Authors: Norbert Kased Kim Huang Jean L Nakamura Arjun Sahgal David A Larson Michael W McDermott Penny K Sneed
Publish Date: 2007/07/13
Volume: 86, Issue: 2, Pages: 195-205
Abstract
Purpose To assess clinical and imaging outcomes in patients treated with Gamma Knife stereotactic radiosurgery SRS for brainstem metastases Materials and methods We reviewed all patients with brain metastases treated with SRS at the University of California San Francisco from 1991–2005 to identify patients who had SRS to a brainstem metastasis Survival time and freedom from progression FFP were calculated from date of SRS using the Kaplan–Meier method Prognostic factors were evaluated using the logrank test and Cox proportional hazards model Results From 1991 through 2005 42 consecutive patients with brainstem metastases had SRS to 44 lesions seven midbrain 31 pontine and six medullary in 42 sessions Primary diagnoses included 14 cases of lung cancer one smallcell 10 melanoma 12 breast cancer five renal cell and one unknown The median age was 55 years range 25–79 The median survival time was 9 months after SRS Longer survival time was associated with single metastasis nonmelanoma histology and extracranial disease control The median target volume was 026 ml 0015–28 ml and the median prescribed dose was 160 Gy 100–198 Gy Brainstem lesion FFP was 90 at 6 months and 77 at 1 year Four patients had brainstem complications following treatment Poor brainstem outcome was associated with melanoma and renal cell histology as well as brainstem lesion volume ≥1 ml Conclusions In this series SRS using a median dose of 16 Gy provided excellent local control with relatively low morbidity in patients with brainstem metastases less than 1 ml or nonmelanoma nonrenal cell histology
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