scholarly journals RADI-21. Feasibility of Gamma Knife Surgery for patients with 20 or more brain metastases

2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii22-iii22
Author(s):  
Sherry Jiani Liu ◽  
Bengt Karlsson ◽  
Choo Heng Tan ◽  
Vellayappan Balamurugan ◽  
Yvonne Ang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Radiation Treatment ◽  
Systemic Treatment ◽  
Intracranial Tumor ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Neurocognitive Deficits ◽  
Intracerebral Tumor

Abstract Background The current standard-of-care treatment for brain metastases (BM)≥20 is Whole Brain Radiotherapy (WBRT), which can cause neurocognitive decline detrimental to patients’ quality of life, especially if their functional status is good on presentation. The benefits of Gamma Knife Surgery (GKS) have been shown for BM≤10, but there is no consensus on the upper limit where GKS is no longer beneficial. We hypothesize that selected patients with ≥20 BM may benefit by replacing WBRT with GKS to preserve neurocognition without compromising intracerebral tumor control and overall survival, with additional treatments as needed. Methodology This is retrospective analysis of 31 patients with ≥20 BM who underwent single-session GKS between 2016–2021. Twenty-two patients had ECOG of 0 at the time of GKS. Median number of BM at GKS was 30 (20–79) with median total tumour volume 4cm3 (2–28 cm3). Median marginal dose was 20Gy (10-25Gy). Results Median overall survival following GKS was 14-months (95%CI 4-24months), justifying GKS in this population. 11/12 patients that died succumbed due to extracranial disease, while 1 patient, who was treated with WBRT before GKS, succumbed to intracranial tumor progression. Local tumor control achieved was achieved for 63% of patients at 2-years and distal tumor control in 24% of patients at 1.5-years without additional radiation treatment. Salvage GKS was given in seven patients and salvage WBRT in three. One local recurrence was surgically resected. Systemic treatment given to most patients probably contributed to intracranial tumor control. No patients developed significant neurocognitive deficits attributable to GKS during the follow-up period of median 7-months (Q1-Q3: 3-12months). Conclusion Most patients treated with GKS for ≥20 BM have sufficient survival time to benefit from the treatment. Local and distal recurrences can be managed with systemic treatment, salvage GKS, or WBRT, resulting in intracerebral tumor control in vast majority of cases.

Gamma Knife surgery in the management of radioresistant brain metastases in high-risk patients with melanoma, renal cell carcinoma, and sarcoma

2008 ◽  
Vol 109 (Supplement) ◽  
pp. 122-128 ◽  
Author(s):  
John W. Powell ◽  
Chung T. Chung ◽  
Hemangini R. Shah ◽  
Gregory W. Canute ◽  
Charles J. Hodge ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Brain Metastases ◽  
Cell Carcinoma ◽  
Gamma Knife ◽  
Treatment Option ◽  
Renal Cell ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Local Progression

Object The purpose of this study was to examine the results of using Gamma Knife surgery (GKS) for brain metastases from classically radioresistant malignancies. Methods The authors retrospectively reviewed the records of 76 patients with melanoma (50 patients), renal cell carcinoma (RCC; 23 patients), or sarcoma (3 patients) who underwent GKS between August 1998 and July 2007. Overall patient survival, intracranial progression, and local progression of individual lesions were analyzed. Results The median age of the patients was 57 years (range 18–85 years) and median Karnofsky Performance Scale (KPS) score was 80 (range 20–100). Sixty-two patients (81.6%) had uncontrolled extracranial disease. A total of 303 intracranial lesions (average 3.97 per patient, range 1–27 lesions) were treated using GKS. More than 3 lesions were treated in 30 patients (39.5%). Median GKS tumor margin dose was 18 Gy (range 8–30 Gy). Thirty-seven patients (48.7%) underwent whole brain radiation therapy. The actuarial 12-month rate for freedom from local progression for individual lesions was 77.7% and was significantly higher for RCC compared with melanoma (93.6 vs 63.0%; p = 0.001). The percentage of coverage of the prescribed dose to target volume was the only treatment–related variable associated with local control: 12-month actuarial rate of freedom from local progression was 71.4% for lesions receiving ≥ 90% coverage versus 0.0% for lesions receiving < 90% (p = 0.00048). Median overall survival was 5.1 months after GKS and 8.4 months after the discovery of brain metastases. Univariate analysis revealed that KPS score (p = 0.000004), recursive partitioning analysis class (p = 0.00043), and single metastases (p = 0.028), but not more than 3 metastases, to be prognostic factors of overall survival. The KPS score remained significant after multivariate analysis. Overall survival for patients with a KPS score ≥ 70 was 7.1 months compared with 1.3 months for a KPS score ≤ 60 (p = 0.013). Conclusions Gamma Knife surgery is an effective treatment option for patients with radioresistant brain metastases. In this setting, KPS score appeared to be a more important factor in predicting survival than having > 3 metastases. Higher rates of local tumor control were achieved for RCC in comparison with melanoma, and this may have an effect on survival in some patients. Although outcomes generally remained poor in this study population, these results suggest that GKS can be considered as a treatment option for many patients with radioresistant brain metastases, even if these patients have multiple lesions.

scholarly journals Role of Gamma Knife surgery in patients with 5 or more brain metastases

2012 ◽  
Vol 117 (Special_Suppl) ◽  
pp. 5-12 ◽  
Author(s):  
Alireza Mohammad Mohammadi ◽  
Pablo F. Recinos ◽  
Gene H. Barnett ◽  
Robert J. Weil ◽  
Michael A. Vogelbaum ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Cleveland Clinic ◽  
Salvage Treatment ◽  
Gamma Knife Surgery ◽  
Karnofsky Performance Scale ◽  
Related Factors ◽  
Extracranial Metastases

Object The authors evaluated overall survival and factors predicting outcome in patients with ≥ 5 brain metastases who were treated with Gamma Knife surgery (GKS). Methods Medical records from patients with ≥ 5 brain metastases treated with GKS between 1997 and 2010 at the Cleveland Clinic Gamma Knife Center were retrospectively reviewed. Patient demographics, tumor characteristics, treatment-related factors, and outcome data were evaluated. Results One hundred seventy patients were identified, with a median age of 58 years. The female/male ratio was 1.2:1. Gamma Knife surgery was used as an upfront treatment in 35% of patients and as salvage treatment in 65% of patients with multiple brain metastases. The median overall survival after GKS was 6.7 months (95% CI 5.5–8.1). At the time of GKS, 128 patients (75%) had concurrent extracranial metastases, and in 69 patients (41%) multiple extracranial sites were involved. Ninety-two patients (54%) had a history of whole-brain radiation therapy, and 158 patients (93%) had a Karnofsky Performance Scale (KPS) score ≥ 70. The median total intracranial disease volume was 3.2 cm3 (range 0.2–37.2 cm3). A total intracranial tumor volume ≥ 10 cm3 was observed in 32 patients (19%). Lower KPS score at the time of treatment (p < 0.0001), patient age > 60 years (p = 0.004), multiple extracranial metastases (p = 0.0001), and greater intracranial burden of disease (p = 0.03) were prognostic factors for poor outcome in the univariate and multivariate analyses. Conclusions In this study, GKS was safe and effective for upfront and salvage treatment in patients with ≥ 5 brain metastases. Gamma Knife surgery should be considered as an additional treatment modality for these patients, especially in the subset of patients with favorable prognostic factors.

Volumetric follow up of brain metastases: a useful method to evaluate treatment outcome and predict survival after Gamma Knife surgery?

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 91-98 ◽  
Author(s):  
Guenther Christian Feigl ◽  
Gerhard A. Horstmann
Keyword(s):  
Treatment Outcome ◽  
Side Effects ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Tumor Type ◽  
The Mean

ObjectBrain metastases are diagnosed in 20 to 40% of all cancer patients and are associated with a considerable drop in life expectancy and often also in quality of life for these patients. Several treatment options are available including surgery, chemotherapy, whole-brain radiotherapy, stereotactic radiotherapy, stereotactic radiosurgery, and Gamma Knife surgery (GKS). However, management of brain metastases still presents a challenge and there is no general consensus on the best treatment strategy. The aim of the authors' study was to further evaluate the efficacy of GKS in the treatment of brain metastases and to evaluate the predictive value of volumetric tumor follow-up measurement.MethodsConsecutive patients with controlled systemic cancer and variable numbers of brain metastases were included in this prospective study. Patients with severe symptoms of brain compression underwent surgery before GKS. Each follow-up examination included a thorough neurological examination and a neuroradiological quantitative volumetric tumor analysis.A total of 300 consecutive patients (mean age 58 years) with 703 brain metastases were treated between December 1998 and October 2005. The mean total tumor volume (TTV) was 2.1 cm3. The overall local tumor control rate was 84.5%. In 79% of all treated metastases a mean TTV reduction of 84.7% was achieved using a mean prescription dose of 21.8 Gy. Only few, mostly mild, side effects were observed during the mean follow-up period of 12.7 months. The overall mean progression-free survival period was 9.4 months. There was a statistically significant difference in survival of patients with one compared with multiple metastases, regardless of the histological type and preceding treatment.Conclusions Gamma Knife surgery is a safe and effective treatment for patients with brain metastases regardless of the history of treatment and histological tumor type. It achieves excellent tumor control, significant TTV reduction without causing severe side effects, and accordingly, preserves quality of live. Volume changes after GKS did not serve as a predictor for treatment outcome and survival.

scholarly journals Relationship between WBRT total dose, intracranial tumor control, and overall survival in NSCLC patients with brain metastases - a single-center retrospective analysis

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Zhensheng Li ◽  
Dongxing Shen ◽  
Jian Zhang ◽  
Jun Zhang ◽  
Fang Yang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Lung Tumor ◽  
Tumor Resection ◽  
Prognostic Index ◽  
Whole Brain Radiotherapy ◽  
Progression Free Survival ◽  
Intracranial Tumor ◽  
Tumor Control ◽  
Cox Models

Abstract Background The relationship between whole brain radiotherapy (WBRT) dose with intracranial tumor control and overall survival (OS) in patients with non-small cell lung cancer (NSCLC) brain metastases (BM) is largely unknown. Methods We retrospectively analyzed 595 NSCLC BM patients treated consecutively at the Fourth Hospital of Hebei Medical University between 2013 to 2015. We assigned the patients into 4 dose groups of WBRT: none, < 30, 30–39, and ≥ 40 Gy and assessed their relationship with OS and intracranial progression-free survival (iPFS). Cox models were utilized. Covariates included sex, age, KPS, BM lesions, extracranial metastasis, BM and lung tumor resection, chemotherapy, targeted therapy, and focal radiotherapy modalities. Results Patients had a mean age of 59 years and were 44% female. Their median survival time (MST) of OS and iPFS were 9.3 and 8.9 months. Patients receiving none (344/58%), < 30 (30/5%), 30–39 (93/16%), and ≥ 40 (128/22%) Gy of WBRT had MST of OS (iPFS) of 7.3 (6.8), 6.0 (5.4), 10.3 (11.9) and 11.9 (11.9) months, respectively. Compared to none, other WBRT groups had adjusted HRs for OS - 1.23 (p > 0.20), 0.72 (0.08), 0.61 (< 0.00) and iPFS - 1.63 (0.03), 0.71 (0.06), 0.67 (< 0.01). Compared to 30–39 Gy, WBRT dose ≥40 Gy was not associated with improved OS and iPFS (all p > 0.40). Stratified analyses by 1–3 and ≥ 4 BM lesions and adjustment analyses by each prognostic index of RPA class, Lung-GPA and Lung-molGPA supported these relationships as well. Conclusions Compared to none, WBRT doses ≥30 Gy are invariably associated with improved intracranial tumor control and survival in NSCLC BM patients.

scholarly journals Comparison of treatment results between 3- and 2-stage Gamma Knife radiosurgery for large brain metastases: a retrospective multi-institutional study

2019 ◽  
Vol 131 (1) ◽  
pp. 227-237 ◽  
Author(s):  
Toru Serizawa ◽  
Yoshinori Higuchi ◽  
Masaaki Yamamoto ◽  
Shigeo Matsunaga ◽  
Osamu Nagano ◽  
...  
Keyword(s):  
Overall Survival ◽  
Adverse Events ◽  
Brain Metastases ◽  
Tumor Progression ◽  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Treatment Results ◽  
Matched Study

OBJECTIVEIn 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.METHODSThis 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.RESULTSIn 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.CONCLUSIONSThis 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.

scholarly journals Gamma Knife surgery for treating brain metastases arising from hepatocellular carcinomas

2014 ◽  
Vol 121 (Suppl_2) ◽  
pp. 102-109 ◽  
Author(s):  
Eun Suk Park ◽  
Do Hoon Kwon ◽  
Jun Bum Park ◽  
Do Hee Lee ◽  
Young Hyun Cho ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Univariate Analysis ◽  
Radiation Therapy Oncology Group ◽  
Local Tumor Control ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Significant Variable ◽  
Local Tumor ◽  
The Mean

ObjectBrain metastases from hepatocellular carcinoma (HCC) are rare, and the evidence of the effectiveness of Gamma Knife surgery (GKS) in this disease is lacking. The authors report their institutional experience with GKS in patients with brain metastases from HCCs.MethodsThe authors retrospectively reviewed the medical records of 73 consecutive patients who had a combined total of 141 brain metastases arising from HCCs and were treated with GKS. Sixty-four (87.7%) patients were male, and the mean age of the patients was 52.5 years (range 30–79 years). The mean tumor volume was 7.35 cm3 (range 0.19–33.7 cm3). The median margin dose prescribed was 23 Gy (range 15–32 Gy). Univariate and multivariate survival analyses were performed to identify possible prognostic factors of outcomes.ResultsThe estimated rate of local tumor control was 79.6% at 3 months after GKS. The median overall survival time after GKS was 16 weeks. The actuarial survival rates were 76.7%, 58.9%, and 26.0% at 4, 12, and 24 weeks after GKS, respectively. In the univariate analysis, an age of ≤ 65 years, Child-Pugh Class A (pertaining to liver function), high Karnofsky Performance Scale score (≥ 70), and low Radiation Therapy Oncology Group recursive partitioning analysis class (I or II) were positively associated with the survival times of patients. No statistically significant variable was identified in the multivariate analysis.ConclusionsAlthough survival was extremely poor in patients with brain metastases from HCCs, GKS showed acceptable local tumor control at 3 months after the treatment. The authors suggest that GKS represents a noninvasive approach that may provide a valuable option for treating patients with brain metastases from HCCs.

Gamma Knife surgery for brain metastases from colorectal cancer

2011 ◽  
Vol 114 (3) ◽  
pp. 782-789 ◽  
Author(s):  
Shigeo Matsunaga ◽  
Takashi Shuto ◽  
Nobutaka Kawahara ◽  
Jun Suenaga ◽  
Shigeo Inomori ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Brain Metastases ◽  
Tumor Growth ◽  
Gamma Knife ◽  
Growth Control ◽  
Gamma Knife Surgery ◽  
Local Tumor ◽  
Local Tumor Growth

Object The outcomes after Gamma Knife surgery (GKS) were retrospectively analyzed in patients with brain metastases from radioresistant primary colorectal cancer to evaluate the efficacy of GKS and the prognostic factors for local tumor control and overall survival. Methods The authors reviewed the medical records of 152 patients with 616 tumors. The group included 102 men and 50 women aged 35–85 years (mean age 64.4 years), who underwent GKS for metastatic brain tumors from colorectal cancer between April 1992 and September 2008 at Yokohama Rosai Hospital. Results The mean prescription dose to the tumor margin was 18.5 Gy (range 8–30 Gy). The mean tumor volume at GKS was 2.0 cm3 (range 0.004–10.0 cm3). The primary tumors were located in the colon in 88 patients and the rectum in 64. The median interval between the diagnosis of primary lesions and the diagnosis of brain metastases was 27 months (range 0–180 months). The median neuroradiological follow-up period after GKS was 3 months (mean 6.4 months, range 1–93 months). The local tumor growth control rate, based on MR imaging, was 91.2%. The significant factors for unfavorable local tumor growth control, based on multivariate analysis, were larger tumor volume (p = 0.001) and lower margin dose (p = 0.016). The median overall survival time was 6 months. Lower Karnofsky Performance Scale (KPS) score (p = 0.026) and the presence of extracranial metastases (p = 0.004) at first GKS were significantly correlated with poor overall survival period in multivariate analysis. The cause of death was systemic disease in 112 patients and neurological disease in 13 patients. Leptomeningeal carcinomatosis was significantly correlated with a shorter duration of neurological survival in multivariate analysis (p < 0.0001). Conclusions Gamma Knife surgery is effective for suppression of local tumor growth in patients with brain metastases from radioresistant colorectal primary cancer. Therefore, clinical and radiological screening of intracranial metastases for patients with lower KPS scores and/or the presence of extracranial metastases as well as follow-up examinations after GKS for brain metastases should be performed periodically in patients with colorectal cancer, because the neurological prognosis is improved by initial and repeat GKS for newly diagnosed or recurrent tumors leading to a prolonged high-quality survival period.

Gamma Knife surgery for brain metastases from gastrointestinal cancer

2009 ◽  
Vol 111 (3) ◽  
pp. 423-430 ◽  
Author(s):  
Arnaldo Neves Da Silva ◽  
Kazuki Nagayama ◽  
David J. Schlesinger ◽  
Jason P. Sheehan
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Gastrointestinal Cancer ◽  
Systemic Disease ◽  
Univariate Analysis ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Gastrointestinal Cancers ◽  
Brain Radiotherapy ◽  
The Mean

Object Brain metastases from gastrointestinal cancers are rare. However, the incidence is increasing because patients with gastrointestinal carcinoma tend to live longer due to earlier diagnosis and more effective treatment of systemic disease. The purpose of this study was to evaluate the efficacy of Gamma Knife surgery (GKS) for the treatment of brain metastases from gastrointestinal cancers. Methods The authors performed a retrospective review of 40 patients (18 women and 22 men) who had undergone GKS to treat a total of 118 metastases from gastrointestinal cancers between January 1996 and December 2006. The mean patient age was 58.7 years, and the mean Karnofsky Performance Scale (KPS) score was 70. There were 7 patients with esophageal cancer, 25 with colon cancer, 5 with rectal cancer, 2 with pancreatic cancer, and 1 with gastric cancer. Nineteen patients were treated with whole-brain radiotherapy and/or local brain radiotherapy before GKS. Twenty-four patients had extracranial metastases, and 3 had an additional primary cancer. The mean metastatic brain tumor volume was 4.3 cm3, and the mean maximum tumor dose varied from 17.1 to 76.7 Gy (mean 41.8 Gy). Results Follow-up imaging studies were available in 25 patients with a total of 90 treated metastases. The results demonstrate a tumor control rate of 91%. The median survival time was 6.7 months, and the 6-month and 1-year survival rates were 55 and 25%, respectively. A univariate analysis revealed that the KPS score (≤ 70 vs ≥ 80) was significant (p = 0.018) for improved survival. Conclusions Results in this series suggest that GKS can be an effective tool for the treatment of brain metastases from gastrointestinal cancer.

Single- versus 2-session Gamma Knife surgery for symptomatic midsize brain metastases: a propensity score–matched analysis

2020 ◽  
Vol 133 (6) ◽  
pp. 1646-1654 ◽  
Author(s):  
Shoji Yomo ◽  
Kyota Oda ◽  
Kazuhiro Oguchi
Keyword(s):  
Propensity Score ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Neurological Deficits ◽  
Functional Improvement ◽  
Tumor Control ◽  
Therapeutic Effects ◽  
Single Session ◽  
Local Progression

OBJECTIVETwo-session Gamma Knife surgery (GKS) has recently been demonstrated to be an effective and less-invasive alternative for large brain metastases not treatable by microsurgical resection. This raises the clinical question of whether the 2-session GKS strategy further improves treatment outcomes for patients with symptomatic midsize brain metastases (2–10 cm3) as compared to single-session GKS. The present study aimed to compare the local therapeutic effects and toxicities of single-session and 2-session GKS for treating these lesions.METHODSPatients with focal neurological deficits attributable to midsize brain metastases who underwent upfront GKS during the period from 2010 to 2018 were retrospectively identified from an institutional database. Patients for whom both post-GKS imaging studies and neurological evaluations from outpatient visits were available were eligible. Using propensity score–matching (PSM) analysis, unique matched pairs which had a similar likelihood of receiving 2-session GKS were generated. The main outcome measure was a composite of imaging and/or neurological worsening of the lesion of interest. Functional improvement and overall survival (OS) were also compared between the 2 treatment arms.RESULTSIn total, 219 cancer patients with 252 symptomatic midsize brain metastases were eligible. Of these 252 tumors, 176 and 76 were treated with single- and 2-session GKS, respectively. After PSM, 68 pairs of tumors were obtained. The Gray test showed that 2-session GKS achieved a longer local progression–free interval than single-session GKS (1-year local control rate: 84% vs 53%; HR 0.31, 95% CI 0.16–0.63, p = 0.001). Two-session GKS was also associated with greater functional improvement in KPS scores (mean 18.3 ± 14.6 vs 12.8 ± 14.1, p = 0.040). The median OS did not differ significantly between single- and 2-session GKS (15.6 vs 24.7 months; HR 0.69, 95% CI 0.44–1.10, p = 0.11).CONCLUSIONSTwo-session GKS achieved more durable local tumor control and greater functional improvement than single-session GKS for patients with symptomatic midsize brain metastases, although there was no OS advantage.

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