J Korean Neurosurg Soc.  2013 Aug;54(2):107-111. 10.3340/jkns.2013.54.2.107.

The Usefulness of Stereotactic Radiosurgery for Radioresistant Brain Metastases

• Kim H
• Jung TY
• Kim IY
• Jung S
• Moon KS
• Park SJ

• KMID: 1814246
• DOI: http://doi.org/10.3340/jkns.2013.54.2.107

Abstract

OBJECTIVE
We investigated the effectiveness of stereotactic gamma knife Radiosurgery (GKR) for radioresistant brain metastases with the impact upon histology.
METHODS
Between April 2004 and May 2011, a total of 23 patients underwent GKR for 67 metastatic brain tumors from 12 renal cell cancers, 5 sarcomas and 6 melanomas. The mean age was 56 years (range, 18 to 79 years). Most of the patients were classified as the Radiation Therapy Oncology Group recursive partitioning analysis class II (91.3%). The synchronous metastasis was found in 6 patients (26.1%) and metachronous metastasis in 17 patients (73.9%). We analyzed the local control rate, intracranial progression-free survival (PFS) and overall survival (OS).
RESULTS
The mean tumor volume for GKR was 2.24 cc and the mean prescription dose was 19.4 Gy (range, 10 to 24) to the tumor margin. Out of metachronous metastases, the median duration to intracranial metastasis was 3.3 years in renal cell cancer (RCC), 2.4 years in melanoma and 1.1 years in sarcoma (p=0.012). The total local control rate was 89.6% during the mean 12.4 months follow-up. The six-month and one-year local control rate was 90.2% and 83% respectively. Depending on the pathology, the control rate of RCC was 95.7%, sarcoma 91.3% and melanoma 80.5% during the follow-up. The common cause of local failure was the tumor bleeding in melanoma. The median PFS and OS were 5.2 and 8.4 months in RCC patients, 6.5 and 9.8 months in sarcoma, and 3.8 and 5.1 months in melanoma.
CONCLUSION
The GKR can be one of the effective management options for the intracranial metastatic tumors from the radioresistant tumors. The melanoma showed a poor local control rate compared to other pathologies because of the hemorrhage.

Keyword

Intracranial; Metastasis; Radioresistant; Renal cell cancer; Sarcoma; Melanoma

MeSH Terms

Brain
Brain Neoplasms
Carcinoma, Renal Cell
Disease-Free Survival
Follow-Up Studies
Hemorrhage
Humans
Melanoma
Neoplasm Metastasis
Prescriptions
Radiosurgery
Sarcoma
Tumor Burden

Figure

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  Fig. 1 Kaplan-Meier curve of local control rate depending on the tumor volume (p=0.001). B : Kaplan-Meier curve of local control rate depending on the pathology (p=0.137).

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