Pulmonary resection in patients with nonsmall-cell lung cancer treated with gamma-knife radiosurgery for synchronous brain metastases

The combination of Gamma Knife radiosurgery (GKRS) and systemic immunotherapy (IT) or targeted therapy (TT) is a novel treatment method for brain metastases (BMs) in non-small cell lung cancer (NSCLC). To elucidate the safety and efficacy of concomitant IT or TT on the outcome after GKRS, 496 NSCLC patients with BMs, who were treated with GKRS were retrospectively reviewed. The median time between the initial lung cancer diagnosis and the diagnosis of brain metastases was one month. The survival after the initial BM diagnosis was significantly longer than the survival predicted by prognostic BM scores. After the first Gamma Knife radiosurgery treatment (GKRS1), the estimated median survival was 9.9 months (95% CI = 8.3–11.4). Patients with concurrent IT or TT presented with a significantly longer survival after GKRS1 than patients without IT or TT (p < 0.001). These significant differences in the survival were also apparent among the four treatment groups and remained significant after adjustment for Karnofsky performance status scale (KPS), recursive partitioning analysis (RPA) class, sex, and multiple BMs. About half of all our patients (46%) developed new distant BMs after GKRS1. Of note, no statistically significant differences in the occurrence of radiation reaction, radiation necrosis, or intralesional hemorrhage in association with IT or TT at or after GKRS1 were observed. In NSCLC-BM patients, the concomitant use of GKRS and IT or TT showed an increase in overall survival without increased complications related to GKRS. Therefore, the combined treatment with GKRS and IT or TT seems to be a safe and powerful treatment option and emphasizes the role of radiosurgery in modern BM treatment.

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Gamma knife radiosurgery for brain metastasis of nonsmall cell lung cancer: Is there a difference in outcome between morning and afternoon treatment?

Cancer ◽

10.1002/cncr.25423 ◽

2010 ◽

Vol 117 (2) ◽

pp. 414-420 ◽

Cited By ~ 23

Author(s):

Douglas A. Rahn ◽

Dibyendu K. Ray ◽

David J. Schlesinger ◽

Ladislau Steiner ◽

Jason P. Sheehan ◽

...

Keyword(s):

Lung Cancer ◽

Brain Metastasis ◽

Gamma Knife ◽

Cell Lung Cancer ◽

Gamma Knife Radiosurgery ◽

Nonsmall Cell Lung Cancer

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EP-1293 IMPACT OF TIME OF DAY OF GAMMA KNIFE RADIOSURGERY ON SURVIVAL FOR NON-SMALL CELL LUNG CANCER BRAIN METASTASES

Radiotherapy and Oncology ◽

10.1016/s0167-8140(12)71626-2 ◽

2012 ◽

Vol 103 ◽

pp. S491-S492

Author(s):

S.N. Badiyan ◽

D.J. Ferraro ◽

S. Yaddanapudi ◽

R.E. Drzymala ◽

A.Y. Lee ◽

...

Keyword(s):

Lung Cancer ◽

Brain Metastases ◽

Small Cell Lung Cancer ◽

Gamma Knife ◽

Cell Lung Cancer ◽

Gamma Knife Radiosurgery ◽

Time Of Day ◽

Small Cell ◽

Small Cell Lung

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RADI-07. GAMMA KNIFE RADIOSURGERY FOR SMALL CELL LUNG CANCER: PROGNOSTIC FACTORS INCLUDING ADDITIONAL LESIONS IDENTIFIED ON THE DAY OF RADIOSURGERY

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz014.100 ◽

2019 ◽

Vol 1 (Supplement_1) ◽

pp. i23-i23

Author(s):

Kevin Chaung ◽

Michael Kharouta ◽

Stephen Shamp ◽

Mitchell Machtay ◽

Andrew Sloan ◽

...

Keyword(s):

Lung Cancer ◽

Brain Metastases ◽

Small Cell Lung Cancer ◽

Gamma Knife ◽

Cell Lung Cancer ◽

Gamma Knife Radiosurgery ◽

Small Cell ◽

Initial Diagnosis ◽

Small Cell Lung ◽

Extracranial Metastases

Abstract OBJECTIVES: Prophylactic cranial irradiation (PCI) and whole brain radiation (WBRT) are standard of care for intracranial disease in small cell lung cancer (SCLC) patients. We sought to identify predictors of overall survival (OS) in SCLC patients treated with salvage Gamma Knife radiosurgery (GKRS) for brain metastases after prior WBRT or PCI. METHODS: Retrospective analyses were conducted on 26 SCLC patients treated with GKRS at one institution between May 2010 and June 2018. Factors predictive of OS were analyzed using Cox proportional hazards regression and Wilcoxon sum-rank testing. RESULTS: Median follow-up and median OS following GKRS was 6.6 mos (range 0.7–24.2 mos). Median OS was 21.4 mos from initial diagnosis (range 7.3–49.3 mos). Presence of extracranial metastases at the time of GKRS was not significantly associated with median OS after GKRS (5.8 mos for patients with extracranial metastases vs 7.2 mos for patients without, p=0.425). Mean number of lesions was 2.7 (range 1–10) on diagnostic brain MRIs and 4.1 (range 1–12) on GKRS planning MRIs. Eleven patients (42%) had the same number of lesions between diagnostic MRI and GKRS MRI, and 15 patients (58%) had additional lesions on the GKRS MRI. Number of lesions treated and total tumor volume were not associated with median OS. Patients who had additional lesions on GKRS MRI compared to diagnostic MRI had lower median OS from initial diagnosis of SCLC (29.9 mos vs 18.1 mos, p=0.0182) and a trend toward lower median OS from time of GKRS (7.3 mos vs 4.8 mos, p=0.0547) compared to patients who did not have additional lesions. CONCLUSIONS: Finding additional brain metastases on GKRS planning MRIs is associated with decreased OS in SCLC patients treated with salvage GKRS. Presence of extracranial metastases at the time of GKRS and number or total volume of brain metastases were not associated with OS.

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Efficacy and limitations of salvage gamma knife radiosurgery for brain metastases of small-cell lung cancer after whole-brain radiotherapy

Acta Neurochirurgica ◽

10.1007/s00701-012-1520-0 ◽

2012 ◽

Vol 155 (1) ◽

pp. 107-114 ◽

Cited By ~ 13

Author(s):

Kiyoshi Nakazaki ◽

Yoshinori Higuchi ◽

Osamu Nagano ◽

Toru Serizawa

Keyword(s):

Lung Cancer ◽

Brain Metastases ◽

Small Cell Lung Cancer ◽

Gamma Knife ◽

Cell Lung Cancer ◽

Gamma Knife Radiosurgery ◽

Whole Brain Radiotherapy ◽

Small Cell ◽

Small Cell Lung ◽

Brain Radiotherapy

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Long-Term Survival of a Patient with Brainstem and Recurrent Brain Metastasis from Stage IV Nonsmall Cell Lung Cancer Treated with Multiple Gamma Knife Radiosurgeries and Craniotomies: A Case Report and Review of the Literature

Case Reports in Oncological Medicine ◽

10.1155/2012/621641 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Andrew F. Lamm ◽

Ameer L. Elaimy ◽

Alexander R. Mackay ◽

Robert K. Fairbanks ◽

John J. Demakas ◽

...

Keyword(s):

Lung Cancer ◽

Brain Metastasis ◽

Gamma Knife ◽

Cell Lung Cancer ◽

Gamma Knife Radiosurgery ◽

Stage Iv ◽

Nonsmall Cell Lung Cancer ◽

Term Survival ◽

The Right

The prognosis of patients diagnosed with stage IV nonsmall cell lung cancer that have brain and brainstem metastasis is very poor, with less than a third surviving a year past their initial date of diagnosis. We present the rare case of a 57-year-old man who is a long-term survivor of brainstem and recurrent brain metastasis, after aggressive treatment. He is now five and a half years out from diagnosis and continues to live a highly functional life without evidence of disease. Four separate Gamma Knife stereotactic radiosurgeries in conjunction with two craniotomies were utilized since his initial diagnosis to treat recurrent brain metastasis while chemoradiation therapy and thoracic surgery were used to treat his primary disease in the right upper lung. In his situation, Gamma Knife radiosurgery proved to be a valuable, safe, and effective tool for the treatment of multiply recurrent brain metastases within critical normal structures.

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