Gamma Knife Stereotactic Radiosurgery for Brain Metastases Using Only 3 Pins

Abstract BACKGROUND: Removal of a pin during Gamma Knife stereotactic radiosurgery (GK-SRS) may be necessary to prevent collision and allow treatment. OBJECTIVE: To investigate outcomes after GK-SRS for treatment of brain metastases using a head frame immobilized to the skull with only 3 pins. METHODS: Between 2009 and 2014, we retrospectively reviewed the records of 1971 patients and identified 20 patients with multiple brain metastases treated with GK-SRS in which 1 anterior pin was removed immediately before treatment of a single posterior lesion. GK-SRS was also delivered to 116 other lesions in these 20 patients using the standard 4 pins during the same session, serving as an internal control for comparison. Endpoints included local control, dosimetric parameters, toxicity, and overall survival. RESULTS: The median number of lesions treated per session was 6 (range, 2-14). The lesions treated using 3 pins were located in the occipital lobe (n = 14) or the cerebellum (n = 6). Median follow-up was 12.3 months. There was 1 local failure involving a control lesion. Lesions treated using 3 pins had a lower prescription isodose line. GK-SRS of a lesion using 3 pins did not cause any clinical toxicities or increase in radiographic edema or hemorrhage. CONCLUSION: Treating posteriorly located brain metastases with GK-SRS using only 3 pins provided excellent local control and no difference in treatment toxicity, which may make it a safe and reasonable option for lesions that may otherwise be difficult to treat.

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Clinical dose profile of Gamma Knife stereotactic radiosurgery for extensive brain metastases

Journal of Neurosurgery ◽

10.3171/2020.3.jns193369 ◽

2020 ◽

pp. 1-5

Author(s):

Gregory Neil Bowden ◽

Jong Oh Kim ◽

Andrew Faramand ◽

Kevin Fallon ◽

John Flickinger ◽

...

Keyword(s):

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Gamma Knife ◽

Tumor Volume ◽

Median Number ◽

Whole Brain Radiation ◽

Clinical Scenarios ◽

The Mean ◽

Gamma Knife Stereotactic Radiosurgery ◽

The Brain

OBJECTIVEThe use of Gamma Knife stereotactic radiosurgery (GKSRS) for the treatment of extensive intracranial metastases has been expanding due to its superior dosimetry and efficacy. However, there remains a dearth of data regarding the dose parameters in actual clinical scenarios. The authors endeavored to calculate the radiation dose to the brain when treating ≥ 15 brain metastases with GKSRS.METHODSThis retrospective analysis reviewed dosage characteristics for patients requiring single-session GKSRS for the treatment of ≥ 15 brain metastases. Forty-two patients met the inclusion criteria between 2008 and 2017. The median number of tumors at the initial GKSRS procedure was 20 (range 15–39 tumors), accounting for 865 tumors in this study. The median aggregate tumor volume was 3.1 cm3 (range 0.13–13.26 cm3), and the median marginal dose was 16 Gy (range 14–19 Gy).RESULTSThe median of the mean brain dose was 2.58 Gy (range 0.95–3.67 Gy), and 79% of patients had a dose < 3 Gy. The 12-Gy dose volume was a median of 12.45 cm3, which was equivalent to 0.9% of the brain volume. The median percentages of brain receiving 5 Gy and 3 Gy were 6.7% and 20.4%, respectively. There was no correlation between the number of metastases and the mean dose to the brain (p = 0.8). A greater tumor volume was significantly associated with an increased mean brain dose (p < 0.001). The median of the mean dose to the bilateral hippocampi was 2.3 Gy. Sixteen patients had supplementary GKSRS, resulting in an additional mean dose of 1.4 Gy (range 0.2–3.8 Gy) to the brain.CONCLUSIONSGKSRS is a viable means of managing extensive brain metastases. This procedure provides a relatively low dose of radiation to the brain, especially when compared with traditional whole-brain radiation protocols.

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BMET-12SURVIVAL IN BREAST CANCER PATIENTS WITH BRAIN METASTASES AFTER GAMMA KNIFE STEREOTACTIC RADIOSURGERY

Neuro-Oncology ◽

10.1093/neuonc/nov208.12 ◽

2015 ◽

Vol 17 (suppl 5) ◽

pp. v47.3-v47

Author(s):

Christopher Grubb ◽

Ashish Jani ◽

Cheng-Chia Wu ◽

Shumaila Saad ◽

Yasir H. Qureshi ◽

...

Keyword(s):

Breast Cancer ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Cancer Patients ◽

Gamma Knife ◽

Breast Cancer Patients ◽

Gamma Knife Stereotactic Radiosurgery

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Hippocampal Dosimetry and the Necessity of Hippocampal-Sparing in Gamma Knife Stereotactic Radiosurgery for Extensive Brain Metastases

Advances in Radiation Oncology ◽

10.1016/j.adro.2019.10.003 ◽

2020 ◽

Vol 5 (2) ◽

pp. 180-188

Author(s):

Matthew D. Riina ◽

Cassandra K. Stambaugh ◽

Kathryn E. Huber

Keyword(s):

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Gamma Knife ◽

Hippocampal Sparing ◽

Gamma Knife Stereotactic Radiosurgery

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Gamma knife stereotactic radiosurgery for brain metastases of primary gynecologic origin

Gynecologic Oncology ◽

10.1016/j.ygyno.2018.04.190 ◽

2018 ◽

Vol 149 ◽

pp. 83

Author(s):

K.G. Petras ◽

I. Helenowski ◽

R.A. Patel ◽

J.R. Lurain ◽

M.C. Tate ◽

...

Keyword(s):

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Gamma Knife ◽

Gamma Knife Stereotactic Radiosurgery

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Gamma Knife stereotactic radiosurgery in the treatment of brain metastases from breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10555 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 10555-10555

Author(s):

R. Gutt ◽

S. Yovino ◽

L. Chin ◽

W. Regine ◽

P. Amin ◽

...

Keyword(s):

Breast Cancer ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Gamma Knife ◽

Karnofsky Performance Status ◽

Systemic Disease ◽

Univariate Analysis ◽

Complication Rates ◽

Gamma Knife Stereotactic Radiosurgery

10555 Background: Outcomes of gamma knife stereotactic radiosurgery (GK-SRS) for patients with brain metastases specifically from breast cancer have not been well-defined. This study was undertaken to report the long-term experience with GK-SRS in this subset of patients. Methods: From 1995 to 2005, 75 patients with 162 brain lesions were treated with GK-SRS at the University of Maryland Medical Center. Complete follow-up data were available in 65 patients. Additional whole brain radiation therapy (WBRT) was administered to 53 (81.5%) patients. The median WBRT dose was 36.75 Gy (30.0–45.0 Gy). The median number of lesions treated with GK-SRS was 2 (1–8 lesions). The median follow-up, age, and KPS were 7.2 months (0.4–75.7 months), 53.5 years (23–81 years), and 90 (40–100), respectively. The factors included in the univariate and multivariate analyses for overall survival (OS) and progression free survival (PFS) were age, Karnofsky Performance Status (KPS), tumor histology, estrogen receptor status, Her-2-neu status, number of intracranial lesions, and presence of systemic disease. Results: Median PFS and OS from GK-SRS were 5.3 months (0.4–33.2 months) and 8.1 months (0.4–75.7 months), respectively. The 6, 12, and 24 month actuarial PFS were 47.8%, 24.9%, and 9.6% respectively. The 6, 12, and 24 month actuarial OS were 60.7%, 39.1%, and 18.1% respectively. The tumor local control after WBRT and GK-SRS was 87.7%. Radiation necrosis was a complication in 10.8% of patients. Forty-seven (72.3%) patients had neurological symptoms prior to gamma knife treatment. Seven (14.9%) and 9 (19.1%) of these patients experienced symptom resolution and significant symptomatic improvement, respectively. Multivariate and univariate analysis did not reveal any of the prognostic factors in question to be significantly associated with OS nor PFS. Conclusions: This relatively large cohort of patients experienced poor survival outcomes despite aggressive therapy with WBRT and GK-SRS. However, GK-SRS can provide significant symptomatic relief, with acceptable complication rates. More research is required to improve the survival of breast cancer patients with intracranial metastases. No significant financial relationships to disclose.

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