Kiyoshi Nakazaki1, Shoji Yomo2, Takeshi Kondoh3, Toru Serizawa4, Hiroyuki Kenai5, Jun Kawagishi6, Sonomi Sato7, Osamu Nagano8, Hitoshi Aiyama9, Hideya Kawai10, Toshinori Hasegawa11, Yoshiyasu Iwai12, Yasushi Nagatomo13, Yoshihisa Kida14, Masakazu Nishigaki15. 1. Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, 3-6-28 Okinogami, Fukuyama, Hiroshima, 7200825, Japan. knakazaki@h7.dion.ne.jp. 2. Department of Neurosurgery, Aizawa Hospital, Matsumoto, Nagano, Japan. 3. Department of Neurosurgery, Shinsuma General Hospital, Kobe, Hyogo, Japan. 4. Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo, Japan. 5. Department of Neurosurgery, Nagatomi Neurosurgical Hospital, Oita, Japan. 6. Jiro Suzuki Memorial GammaHouse, Furukawa Seiryo Hospital, Osaki, Miyagi, Japan. 7. Department of Neurosurgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Koriyama, Fukushima, Japan. 8. Gamma Knife House, Chiba Cerebral and Cardiovascular Center, Ichihara, Chiba, Japan. 9. Katsuta Hospital Mito GammaHouse, Hitachi-naka, Ibaraki, Japan. 10. Department of Neurosurgery, Research Institute for Brain and Blood-Vessels-Akita, Akita, Japan. 11. Department of Neurosurgery, Komaki City Hospital, Komaki, Aichi, Japan. 12. Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan. 13. Department of Neurosurgery, Kouseikai Takai Hospital, Tenri, Nara, Japan. 14. Department of Neurosurgery, Ookuma Hospital, Nagoya, Japan. 15. Department of Human Health Sciences, School of Medicine, Kyoto University, Kyoto, Japan.
Abstract
PURPOSE: To evaluate the efficacy of gamma knife radiosurgery (GKS) for brain metastases (BMs) from small-cell lung cancer after whole-brain radiotherapy (WBRT). METHODS: We retrospectively analyzed the usefulness and safety of GKS in 163 patients from 15 institutions with 1-10 active BMs after WBRT. The usefulness and safety of GKS were evaluated using statistical methods. RESULTS: The median age was 66 years, and 79.1% of patients were men. The median number and largest diameter of BM were 2.0 and 1.4 cm, respectively. WBRT was administered prophylactically in 46.6% of patients. The median overall survival (OS) was 9.3 months, and the neurologic mortality was 20.0%. Crude incidences of local control failure and new lesion appearance were 36.6% and 64.9%, respectively. A BM diameter ≥ 1.0 cm was a significant risk factor for local progression (hazard ratio [HR] 2.556, P = 0.039) and neurologic death (HR 4.940, P = 0.031). Leukoencephalopathy at the final follow-up was more prevalent in the therapeutic WBRT group than in the prophylactic group (P = 0.019). The symptom improvement rate was 61.3%, and neurological function was preserved for a median of 7.6 months. Therapeutic WBRT was not a significant risk factor for OS, neurological death, local control, or functional deterioration (P = 0.273, 0.490, 0.779, and 0.560, respectively). Symptomatic radiation-related adverse effects occurred in 7.4% of patients. CONCLUSIONS: GKS can safely preserve neurological function and prevent neurologic death in patients with 1-10 small, active BMs after prophylactic and therapeutic WBRT.
PURPOSE: To evaluate the efficacy of gamma knife radiosurgery (GKS) for brain metastases (BMs) from small-cell lung cancer after whole-brain radiotherapy (WBRT). METHODS: We retrospectively analyzed the usefulness and safety of GKS in 163 patients from 15 institutions with 1-10 active BMs after WBRT. The usefulness and safety of GKS were evaluated using statistical methods. RESULTS: The median age was 66 years, and 79.1% of patients were men. The median number and largest diameter of BM were 2.0 and 1.4 cm, respectively. WBRT was administered prophylactically in 46.6% of patients. The median overall survival (OS) was 9.3 months, and the neurologic mortality was 20.0%. Crude incidences of local control failure and new lesion appearance were 36.6% and 64.9%, respectively. A BM diameter ≥ 1.0 cm was a significant risk factor for local progression (hazard ratio [HR] 2.556, P = 0.039) and neurologic death (HR 4.940, P = 0.031). Leukoencephalopathy at the final follow-up was more prevalent in the therapeutic WBRT group than in the prophylactic group (P = 0.019). The symptom improvement rate was 61.3%, and neurological function was preserved for a median of 7.6 months. Therapeutic WBRT was not a significant risk factor for OS, neurological death, local control, or functional deterioration (P = 0.273, 0.490, 0.779, and 0.560, respectively). Symptomatic radiation-related adverse effects occurred in 7.4% of patients. CONCLUSIONS: GKS can safely preserve neurological function and prevent neurologic death in patients with 1-10 small, active BMs after prophylactic and therapeutic WBRT.