Gamma knife radiosurgery for metastatic brain tumors from lung cancer: a comparison between small cell and non—small cell carcinoma

Object. The purpose of this retrospective study was to evaluate the effectiveness of gamma knife radiosurgery (GKS) for the treatment of metastatic brain tumors from lung cancer, with particular reference to small cell lung carcinoma (SCLC) compared with non-SCLC (NSCLC). Methods. Two hundred forty-five consecutive patients meeting the following five criteria were evaluated in this study: 1) no prior brain tumor treatment; 2) 25 or fewer lesions; 3) a maximum of three tumors with a diameter of 20 mm or larger; 4) no surgically inaccessible tumor 30 mm or greater in diameter; and 5) more than 3 months of life expectancy. According to the same treatment protocol, large tumors (≥ 30 mm) were surgically removed and the other small lesions (< 30 mm) were treated with GKS. New lesions were treated with repeated GKS. Chemotherapy was administered, according to the primary physician's protocol, as aggressively as possible. Progression-free, overall, neurological, qualitative, and new lesion—free survival were calculated with the Kaplan—Meier method and were compared in the SCLC and NSCLC groups by using the log-rank test. The poor prognostic factors for each type of survival were also analyzed with the Cox proportional hazard model. Conclusions. Tumor control rate at 1 year was 94.5% in the SCLC group and 98% in the NSCLC group. The median survival time was 9.1 months in the SCLC group and 8.6 months in the NSCLC group. The 1-year survival rates in the SCLC group were 86.5% for neurological survival and 68.9% for qualitative survival; those in the NSCLC group were 87.9% for neurological and 78.9% for qualitative survival. The estimated median interval to emergence of a new lesion was 6.9 months in the SCLC group and 9.8 months in the NSCLC group. There was no significant difference between the two groups for any type of survival; this finding was verified by multivariate analysis. The results of this study suggest that GKS appears to be as effective in treating brain metastases from SCLC as for those from NSCLC.

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Outcome of gamma knife radiosurgery for metastatic brain tumors derived from non-small cell lung cancer

Journal of Neuro-Oncology ◽

10.1007/s11060-015-1915-x ◽

2015 ◽

Vol 125 (2) ◽

pp. 331-338 ◽

Cited By ~ 12

Author(s):

Kyung Rae Cho ◽

Min Ho Lee ◽

Doo-Sik Kong ◽

Ho Jun Seol ◽

Do-Hyun Nam ◽

...

Keyword(s):

Lung Cancer ◽

Brain Tumors ◽

Small Cell Lung Cancer ◽

Gamma Knife ◽

Cell Lung Cancer ◽

Gamma Knife Radiosurgery ◽

Small Cell ◽

Metastatic Brain Tumors ◽

Small Cell Lung

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Gamma knife radiosurgery for simultaneous multiple metastatic brain tumors

Journal of Neurosurgery ◽

10.3171/jns.2000.93.supplement_3.0030 ◽

2000 ◽

Vol 93 (supplement_3) ◽

pp. 30-31 ◽

Cited By ~ 38

Author(s):

Satoshi Suzuki ◽

Junichi Omagari ◽

Shunji Nishio ◽

Eiichiro Nishiye ◽

Masashi Fukui

Keyword(s):

Survival Rate ◽

Brain Metastasis ◽

Brain Tumors ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Metastatic Brain Tumors ◽

Content Type ◽

Cumulative Survival ◽

Kaplan Meier ◽

Fine Print

Object. The authors assessed the efficacy of gamma knife radiosurgery (GKS) in the treatment of patients with 10 or more simultaneous metastatic brain tumors. Methods. Gamma knife radiosurgery was performed for the treatment of 10 or more simultaneous metastatic brain tumors in 24 patients. The performance status before and after GKS was expressed using the Karnofsky Performance Scale (KPS). The cumulative survival rate was analyzed using the Kaplan—Meier method. The level of satisfaction with the procedure was assessed by telephone interview. No patient has died due to brain metastasis—related symptoms, and all patients and/or their families were satisfied with the GKS. In 12 patients who had brain metastasis—related symptoms, five improved, six were unchanged, and one deteriorated, as reflected by the KPS scores. The cumulative survival rate calculated by the Kaplan—Meier method was 70.4%, 49.3%, and 12.3% at 12 weeks, 24 weeks, and 36 weeks, respectively. The median survival time was 11 weeks. Conclusions. Single-fraction GKS can achieve acceptable tumor control, low morbidity, and good quality of life in the treatment of multiple metastatic brain tumors even in cases with 10 or more simultaneous metastases.

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Radiosurgery for patients with recurrent small cell lung carcinoma metastatic to the brain: outcomes and prognostic factors

Journal of Neurosurgery ◽

10.3171/sup.2005.102.s_supplement.0247 ◽

2005 ◽

Vol 102 (Special_Supplement) ◽

pp. 247-254 ◽

Cited By ~ 10

Author(s):

Jason Sheehan ◽

Douglas Kondziolka ◽

John Flickinger ◽

L. Dade Lunsford

Keyword(s):

Lung Cancer ◽

Brain Metastases ◽

Lung Carcinoma ◽

Small Cell Lung Carcinoma ◽

Small Cell ◽

Small Cell Lung ◽

Cell Lung Carcinoma ◽

Content Type ◽

The Brain ◽

Fine Print

Object. Lung carcinoma is the leading cause of death from cancer. More than 50% of those with small cell lung cancer develop a brain metastasis. Corticosteroid agents, radiotherapy, and resection have been the mainstays of treatment. Nonetheless, median survival for patients with small cell lung carcinoma metastasis is approximately 4 to 5 months after cranial irradiation. In this study the authors examine the efficacy of gamma knife surgery for treating recurrent small cell lung carcinoma metastases to the brain following tumor growth in patients who have previously undergone radiation therapy, and they evaluate factors affecting survival. Methods. A retrospective review of 27 patients (47 recurrent small cell lung cancer brain metastases) undergoing radiosurgery was performed. Clinical and radiographic data obtained during a 14-year treatment period were collected. Multivariate analysis was utilized to determine significant prognostic factors influencing survival. The overall median survival was 18 months after the diagnosis of brain metastases. In multivariate analysis, factors significantly affecting survival included: 1) tumor volume (p = 0.0042); 2) preoperative Karnofsky Performance Scale score (p = 0.0035); and 3) time between initial lung cancer diagnosis and development of brain metastasis (p = 0.0127). Postradiosurgical imaging of the brain metastases revealed that 62% decreased, 19% remained stable, and 19% eventually increased in size. One patient later underwent a craniotomy and tumor resection for a tumor refractory to radiosurgery and radiation therapy. In three patients new brain metastases were demonstrating on follow-up imaging. Conclusions. Stereotactic radiosurgery for recurrent small cell lung carcinoma metastases provided effective local tumor control in the majority of patients. Early detection of brain metastases, aggressive treatment of systemic disease, and a therapeutic strategy including radiosurgery can extend survival.

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Does gamma knife surgery stimulate cellular immune response to metastatic brain tumors? A histopathological and immunohistochemical study

Journal of Neurosurgery ◽

10.3171/sup.2005.102.s_supplement.0180 ◽

2005 ◽

Vol 102 (Special_Supplement) ◽

pp. 180-184 ◽

Cited By ~ 3

Author(s):

György T. Szeifert ◽

Isabelle Salmon ◽

Sandrine Rorive ◽

Nicolas Massager ◽

Daniel Devriendt ◽

...

Keyword(s):

Immune Response ◽

Brain Tumors ◽

Gamma Knife ◽

Cellular Immune Response ◽

Lymphocytic Infiltration ◽

Gamma Knife Surgery ◽

Metastatic Brain Tumors ◽

Content Type ◽

Cellular Immune ◽

Fine Print

Object. The aim of this study was to analyze the cellular immune response and histopathological changes in secondary brain tumors after gamma knife surgery (GKS). Methods. Two hundred ten patients with cerebral metastases underwent GKS. Seven patients underwent subsequent craniotomy for tumor removal between 1 and 33 months after GKS. Four of these patients had one tumor, two patients had two tumors, and one patient had three. Histological and immunohistochemical investigations were performed. In addition to routine H & E and Mallory trichrome staining, immunohistochemical reactions were conducted to characterize the phenotypic nature of the cell population contributing to the tissue immune response to neoplastic deposits after radiosurgery. Light microscopy revealed an intensive lymphocytic infiltration in the parenchyma and stroma of tumor samples obtained in patients in whom surgery was performed over 6 months after GKS. Contrary to this, extensive areas of tissue necrosis with either an absent or scanty lymphoid population were observed in the poorly controlled neoplastic specimens obtained in cases in which surgery was undertaken in patients less than 6 months after GKS. Immunohistochemical characterization demonstrated the predominance of CD3-positive T cells in the lymphoid infiltration. Conclusions. Histopathological findings of the present study are consistent with a cellular immune response of natural killer cells against metastatic brain tumors, presumably stimulated by the ionizing energy of focused radiation.

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Analysis of long-term outcomes and prognostic factors in patients with non—small cell lung cancer brain metastases treated by gamma knife radiosurgery

Journal of Neurosurgery ◽

10.3171/sup.2005.102.s_supplement.0075 ◽

2005 ◽

Vol 102 (Special_Supplement) ◽

pp. 75-80 ◽

Cited By ~ 7

Author(s):

Massimo Gerosa ◽

Antonio Nicolato ◽

Roberto Foroni ◽

Laura Tomazzoli ◽

Albino Bricolo

Keyword(s):

Lung Cancer ◽

Prognostic Factors ◽

Brain Metastases ◽

Gamma Knife ◽

Small Cell ◽

Small Cell Lung ◽

Long Term Outcomes ◽

Content Type ◽

Fine Print

Object. The authors conducted a study to evaluate the long-term outcomes and prognostic factors for survival in a large series of patients treated by gamma knife surgery (GKS) for non—small cell lung cancer (NSCLC) brain metastases. Methods. The study is based on the retrospective analysis of clinical and radiological records obtained during a 10-year period (1993–2003), concerning 836 lesions in 504 patients. The lesions were primary in 86% and recurrent 14% of the cases; they were solitary in 31%, single in 29%, and multiple in 40%. The mean follow-up period was 16 months (range 4–113 months). The most common histological types were adenocarcinoma (51%) and squamous cell carcinoma (27%). Dose planning parameters were as follows: mean target volume 6.2 cm3 (range 0.06–22.5 cm3); mean prescription dose 21.4 Gy (range 15.5–28 Gy); and mean number of isocenters 6.7 (range one–18). Progression-free and actuarial survival curves were calculated using the Kaplan—Meier method. The main factors affecting survival were determined by unimultivariate analysis (log-rank test and Cox proportional hazard models). Analysis of long-term outcomes seemed to confirm that GKS is a primary therapeutic option in these patients. The 1-year local tumor control rate was 94%. The overall median survival was 14.5 months, with extremely rewarding quality of life indices. The recursive partitioning analysis classification was the dominant prognostic factor. Conclusions. Gamma knife surgery is a useful treatment for brain metastases from NSCLC.

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Radiosurgery for patients with recurrent small cell lung carcinoma metastatic to the brain: outcomes and prognostic factors

Journal of Neurosurgery ◽

10.3171/jns.2005.102.s_supplement.0247 ◽

2005 ◽

Vol 102 ◽

pp. 247-254 ◽

Cited By ~ 42

Author(s):

Jason Sheehan ◽

Douglas Kondziolka ◽

John Flickinger ◽

L. Dade Lunsford

Keyword(s):

Lung Cancer ◽

Brain Metastases ◽

Lung Carcinoma ◽

Small Cell Lung Carcinoma ◽

Small Cell ◽

Small Cell Lung ◽

Cell Lung Carcinoma ◽

Content Type ◽

The Brain ◽

Fine Print

Object.Lung carcinoma is the leading cause of death from cancer. More than 50% of those with small cell lung cancer develop a brain metastasis. Corticosteroid agents, radiotherapy, and resection have been the mainstays of treatment. Nonetheless, median survival for patients with small cell lung carcinoma metastasis is approximately 4 to 5 months after cranial irradiation. In this study the authors examine the efficacy of gamma knife surgery for treating recurrent small cell lung carcinoma metastases to the brain following tumor growth in patients who have previously undergone radiation therapy, and they evaluate factors affecting survival.Methods.A retrospective review of 27 patients (47 recurrent small cell lung cancer brain metastases) undergoing radiosurgery was performed. Clinical and radiographic data obtained during a 14-year treatment period were collected. Multivariate analysis was utilized to determine significant prognostic factors influencing survival.The overall median survival was 18 months after the diagnosis of brain metastases. In multivariate analysis, factors significantly affecting survival included: 1) tumor volume (p = 0.0042); 2) preoperative Karnofsky Performance Scale score (p = 0.0035); and 3) time between initial lung cancer diagnosis and development of brain metastasis (p = 0.0127). Postradiosurgical imaging of the brain metastases revealed that 62% decreased, 19% remained stable, and 19% eventually increased in size. One patient later underwent a craniotomy and tumor resection for a tumor refractory to radiosurgery and radiation therapy. In three patients new brain metastases were demonstrating on follow-up imaging.Conclusions.Stereotactic radiosurgery for recurrent small cell lung carcinoma metastases provided effective local tumor control in the majority of patients. Early detection of brain metastases, aggressive treatment of systemic disease, and a therapeutic strategy including radiosurgery can extend survival.

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Analysis of long-term outcomes and prognostic factors in patients with non—small cell lung cancer brain metastases treated by gamma knife radiosurgery

Journal of Neurosurgery ◽

10.3171/jns.2005.102.s_supplement.0075 ◽

2005 ◽

Vol 102 ◽

pp. 75-80 ◽

Cited By ~ 26

Author(s):

Massimo Gerosa ◽

Antonio Nicolato ◽

Roberto Foroni ◽

Laura Tomazzoli ◽

Albino Bricolo

Keyword(s):

Lung Cancer ◽

Prognostic Factors ◽

Brain Metastases ◽

Gamma Knife ◽

Small Cell ◽

Small Cell Lung ◽

Long Term Outcomes ◽

Content Type ◽

Fine Print

Object.The authors conducted a study to evaluate the long-term outcomes and prognostic factors for survival in a large series of patients treated by gamma knife surgery (GKS) for non—small cell lung cancer (NSCLC) brain metastases.Methods.The study is based on the retrospective analysis of clinical and radiological records obtained during a 10-year period (1993–2003), concerning 836 lesions in 504 patients. The lesions were primary in 86% and recurrent 14% of the cases; they were solitary in 31%, single in 29%, and multiple in 40%. The mean follow-up period was 16 months (range 4–113 months). The most common histological types were adenocarcinoma (51%) and squamous cell carcinoma (27%). Dose planning parameters were as follows: mean target volume 6.2 cm3(range 0.06–22.5 cm3); mean prescription dose 21.4 Gy (range 15.5–28 Gy); and mean number of isocenters 6.7 (range one–18). Progression-free and actuarial survival curves were calculated using the Kaplan—Meier method. The main factors affecting survival were determined by unimultivariate analysis (log-rank test and Cox proportional hazard models).Analysis of long-term outcomes seemed to confirm that GKS is a primary therapeutic option in these patients. The 1-year local tumor control rate was 94%. The overall median survival was 14.5 months, with extremely rewarding quality of life indices. The recursive partitioning analysis classification was the dominant prognostic factor.Conclusions.Gamma knife surgery is a useful treatment for brain metastases from NSCLC.

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Metastatic Brain Tumors: To Treat or Not to Treat, and with What?

Current Cancer Therapy Reviews ◽

10.2174/1573394715666181211150849 ◽

2020 ◽

Vol 16 (3) ◽

pp. 168-181

Author(s):

Patricia Tai ◽

Kurian Joseph ◽

Avi Assouline ◽

Osama Souied ◽

Nelson Leong ◽

...

Keyword(s):

Lung Cancer ◽

Brain Metastasis ◽

Brain Tumors ◽

Brain Metastases ◽

Performance Status ◽

Primary Lung Cancer ◽

Small Cell ◽

Metastatic Brain Tumors ◽

Small Cell Lung ◽

Cell Lung Carcinoma

A long time ago, metastatic brain tumors were often not treated and patients were only given palliative care. In the past decade, researchers selected those with single or 1-3 metastases for more aggressive treatments like surgical resection, and/or stereotactic radiosurgery (SRS), since the addition of whole brain radiotherapy (WBRT) did not increase overall survival for the vast majority of patients. Different studies demonstrated significantly less cognitive deterioration in 0-52% patients after SRS versus 85-94% after WBRT at 6 months. WBRT is the treatment of choice for leptomeningeal metastases. WBRT can lower the risk for further brain metastases, particularly in tumors of fast brain metastasis velocity, i.e. quickly relapsing, often seen in melanoma or small cell lung carcinoma. Important relevant literature is quoted to clarify the clinical controversies at point of care in this review. Synchronous primary lung cancer and brain metastasis represent a special situation whereby the oncologist should exercise discretion for curative treatments, with reported 5-year survival rates of 7.6%-34.6%. Recent research suggests that those patients with Karnofsky performance status less than 70, not capable of caring for themselves, are less likely to derive benefit from aggressive treatments. Among patients with brain metastases from non-small cell lung cancer (NSCLC), the QUARTZ trial (Quality of Life after Radiotherapy for Brain Metastases) helps the oncologist to decide when not to treat, depending on the performance status and other factors.

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