tumor progression (21.6% vs 16.7% at 1 year, p = 0.31), neurological death (5.1% vs 6.0% at 1 year, p = 0.58), or serious radiation-related adverse events (3.0% vs 4.0% at 1 year, p = 0.49) did not differ significantly. CONCLUSIONS: This retrospective multi-institutional study showed no differences between 3-stage and 2-stage GKS in terms of overall survival, tumor progression, neurological death, and radiation-related adverse events. Both 3-stage and 2-stage GKS performed according to the aforementioned protocols are good treatment options in selected patients with large BMs.
Authors: Taoran Cui; Joseph Weiner; Shabbar Danish; Anupama Chundury; Nisha Ohri; Ning Yue; Xiao Wang; Ke Nie Journal: Front Oncol Date: 2022-06-30 Impact factor: 5.738
Authors: Francesco Maria Crisà; Filippo Leocata; Virginia Maria Arienti; Marco Picano; Luca Berta; Hae Song Mainardi; Angelo Filippo Monti; Francesco Musca; Silvia Colombo; Mauro Palazzi; Alessandro La Camera Journal: Stereotact Funct Neurosurg Date: 2020-07-29 Impact factor: 1.875