Abstract
BACKGROUND:
Brain metastasis represents a significant source of morbidity and mortality in patients with systemic cancer, In adults, cerebral metastasis are by far the most common intracranial tumors, and their incidence is rising because of increased cancer survival.
GKRS has arguably been the most important advancement in the management of metastatic brain tumors since the 1980s.
PATIENTS AND METHODS:
This is a prospective study of 50 patients of brain metastasis treated with (GKRS) between January 2017 and January 2019. A group of 14 males and 36 females with mean age was 59.1 years, 34 patient were <65 years old and 16 patients were >65 years old.
Patients status assessed according Karnofsky Performance Score (KPS), 4 % were >70 KPS and 96% were <70 KPS. The lung cancer was the primary lesion in 56% of patients, breast was 32%, and Skin Melanoma 8% and unknown origin 4%.
80% of the patients had previous treatment: surgery and chemotherapy (22%), chemotherapy (20%), surgery (16%), surgery, chemotherapy and DXT (10%), surgery, chemotherapy and WBRT (8%) WBRT (2%) and DXT (2%), while absent in 20%.
Brain MRI with contrast follow up was done in 6 months, and after 12 months
RESULTS:
After 12 months of follow up the mean of tumor volume after (GKRS) decrease from 6.2cm3 to 3.4cm3 , The mean KPS improve from (61) to (75) , Local tumor recurrence was (16%) and edma was seen in (20%) ,The Age of patients > 65, KPS < 70, patients with previous treatment surgery, chemotherapy and WBRT had poor prognosis ,The mortality was seen in (20%) half of them related to neurological death and the other to primary tumor.
CONCLUSION:
The Gamma knife radiosurgery is effective and safe treatment modality of secondary brain metastasis and is effective in increasing survival rate and Karnofsky performance scale in addition to reduction of the tumor size of patients with brain metastasis.
Main Subjects
|
Jaboin JJ, Ferraro DJ, DeWees TA. Survival following gamma knife radiosurgery for brain metastasis from breast cancer. Radiat Oncol 2013; 8:131.
10. Lee CK, Lee SR, Cho JM, Yang KA, Kim SH. Therapeutic effect of gamma knife radiosurgery for multiple brain metastasis. J Korean Neurosurg Soc 2011; 50:179–84.
11. Bir SC, Ambekar S, Bollam P, Nanda A. Long-term outcome of gamma knife radiosurgery for metastatic brain tumors originating from lung cancer. Surg Neurol Int 2014; 5:S396-403.
12. Matsunaga S, Shuto T, Yamamoto M, Yomo S, Kondoh T, Kobayashi T, et al. Gamma Knife Radiosurgery for Metastatic Brain Tumors from Malignant Melanomas: A Japanese Multi-Institutional Cooperative and Retrospective Cohort Study (JLGK1501). Stereotact Funct Neurosurg 2018; 96:162-71.
13. Shweikeh F, Bukavina L, Saeed K, Sarkis R, Suneja A, Sweiss F, Drazin D. Brain metastasis in bone and soft tissue cancers: a review of incidence, interventions, and outcomes. Sarcoma. 2014 Mar 16;2014.
14. Huang CY, Lee CC, Yang HC, Lin CJ, Wu HM, Chung WY, Shiau CY, Guo WY, Pan DH, Peng SJ. Radiomics as prognostic factor in brain metastases treated with Gamma Knife radiosurgery. Journal of Neuro-Oncology. 2020 ;146:439-49.
15. Park JY, Moon KS, Lee KH. Gamma knife radiosurgery for elderly patients with brain metastasis: evaluation of scoring systems that predict survival. BMC Cancer 2015; 15:54.
16. Tsao MN, Rades D, Wirth A, Lo SS, Danielson BL, Gaspar LE, Sperduto PW, Vogelbaum MA, Radawski JD, Wang JZ, Gillin MT. Radiotherapeutic and surgical management for newly diagnosed brain metastasis (es): An American Society for Radiation Oncology evidence-based guideline. Practical radiation oncology. 2012;2:210-25.
17. Yamamoto M, Sato Y, Serizawa T, Kawabe T, Higuchi Y, Nagano O, Barfod BE, Ono J, Kasuya H, Urakawa Y. Subclassification of recursive partitioning analysis Class II patients with brain metastases treated radiosurgically. International Journal of Radiation Oncology* Biology* Physics. 2012 ;83:1399-405.
18. Minniti G, Esposito V, Clarke E, Scaringi C, Bozzao A, Lanzetta G, et al. Stereotactic radiosurgery in elderly patients with brain metastasis. J Neurooncol 2013; 111:319–25.
19. Kawabe T, Yamamoto M, Sato Y, Yomo S, Kondoh T, Nagano O, et al. Gamma Knife radiosurgery for brain metastasis from pulmonary large cell neuroendocrine carcinoma: a Japanese multi-institutional cooperative study (JLGK1401). J Neurosurg 2016; 125:11-17.
20. Shin HK, Kim JH, Lee do H, Cho YH, Kwon do H, Roh SW. Clinical Outcomes of Gamma Knife Radiosurgery for Metastatic Brain Tumors from Gynecologic Cancer: Prognostic Factors in Local Treatment Failure and Survival. J Korean Neurosurg Soc 2016; 59:392–99.
21. Choi SW, Kwon DH, Kim CJ. Clinical outcome in gamma knife radiosurgery for metastatic brain tumors from the primary breast cancer: prognostic factors in local treatment failure and survival. J Korean Neurosurg Soc. 2013; 54:329–35.
22. Bailo M, Boari N, Franzin A, Gagliardi F, Spina A, Del Vecchio A, Gemma M, Bolognesi A, Mortini P. Gamma knife radiosurgery as primary treatment for large vestibular schwannomas: clinical results at long-term follow-up in a series of 59 patients. World neurosurgery. 2016 ;95:487-501.
)
