GAMMA KNIFE RADIOSURGERY IN THE MANAGEMENT OF MALIGNANT MELANOMA BRAIN METASTASES

Neurosurgery ◽  
2007 ◽  
Vol 60 (3) ◽  
pp. 471-482 ◽  
Author(s):  
David Mathieu ◽  
Douglas Kondziolka ◽  
Patrick B. Cooper ◽  
John C. Flickinger ◽  
Ajay Niranjan ◽  
...  
Keyword(s):  
Malignant Melanoma ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Local Control ◽  
Tumor Volume ◽  
Systemic Disease ◽  
Gamma Knife Radiosurgery ◽  
Karnofsky Performance Score ◽  
Performance Score ◽  
Melanoma Brain Metastases

Abstract OBJECTIVE Radiosurgery is increasingly used to manage malignant melanoma brain metastases. We reviewed our series of patients who underwent radiosurgery for melanoma brain metastases to assess clinical outcomes and identify prognostic factors for survival and cerebral disease control. METHODS Two hundred forty-four patients had radiosurgery for the management of 754 metastatic tumors. A mean of 2.6 tumors were irradiated per procedure. The median tumor volume was 4.4 cm3. The median margin and maximum doses used were 18 and 32 Gy, respectively. RESULTS The median survival was 5.3 months after radiosurgery (mean, 10 mo; range, 0.2–114.3 mo). Patients survived a median of 7.8 months (mean, 13.4 mo) from the diagnosis of brain metastases and 44.9 months (mean, 69 mo) after the diagnosis of the primary tumor. Survival was better in patients with controlled systemic disease (12.7 mo), single brain metastasis (6.8 mo), and a Karnofsky performance score of 90 or 100% (6.3 mo). Sustained local control was achieved in 86.2% of tumors. Increased tumor volume and previous evidence of hemorrhage increased the risk of local failure. Multiple lesions and failure to provide systemic immunotherapy were predictors for the occurrence of new brain metastases, which developed in 41.7% of the patients. Symptomatic radiation changes occurred in 6.6% of the patients. Overall, 71.4% of the patients improved or remained clinically stable. Brain disease was the cause of death in 40.5% of the patients, usually from the development of new metastases. CONCLUSION Gamma knife radiosurgery for malignant melanoma brain metastases is safe and effective and provides a high rate of durable local control. Improved survival can be achieved in patients with single metastasis, controlled systemic disease, and a high Karnofsky performance score.

Gamma Knife Radiosurgery for Malignant Melanoma Brain Metastases

Neurosurgery ◽  
2006 ◽  
Vol 59 (2) ◽  
pp. 490 ◽  
Author(s):  
David Mathieu ◽  
Douglas S. Kondziolka ◽  
Patrick Cooper ◽  
John C. Flickinger ◽  
Ajay Niranjan ◽  
...  
Keyword(s):  
Malignant Melanoma ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Melanoma Brain Metastases

scholarly journals BRAF Mutation Is Associated with Improved Local Control of Melanoma Brain Metastases Treated with Gamma Knife Radiosurgery

2016 ◽  
Vol 6 ◽  
Author(s):  
Ian S. Gallaher ◽  
Yoichi Watanabe ◽  
Todd E. DeFor ◽  
Kathryn E. Dusenbery ◽  
Chung K. Lee ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Local Control ◽  
Braf Mutation ◽  
Gamma Knife Radiosurgery ◽  
Melanoma Brain Metastases

CYBERKNIFE FOR BRAIN METASTASES OF MALIGNANT MELANOMA AND RENAL CELL CARCINOMA

Neurosurgery ◽  
2009 ◽  
Vol 64 (suppl_2) ◽  
pp. A26-A32 ◽  
Author(s):  
Wendy Hara ◽  
Phuoc Tran ◽  
Gordon Li ◽  
Zheng Su ◽  
Putipun Puataweepong ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Malignant Melanoma ◽  
Brain Metastases ◽  
Cell Carcinoma ◽  
Local Control ◽  
Renal Cell ◽  
Systemic Disease ◽  
Karnofsky Performance Scale ◽  
Actuarial Survival ◽  
The Mean

Abstract OBJECTIVE To evaluate the efficacy of CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) for patients with brain metastases of malignant melanoma and renal cell carcinoma. METHODS We conducted a retrospective review of all patients treated by image-guided radiosurgery at our institution between March 1999 and December 2005. Sixty-two patients with 145 brain metastases of renal cell carcinoma or melanoma were identified. RESULTS The median follow-up period was 10.5 months. Forty-four patients had malignant melanoma, and 18 patients had renal cell carcinoma. The median age was 57 years, and patients were classified as recursive partitioning analysis Class 1 (6 patients), 2 (52 patients) or 3 (4 patients). Thirty-three patients had been treated systemically with either chemotherapy or immunotherapy, and 33 patients were taking corticosteroids at the time of treatment. The mean tumor volume was 1.47 mL (range, 0.02–35.7 mL), and the mean prescribed dose was 20 Gy (range, 14–24 Gy). The median survival after SRS was 8.3 months. Actuarial survival at 6 and 12 months was 57 and 37%, respectively. On multivariate analysis, Karnofsky Performance Scale score (P < 0.01) and previous immunotherapy/clinical trial (P = 0.01) significantly affected overall survival. One-year intracranial progression-free survival was 38%, and local control was 87%. Intracranial control was impacted by whole-brain radiotherapy (P = 0.01), previous chemotherapy (P = 0.01), and control of the primary at the time of SRS (P = 0.02). Surgical resection had no effect on intracranial or local control. Radiographic evidence of radiation necrosis developed in 4 patients (6%). CONCLUSION CyberKnife radiosurgery provided excellent local control with acceptable toxicity in patients with melanoma or renal cell brain metastases. Initial SRS alone appeared to be a reasonable option, as survival was dictated by systemic disease.

Outcome with stereotactic radiosurgery (SRS) and ipilimumab (Ipi) for malignant melanoma brain metastases.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3032-3032 ◽  
Author(s):  
Sana Shoukat ◽  
David Mitchell Marcus ◽  
Monica Rizzo ◽  
David H. Lawson ◽  
Yuan Liu ◽  
...  
Keyword(s):  
Malignant Melanoma ◽  
Brain Metastases ◽  
Local Control ◽  
Performance Status ◽  
Ecog Performance Status ◽  
Entire Cohort ◽  
Kaplan Meier ◽  
Patient Reported ◽  
Melanoma Brain Metastases ◽  
Secondary Endpoints

3032 Background: SRS with Ipi for brain metastases from malignant melanoma has been explored for overall survival (OS) (Knisely JP, Yu JB, Flanigan J, et al. Radiosurgery for melanoma brain metastases in the ipilimumab era and the possibility of longer survival. J Neurosurg. 2012;117:227-33). We present the first retrospective analysis to determine if this combination is safe and improves OS, while accounting for lactate dehydrogenase (LDH). Methods: Patients with melanoma brain metastases who underwent SRS between 1998-2010 (n=124) were compared with those who additionally received Ipi (n=11). The primary endpoint was median OS from time of SRS, calculated using Kaplan-Meier method. Cox proportional hazard model was carried out for univariate and multivariable survival analysis. The secondary endpoints were local control at initial site of SRS, anywhere intra-cranial failure, need for repeat SRS, and toxicity. Results: Median OS for the entire cohort was 6.9 months. Patients in the Ipi group had an improved median OS of 28.3 months vs. 6.8 months in the non-Ipi group (p = 0.013). No difference was noted in local control, anywhere intracranial failures, toxicity (radionecrosis, hemorrhage, patient reported memory deficits), or need for repeated SRS. MVA (Table) showed that Ipi independently predicted for improved OS even when taking into account LDH and ECOG performance status. The only confounding factor within the Ipi group was younger age of the Ipi cohort (43 vs. 55 yrs, p = 0.006). Conclusions: Use of SRS with Ipi appears to be safe and associated with an impressive increase in median OS in patients with brain metastases from malignant melanoma; this combination should be further investigated. [Table: see text]

Initial treatment of melanoma brain metastases using gamma knife radiosurgery

Cancer ◽  
2004 ◽  
Vol 101 (4) ◽  
pp. 825-833 ◽  
Author(s):  
Andrew E. Radbill ◽  
John F. Fiveash ◽  
Elizabeth T. Falkenberg ◽  
Barton L. Guthrie ◽  
Paul E. Young ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Initial Treatment ◽  
Gamma Knife Radiosurgery ◽  
Melanoma Brain Metastases

scholarly journals RADI-05. FRACTIONATED TREATMENT OF BRAIN METASTASES WITH GAMMA KNIFE ICON

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i22-i22
Author(s):  
Jameson Mendel ◽  
Ankur Patel ◽  
Toral Patel ◽  
Robert Timmerman ◽  
Tu Dan ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Local Control ◽  
Stereotactic Radiotherapy ◽  
Tumor Volume ◽  
Univariate Analysis ◽  
Local Failure ◽  
Fractionated Stereotactic Radiotherapy

Abstract PURPOSE/OBJECTIVE(S): Stereotactic radiosurgery with Gamma Knife is a common treatment modality for patients with brain metastasis. The Gamma Knife ICON allows for immobilization with an aquaplast mask, permitting fractionated treatments. We describe one of the first experiences utilizing this technique with brain metastasis and evaluate outcomes. MATERIALS/METHODS: From June 2017 to November 2018, 29 patients with 43 separate intracranial lesions were treated with fractionated stereotactic radiotherapy using the gamma knife ICON at a single institution. Patients received between 20–30 Gy in 3–5 fractions with no margin over the course of 5 to 23 days. Local control was physician assessed. Local failure over time was modeled using cumulative incidence; lesions were censored at last radiographic follow up. RESULTS: Median tumor volume and prescription isodose was 7.7 cm3 (range 0.3–43.9) and 50% (range 40–65), respectively. Median radiographic follow-up was 7 months and median survival was 9 months. Radiation necrosis occurred in 3/3 patients treated with 27 Gy in 3 fractions, one requiring therapeutic resection. Incidence of local failure for all treated lesions was 9% at 1 year. Tumor volume >7 cm3 was associated with local failure on univariate analysis (p=0.025). 100% (2/2) lesions treated with 20 Gy in 5 fractions developed local recurrence. CONCLUSION: Fractionated stereotactic radiotherapy with the Gamma Knife ICON provides excellent local control for small and large brain metastases with minimal toxicity. Tumors >7 cm3 should receive at least 30 Gy in 5 fractions for optimal control. Treatment with 27 Gy in 3 fractions appears to have high rates of treatment related toxicity and should be avoided.

scholarly journals Gamma Knife radiosurgery for brain metastasis: review of 103 patients

2009 ◽  
Vol 28 (04) ◽  
pp. 133-138
Author(s):  
Marcos Antônio Dellaretti Filho ◽  
George de Albuquerque Cavalcanti Mendes ◽  
Nicolas Reyns ◽  
Gustavo Touzet ◽  
François Dubois ◽  
...  
Keyword(s):  
Overall Survival ◽  
Brain Metastasis ◽  
Gamma Knife ◽  
Local Control ◽  
Tumor Volume ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Gamma Knife Radiosurgery ◽  
Intracranial Metastasis ◽  
Free Survival

Abstract Objective: To assess clinical and imaging outcomes in patients treated with Gamma Knife stereotactic radiosurgery (SRS) for brain metastasis. Methods: One hundred and three patients with 158 intracranial metastasis consecutively underwent Gamma Knife SRS between January, 2004 and December, 2006. The results were based on last imaging and the date of the last visit. Average age of the patients was 56 years (range 32-84 years). Karnofsky performance status average was 87.6. Fifty-eight (56.3%) patients had single brain metastasis. The average tumor volume was 2.5cc (range 0.02-16.6 cc). The SRS marginal dose average was 23.4 Gy (range 15-25 Gy). Results: Treatment sequence was SRS alone (89 patients) or SRS plus whole-brain radiotherapy (WBRT) (14 patients). The 1-year local control was 80%, being better for tumors with volume <5cc than for ≥5 cc: 86% vs 53% (p<0.05). The 1-year distant brain metastasis-free survival incidence was 73%. The initial number of brain lesions (single vs multiple) was not a significant factor on distant brain metastasis: free survival at 1 year was 75% for single metastases and 70% for multiple lesions. Renal cancer was the only factor with a significant effect on distant brain metastasis. The median overall survival was 15 months. According to unifactorial and multifactorial analysis, three prognostic factors for overall survival were retrieved recursive partitioning analysis (RPA) class, Karnofsky index performance and tumor volume. Conclusion: In this series, SRS provided excellent local control with relatively low morbidity in patients with brain metastases.

Gamma knife radiosurgery and brain metastases: local control, survival, and quality of life

2002 ◽  
Vol 97 ◽  
pp. 507-510 ◽  
Author(s):  
Theodor S. Vesagas ◽  
Jose A. Aguilar ◽  
Eduardo R. Mercado ◽  
Manuel M. Mariano
Keyword(s):  
Quality Of Life ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Median Survival ◽  
Local Control ◽  
Gamma Knife Radiosurgery ◽  
Content Type ◽  
Control Survival ◽  
Fine Print

Object. The purpose of this paper was to describe the clinical outcome in patients with brain metastases who underwent gamma knife radiosurgery (GKS). Methods. The authors retrospectively reviewed the clinical courses of 54 patients with brain metastases who underwent 62 GKS procedures. This series covered a 43-month period. A total of 174 lesions were treated: 38 patients harbored solitary whereas 24 patients harbored multiple metastases. The authors assessed outcome by examining local disease control, survival, and quality of life. The overall local control rate was 85%; the mean time to failure of local control was 10.5 months; and median survival was 8.4 months. Median survival, evaluated by the log-rank test, was greater among patients with a single metastasis (p = 0.043), breast cancer (p = 0.021), and those who had undergone multiple GKS procedures for local failure (p = 0.009). The initial Karnofsky Performance Scale (KPS) score and whole-brain radiotherapy were not significantly related to median survival. The KPS scores tended to remain stable through the follow-up period. There were no morbidities or deaths attributable to the procedure. Conclusions. Results in this series suggest that GKS can be an effective tool for the control of brain metastases. A prospective investigation should be performed to validate trends seen in this retrospective study.

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