Objective : Brainstem metastases are rarely operable and generally unresponsive to conventional radiation therapy or chemotherapy. Recently, Gamma Knife Radiosurgery (GKRS) was used as feasible treatment option for brainstem metastasis. The present study evaluated our experience of brainstem metasta...
Objective : Brainstem metastases are rarely operable and generally unresponsive to conventional radiation therapy or chemotherapy. Recently, Gamma Knife Radiosurgery (GKRS) was used as feasible treatment option for brainstem metastasis. The present study evaluated our experience of brainstem metastasis which was treated with GKRS. Methods : Between November 1992 and June 2010, 32 patients (23 men and 9 women, mean age 56.1 years, range 39-73) were treated with GKRS for brainstem metastases. There were metastatic lesions in pons in 23, the midbrain in 6, and the medulla oblongata in 3 patients, respectively. The primary tumor site was lung in 21, breast in 3, kidney in 2 and other locations in 6 patients. The mean tumor volume was $1,517mm^3$ (range, 9-6,000), and the mean marginal dose was 15.9 Gy (range, 6-23). Magnetic Resonance Imaging (MRI) was obtained every 2-3 months following GKRS. Follow-up MRI was possible in 24 patients at a mean follow-up duration of 12.0 months (range, 1-45). Kaplan-Meier survival analysis was used to evaluate the prognostic factors. Results : Follow-up MRI showed tumor disappearance in 6, tumor shrinkage in 14, no change in tumor size in 1, and tumor growth in 3 patients, which translated into a local tumor control rate of 87.5% (21 of 24 tumors). The mean progression free survival was 12.2 months (range, 2-45) after GKRS. Nine patients were alive at the completion of the study, and the overall mean survival time after GKRS was 7.7 months (range, 1-22). One patient with metastatic melanoma experienced intratumoral hemorrhage during the follow-up period. Survival was found to be associated with score of more than 70 on Karnofsky performance status and low recursive partitioning analysis class (class 1 or 2), in terms of favorable prognostic factors. Conclusion : GKRS was found to be safe and effective for management of brainstem metastasis. The integral clinical status of patient seems to be important in determining the overall survival time.
Objective : Brainstem metastases are rarely operable and generally unresponsive to conventional radiation therapy or chemotherapy. Recently, Gamma Knife Radiosurgery (GKRS) was used as feasible treatment option for brainstem metastasis. The present study evaluated our experience of brainstem metastasis which was treated with GKRS. Methods : Between November 1992 and June 2010, 32 patients (23 men and 9 women, mean age 56.1 years, range 39-73) were treated with GKRS for brainstem metastases. There were metastatic lesions in pons in 23, the midbrain in 6, and the medulla oblongata in 3 patients, respectively. The primary tumor site was lung in 21, breast in 3, kidney in 2 and other locations in 6 patients. The mean tumor volume was $1,517mm^3$ (range, 9-6,000), and the mean marginal dose was 15.9 Gy (range, 6-23). Magnetic Resonance Imaging (MRI) was obtained every 2-3 months following GKRS. Follow-up MRI was possible in 24 patients at a mean follow-up duration of 12.0 months (range, 1-45). Kaplan-Meier survival analysis was used to evaluate the prognostic factors. Results : Follow-up MRI showed tumor disappearance in 6, tumor shrinkage in 14, no change in tumor size in 1, and tumor growth in 3 patients, which translated into a local tumor control rate of 87.5% (21 of 24 tumors). The mean progression free survival was 12.2 months (range, 2-45) after GKRS. Nine patients were alive at the completion of the study, and the overall mean survival time after GKRS was 7.7 months (range, 1-22). One patient with metastatic melanoma experienced intratumoral hemorrhage during the follow-up period. Survival was found to be associated with score of more than 70 on Karnofsky performance status and low recursive partitioning analysis class (class 1 or 2), in terms of favorable prognostic factors. Conclusion : GKRS was found to be safe and effective for management of brainstem metastasis. The integral clinical status of patient seems to be important in determining the overall survival time.
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제안 방법
A Leksell stereotactic coordinate frame was applied to the patient’s head under local anesthesia and stereotactic gadoliniumenhanced MR imaging was then performed for target coordinate determination and dose planning.
All radiosurgical procedures in this study were carried using a Leksell Gamma Knife (B. and C. Elekta, Stockholm, Sweden). A Leksell stereotactic coordinate frame was applied to the patient’s head under local anesthesia and stereotactic gadoliniumenhanced MR imaging was then performed for target coordinate determination and dose planning.
대상 데이터
Fourteen patients had score of more than 70 on the Karnofsky performance status (KPS), and 18 had scores of less than 70. Lesions were located in the pons in 23 patients, the midbrain in 6 and the medulla oblongata in 3 patients. Fifteen patients presented with brainstem signs which comprised long tract signs in 11, ataxia in 1, and diplopia in 3 patients.
MRI was available for 24 patients. Follow-up MRI showed tumor disappearance in 6 patients (25.
The cause of death was documented in 15 patients. Death was related to brainstem metastasis in one patient (increase in hemorrhagic tumor with clinical worsening), development of other brain metastases in five, and aggravation of primary cancer in nine patients.
The clinical characteristics of the 32 patients are summarized in Table 1. The study population consisted of 23 men and 9 women, with a mean age of 56.1 years (range, 39-73). The primary malignancy was lung cancer in 21 patients, breast cancer in 3, renal cell cancer in 2, prostate cancer in 2, and hepatocellular carcinoma, colorectal cancer in 1, gastric cancer in 1, and melanoma in 1.
2). This patient was a 51-year-old man who had a metastatic tumor with hemorrhage from a malignant melanoma in the right temporal lobe. After tumor resection, 4 new supratentorial metastatic lesions appeared, and they were treated using GKRS.
성능/효과
1. A : There is a significant association between survival time and KPS score at the time of GKRS for brainstem metastasis (mean survival time 22 months among 15 patients in score more than 70 on KPS vs. 6 months for 17 in score less than 70 on KPS, p=0.0001). B : RPA Kaplan-Meier survival curve shows significant a difference between the three classes (p=0.
0001). B : RPA Kaplan-Meier survival curve shows significant a difference between the three classes (p=0.0059), with the expected mean survival for class 1 patients to be 17 months, 22 months for class 2, and 7 months for class 3. C : Survival of 15 patients in RPA 3 (mean survival=7 months) compared with 8 patients in RPA 1 and 2 together (mean survival=21 months), p=0.
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