Gamma Knife surgery for multiple brain metastases from a malignant schwannoma of the penis

✓The occurrence of brain metastases from a malignant schwannoma of the penis is extremely rare. In patients with a single brain metastasis, microsurgical extirpation is the treatment of choice and verifies the diagnosis. In cases of multiple or recurrent metastases, radiosurgery is an effective and safe therapy option. Gamma Knife surgery was performed in a patient who had previously undergone tumor resection and who presented with recurrence of the lesion and three de novo brain metastases. This first report on brain metastasis from a malignant penile schwannoma illustrates the efficacy and safety of radiosurgical treatment for these tumors.

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Tumor recurrence and survival following gamma knife surgery for brain metastases

Journal of Neurosurgery ◽

10.3171/sup.2005.102.s_supplement.0287 ◽

2005 ◽

Vol 102 (Special_Supplement) ◽

pp. 287-288 ◽

Cited By ~ 2

Author(s):

Thomas Mindermann

Keyword(s):

Brain Metastasis ◽

Brain Metastases ◽

Gamma Knife ◽

Tumor Recurrence ◽

Patient Survival ◽

Gamma Knife Surgery ◽

Recurrence Rates ◽

Term Survival ◽

Content Type ◽

Fine Print

Object. The authors evaluated prognostic factors for tumor recurrence and patient survival following gamma knife surgery (GKS) for brain metastasis. Methods. A retrospective review of 101 patient charts was undertaken for those patients treated with GKS for brain metastases from 1994 to 2001. Recurrence rates of brain metastasis following GKS depended on the duration of patient survival. Long-term survival was associated with a higher risk of tumor recurrence and shorter-term survival was associated with a lower risk. The duration of survival following GKS for brain metastases seems to be characteristic of the primary disease rather than the cerebral disease. Conclusions. Recurrence rates of brain metastasis following GKS are related to duration of survival, which is in turn mostly dependent on the nature and course of the primary tumor.

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Tumor recurrence and survival following gamma knife surgery for brain metastases

Journal of Neurosurgery ◽

10.3171/jns.2005.102.s_supplement.0287 ◽

2005 ◽

Vol 102 ◽

pp. 287-288 ◽

Cited By ~ 7

Author(s):

Thomas Mindermann

Keyword(s):

Brain Metastasis ◽

Brain Metastases ◽

Gamma Knife ◽

Tumor Recurrence ◽

Patient Survival ◽

Gamma Knife Surgery ◽

Recurrence Rates ◽

Term Survival ◽

Content Type ◽

Fine Print

Object.The authors evaluated prognostic factors for tumor recurrence and patient survival following gamma knife surgery (GKS) for brain metastasis.Methods.A retrospective review of 101 patient charts was undertaken for those patients treated with GKS for brain metastases from 1994 to 2001.Recurrence rates of brain metastasis following GKS depended on the duration of patient survival. Long-term survival was associated with a higher risk of tumor recurrence and shorter-term survival was associated with a lower risk. The duration of survival following GKS for brain metastases seems to be characteristic of the primary disease rather than the cerebral disease.Conclusions.Recurrence rates of brain metastasis following GKS are related to duration of survival, which is in turn mostly dependent on the nature and course of the primary tumor.

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Gamma Knife surgery as sole treatment for multiple brain metastases: 2-center retrospective review of 1508 cases meeting the inclusion criteria of the JLGK0901 multi-institutional prospective study

Journal of Neurosurgery ◽

10.3171/2010.8.gks10838 ◽

2010 ◽

Vol 113 (Special_Supplement) ◽

pp. 48-52 ◽

Cited By ~ 37

Author(s):

Toru Serizawa ◽

Masaaki Yamamoto ◽

Yasunori Sato ◽

Yoshinori Higuchi ◽

Osamu Nagano ◽

...

Keyword(s):

Brain Metastases ◽

Gamma Knife ◽

Class Ii ◽

Hazard Ratio ◽

Gamma Knife Surgery ◽

Inclusion Criteria ◽

Primary Tumors ◽

Poor Prognostic Factor ◽

Group A ◽

Group B

Object The authors retrospectively reviewed the results of Gamma Knife surgery (GKS) used as the sole treatment for brain metastases in patients who met the eligibility criteria for the ongoing JLGK0901 multi-institutional prospective trial. They also discuss the anticipated results of the JLGK0901 study. Methods Data from 1508 consecutive cases were analyzed. All of the patients were treated at the Gamma Knife House of Chiba Cardiovascular Center or the Mito Gamma House of Katsuta Hospital between 1998 and 2007 and met the following JLGK0901 inclusion criteria: 1) newly diagnosed brain metastases, 2) 1–10 brain lesions, 3) less than 10 cm3 volume of the largest tumor, 4) no more than 15 cm3 total tumor volume, 5) no findings of CSF dissemination, and 6) no impairment of activities of daily living (Karnofsky Performance Scale score < 70) due to extracranial disease. At the initial treatment, all visible lesions were irradiated with GKS without upfront whole-brain radiation therapy. Thereafter, gadolinium-enhanced MR imaging was performed every 2–3 months, and new distant lesions were appropriately retreated with GKS. Patients were divided into groups according to numbers of tumors: Group A, single lesions (565 cases); Group B, 2–4 tumors (577 cases); and Group C, 5–10 tumors (366 cases). The differences in overall survival (OS) were compared between groups. Results The median age of the patients was 66 years (range 19–96 years). There were 963 men and 545 women. The primary tumors were in the lung in 1114 patients, gastrointestinal tract in 179, breast in 105, urinary tract in 66, and other sites in 44. The overall mean survival time was 0.78 years (0.99 years for Group A, 0.68 years for Group B, and 0.62 years for Group C). The differences between Groups A and B (p < 0.0001) and between Groups B and C (p = 0.0312) were statistically significant. Multivariate analysis revealed significant prognostic factors for OS to be sex (poor prognostic factor: male, p < 0.0001), recursive partitioning analysis class (Class I vs Class II and Class II vs III, both p < 0.0001), primary site (lung vs breast, p = 0.0047), and number of tumors (Group A vs Group B, p < 0.0001). However, no statistically difference was detected between Groups B and C (p = 0.1027, hazard ratio 1.124, 95% CI 0.999–1.265). Conclusions The results of this retrospective analysis revealed an upper CI of 1.265 for the hazard ratio, which was lower than the 1.3 initially set by the JLGK0901 study. The JLGK0901 study is anticipated to show noninferiority of GKS as sole treatment for patients with 5–10 brain metastases compared with those with 2–4 in terms of OS.

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Gamma Knife surgery for metastatic brain tumors

Journal of Neurosurgery ◽

10.3171/jns/2008/109/12/s18 ◽

2008 ◽

Vol 109 (Supplement) ◽

pp. 118-121 ◽

Cited By ~ 9

Author(s):

Toru Serizawa ◽

Masaaki Yamamoto ◽

Osamu Nagano ◽

Yoshinori Higuchi ◽

Shinji Matsuda ◽

...

Keyword(s):

Brain Metastases ◽

Gamma Knife ◽

Patient Selection ◽

Selection Criterion ◽

Gamma Knife Surgery ◽

Treatment Result ◽

Karnofsky Performance Scale ◽

Consecutive Series ◽

Primary Tumors ◽

Patient Selection Criterion

Object The authors compared results of Gamma Knife surgery (GKS) for brain metastases obtained at 2 institutions in Japan. Methods They analyzed a consecutive series of 2390 patients with brain metastases who underwent GKS from 1998 through 2005 in 2 institutes (1181 patients in Chiba; 1209 in Mito). In the 2 facilities, 1 neurosurgeon each was responsible for diagnosis, patient selection, GKS procedures, and follow-up (T.S. in Chiba, M.Y. in Mito). Even if tumor numbers exceeded 4, all visible lesions were irradiated with a total skull integral dose (TSID) of ≤ 10–12 J. No prophylactic whole-brain radiotherapy (WBRT) was applied. If new distant lesions were detected, salvage GKS was appropriately performed. Results The distributions of patient and treatment factors did not differ between institutes. The most common primary tumors were lung cancer (1572 patients), followed by gastrointestinal tract (316), breast (211), kidney (113), and other cancers (159). The median survival periods were 7.7 months in Chiba and 7.0 months in Mito (p = 0.0635). The significant poor prognostic factors for overall survival were active extracranial disease status, male sex, and low initial Karnofsky Performance Scale score on multivariate analysis (all p < 0.0001). The neurological survival rates at 1 year were 86.6% in Chiba and 84.2% in Mito (p = 0.3310). Conclusions This 2-institute study demonstrated no significant institutional differences in any of the treatment result items. Gamma Knife surgery for brain metastases without prophylactic WBRT prevents neurological death and allows a patient to maintain good brain condition. However, there is 1 important patient selection criterion: regardless of how many tumors there are, all lesions can be irradiated with a TSID of ≤12 J.

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Prolonged survival in a subgroup of patients with brain metastases treated by gamma knife surgery

Journal of Neurosurgery ◽

10.3171/sup.2005.102.s_supplement.0262 ◽

2005 ◽

Vol 102 (Special_Supplement) ◽

pp. 262-265

Author(s):

C. P. Yu ◽

Joel Y. C. Cheung ◽

Josie F. K. Chan ◽

Samuel C. L. Leung ◽

Robert T. K. Ho

Keyword(s):

Brain Metastases ◽

Gamma Knife ◽

Patient Survival ◽

Gamma Knife Surgery ◽

Prolonged Survival ◽

Organ Involvement ◽

Lesion Volume ◽

Content Type ◽

The Mean ◽

Fine Print

Object. The authors analyzed the factors involved in determining prolonged survival (≥ 24 months) in patients with brain metastases treated by gamma knife surgery (GKS). Methods. Between 1995 and 2003, a total of 116 patients underwent 167 GKS procedures for brain metastases. There was no special case selection. Smaller and larger lesions were treated with different protocols. The mean patient age was 56.9 years, the mean number of initial lesions was 3.15, and the mean lesion volume was 10.45 cm.3 The mean follow-up time was 9.2 months. The median patient survival was 8.68 months. One-, 2-, 3-, 4-, and 5-year actuarial survival rates were 31.8%, 19.8%, 14.6%, 7.7%, and 6.9%, respectively. Patient age, number of lesions at presentation, and lesion volume had no influence on patient survival. Twenty-three (19.8%) patients survived for 24 months or more. Certain factors were associated with increased survival time. These were stable primary disease (21 of 23 patients), a long latency between diagnosis of the primary tumor and the occurrence of brain metastases (mean 28.4 months, median 16 months), absence of third-organ involvement, and repeated local procedures. Ten patients underwent repeated GKS (mean 3.4 per patient). Seven patients required open surgery for local treatment failures (recurrence or radiation necrosis). Two patients had both. Fifteen patients underwent repeated procedures. Conclusions. Aggressive local therapy with GKS, repeated GKS, and GKS plus surgery can achieve increased survival in a subgroup of patients with stable primary disease, no third-organ involvement, and long primary-brain secondary intervals.

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Ten-Year Survival of a Patient Treated with Stereotactic Gamma Knife Radiosurgery for Brain Metastases from Colon Cancer with Ovarian and Lymph Node Metastases: A Case Report

Case Reports in Gastroenterology ◽

10.1159/000445976 ◽

2016 ◽

Vol 10 (1) ◽

pp. 204-211 ◽

Cited By ~ 2

Author(s):

Nobuhiro Morinaga ◽

Naritaka Tanaka ◽

Yoshinori Shitara ◽

Masatoshi Ishizaki ◽

Takatomo Yoshida ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Brain Metastasis ◽

Brain Metastases ◽

Sigmoid Colon ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Sigmoid Colon Cancer ◽

Ovarian Lesion ◽

Node Metastases

Brain metastasis from colorectal cancer is infrequent and carries a poor prognosis. Herein, we present a patient alive 10 years after the identification of a first brain metastasis from sigmoid colon cancer. A 39-year-old woman underwent sigmoidectomy for sigmoid colon cancer during an emergency operation for pelvic peritonitis. The pathological finding was moderately differentiated adenocarcinoma. Eleven months after the sigmoidectomy, a metastatic lesion was identified in the left ovary. Despite local radiotherapy followed by chemotherapy, the left ovarian lesion grew, so resection of the uterus and bilateral ovaries was performed. Adjuvant chemotherapy with tegafur-uracil (UFT)/calcium folinate (leucovorin, LV) was initiated. Seven months after resection of the ovarian lesion, brain metastases appeared in the bilateral frontal lobes and were treated with stereotactic Gamma Knife radiosurgery. Cervical and mediastinal lymph node metastases were also diagnosed, and irradiation of these lesions was performed. After radiotherapy, 10 courses of oxaliplatin and infused fluorouracil plus leucovorin (FOLFOX) were administered. During FOLFOX administration, recurrent left frontal lobe brain metastasis was diagnosed and treated with stereotactic Gamma Knife radiosurgery. In this case, the brain metastases were well treated with stereotactic Gamma Knife radiosurgery, and the systemic disease arising from sigmoid colon cancer has been kept under control with chemotherapies, surgical resection, and radiotherapy.

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Incidence, timing, and treatment of new brain metastases after Gamma Knife surgery for limited brain disease: the case for reducing the use of whole-brain radiation therapy

Journal of Neurosurgery ◽

10.3171/2011.2.jns101724 ◽

2011 ◽

Vol 115 (1) ◽

pp. 37-48 ◽

Cited By ~ 9

Author(s):

Stephen Rush ◽

Robert E. Elliott ◽

Amr Morsi ◽

Nisha Mehta ◽

Jeri Spriet ◽

...

Keyword(s):

Radiation Therapy ◽

Brain Metastases ◽

Gamma Knife ◽

Gamma Knife Surgery ◽

Whole Brain Radiation Therapy ◽

Leptomeningeal Disease ◽

Whole Brain ◽

Whole Brain Radiation ◽

Brain Radiation

Object In this paper, the authors' goal was to analyze the incidence, timing, and treatment of new metastases following initial treatment with 20-Gy Gamma Knife surgery (GKS) alone in patients with limited brain metastases without whole-brain radiation therapy (WBRT). Methods A retrospective analysis of 114 consecutive adults (75 women and 34 men; median age 61 years) with KPS scores of 60 or higher who received GKS for 1–3 brain metastases ≤ 2 cm was performed (median lesion volume 0.35 cm3). Five patients lacking follow-up data were excluded from analysis. After treatment, patients underwent MR imaging at 6 weeks and every 3 months thereafter. New metastases were preferentially treated with additional GKS. Indications for WBRT included development of numerous metastases, leptomeningeal disease, or diffuse surgical-site recurrence. Results The median overall survival from GKS was 13.8 months. Excluding the 3 patients who died before follow-up imaging, 12 patients (11.3%) experienced local failure at a median of 7.4 months. Fifty-three patients (50%) developed new metastases at a median of 5 months. Six (7%) of 86 instances of new lesions were symptomatic. Most patients (67%) with distant failures were successfully treated using salvage GKS alone. Whole-brain radiotherapy was indicated in 20 patients (18.3%). Thirteen patients (11.9%) died of neurological disease. Conclusions For patients with limited brain metastases and functional independence, 20-Gy GKS provides excellent disease control and high-functioning survival with minimal morbidity. New metastases developed in almost 50% of patients, but additional GKS was extremely effective in controlling disease. Using our algorithm, fewer than 20% of patients required WBRT, and only 12% died of progressive intracranial disease.

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Microsurgery for vestibular schwannoma after Gamma Knife surgery: challenges and treatment strategies

Journal of Neurosurgery ◽

10.3171/2014.8.gks141312 ◽

2014 ◽

Vol 121 (Suppl_2) ◽

pp. 150-159 ◽

Cited By ~ 10

Author(s):

Cheng-Chia Lee ◽

Hsiu-Mei Wu ◽

Wen-Yuh Chung ◽

Ching-Jen Chen ◽

David Hung-Chi Pan ◽

...

Keyword(s):

Gamma Knife ◽

Vestibular Schwannoma ◽

Radiation Effects ◽

Tumor Resection ◽

Treatment Strategies ◽

Gamma Knife Surgery ◽

Neurological Outcomes ◽

Radiological Changes ◽

Cyst Development

ObjectResection of vestibular schwannoma (VS) after Gamma Knife surgery (GKS) is infrequently performed. The goals of this study were to analyze and discuss the neurological outcomes and technical challenges of VS resection and to explore strategies for treating tumors that progress after GKS.MethodsIn total, 708 patients with VS underwent GKS between 1993 and 2012 at Taipei Veterans General Hospital. The post-GKS clinical courses, neurological presentations, and radiological changes in these patients were analyzed. Six hundred patients with imaging follow-up of at least 1 year after GKS treatment were included in this study.ResultsThirteen patients (2.2%) underwent microsurgery on average 36.8 months (range 3–107 months) after GKS. The indications for the surgery included symptomatic adverse radiation effects (in 4 patients), tumor progression (in 6), and cyst development (in 3). No morbidity or death as a result of the surgery was observed. At the last follow-up evaluation, all patients, except 1 patient with a malignant tumor, had stable or near-normal facial function.ConclusionsFor the few VS cases that require resection after radiosurgery, maximal tumor resection can be achieved with modern skull-based techniques and refined neuromonitoring without affecting facial nerve function.

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Neurological complications and symptom resolution following Gamma Knife surgery for brain metastases 2 cm or smaller in relation to eloquent cortices

Journal of Neurosurgery ◽

10.3171/2010.7.gks101047 ◽

2010 ◽

Vol 113 (Special_Supplement) ◽

pp. 53-64 ◽

Cited By ~ 6

Author(s):

Robert E. Elliott ◽

Stephen Rush ◽

Amr Morsi ◽

Nisha Mehta ◽

Jeri Spriet ◽

...

Keyword(s):

Brain Metastases ◽

Gamma Knife ◽

Neurological Complications ◽

Gamma Knife Surgery ◽

Neurological Deterioration ◽

Neurological Deficits ◽

Lesion Volume ◽

Symptom Resolution ◽

Grade Ii ◽

Grade Iii

Object Reports on resection of tumors in or near eloquent cortices have noted neurological complications in up to 30% of patients. This paper contains an analysis of symptom resolution and neurological morbidity following 20-Gy Gamma Knife surgery (GKS) for supratentorial brain metastases ≤ 2 cm in greatest diameter. Methods The authors performed a retrospective analysis of 98 consecutively treated adults (33 men and 65 women with a median age of 61.4 years at the time of GKS) with Karnofsky Performance Scale score ≥ 60, who underwent GKS for supratentorial brain metastases ≤ 2 cm in diameter. Lesion location was classified as noneloquent (Grade I), near eloquent (Grade II), or eloquent (Grade III), in accordance with the grading system developed by the group at M. D. Anderson Cancer Center. Following treatment, the patients underwent MR imaging and clinical examinations at 6 weeks and every 3 months thereafter. Results Ninety-eight patients underwent 20-Gy GKS for 131 metastases at initial presentation and 31 patients underwent salvage 20-Gy GKS for 76 new lesions, for a total of 207 lesions (mean lesion volume 0.44 cm3). Lesions were classified as follows: Grade I, 96 (46.4%); Grade II, 51 (24.6%); and Grade III, 60 (29%). Fifteen patients (2 with Grade II and 13 with Grade III lesions) presented with deficits referable to their lesions, yielding pre-GKS deficit rates of 7.2% per lesion and 15.3% per patient. The pre-GKS deficits improved or resolved in 10 patients (66.7%) at a median time of 2.8 months and remained stable in 3 patients (20%). Two patients (13.3%) experienced worsened neurological deficits. One patient who was neurologically intact prior to treatment developed a new hemiparesis (1 of 83 patients [1.2%]). The rates of permanent neurological deterioration following GKS for Grades I, II, and III lesions were 0% (0 of 96 tumors), 2% (1 of 51), and 3.3% (2 of 60), respectively. The pre-GKS neurological deficits and larger lesions were the most significant risk factors for post-GKS neurological deterioration. Conclusions Gamma Knife surgery performed using a 20-Gy dose provides amelioration of neurological deficits from brain metastases that are ≤ 2 cm in diameter and located in or near eloquent cortices in nearly two-thirds of patients with a low incidence of morbidity. Consistent with the surgical literature, higher rates of neurological complications were observed as proximity to eloquent regions and lesion size increased. There was no neurological deterioration in patients harboring metastases in noneloquent areas.

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