Gamma knife stereotactic radiosurgery in the treatment of brainstem metastases: The MD Anderson experience

Khinh Voong, Benjamin Farnia, Qianghu Wang, Dershan Luo, Mary F. McAleer, Ganesh Rao, Nandita Guha-Thakurta, Anna Likhacheva, Amol J. Ghia, Paul D. Brown, Jing Li

Research output: Contribution to journalArticle

Abstract

Background. Brainstem metastases (BSMs) represent a significant treatment challenge. Stereotactic radiosurgery (SRS) is often used to treat BSM. We report our experience in the treatment of BSM with Gamma Knife SRS (GK_SRS). Methods. The records of 1962 patients with brain metastases treated with GK_SRS between 2009 and 2013 were retrospectively reviewed. Seventy-four patients with 77 BSMs and follow-up brain imaging were identified. Local control (LC), overall survival (OS), progression-free survival (PFS), and toxicity were assessed. Results. Median follow-up was 5.5 months (range, 0.2-48.5 months). Median tumor volume was 0.13 cm3 (range, 0.003-5.58 cm3). Median treatment dose was 16 Gy (range, 10-20 Gy) prescribed to 50% isodose line (range, 40%-86%). Crude LC was 94% (72/77). Kaplan-Meier estimate of median OS was 8.5 months (95% CI, 5.6-9.4 months). Symptomatic lesions and larger lesions, especially size ≥2 cm3, were associated with worse LC (HR = 8.70, P = .05; HR = 14.55, P = .02; HR = 62.81, P,.001) and worse OS (HR = 2.00, P = .02; HR = 2.14, P = .03; HR = 2.81, P = .008). Thirty-six percent of BSMs were symptomatic, of which 36% (10/28) resolved after SRS and 50% (14/28) had stable or improved symptoms. Actuarial median PFS was 3.9 months (95% CI, 2.7-4.9 months). Midbrain location was significant for worse PFS (HR = 2.29, P = .03). Toxicity was low (8%, 6/74), with size and midbrain location associated with increased toxicity (HR 1.57, P = .05; HR = 5.25, P = .045). Conclusions. GK_SRS is associated with high LC (94%) and low toxicity (8%) for BSMs. Presence of symptoms or lesion size ≥ 2 cm3 was predictive of worse LC and OS.

Original languageEnglish (US)
Pages (from-to)40-47
Number of pages8
JournalNeuro-Oncology Practice
Volume2
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Radiosurgery
Brain Stem
Neoplasm Metastasis
Disease-Free Survival
Mesencephalon
Therapeutics
Survival
Kaplan-Meier Estimate
Tumor Burden
Neuroimaging
Brain

Keywords

  • Brainstem metastases
  • Gamma Knife
  • Radiosurgery

ASJC Scopus subject areas

  • Medicine (miscellaneous)

Cite this

Gamma knife stereotactic radiosurgery in the treatment of brainstem metastases : The MD Anderson experience. / Voong, Khinh; Farnia, Benjamin; Wang, Qianghu; Luo, Dershan; McAleer, Mary F.; Rao, Ganesh; Guha-Thakurta, Nandita; Likhacheva, Anna; Ghia, Amol J.; Brown, Paul D.; Li, Jing.

In: Neuro-Oncology Practice, Vol. 2, No. 1, 01.01.2015, p. 40-47.

Research output: Contribution to journalArticle

Voong, K, Farnia, B, Wang, Q, Luo, D, McAleer, MF, Rao, G, Guha-Thakurta, N, Likhacheva, A, Ghia, AJ, Brown, PD & Li, J 2015, 'Gamma knife stereotactic radiosurgery in the treatment of brainstem metastases: The MD Anderson experience', Neuro-Oncology Practice, vol. 2, no. 1, pp. 40-47. https://doi.org/10.1093/nop/npu032
Voong, Khinh ; Farnia, Benjamin ; Wang, Qianghu ; Luo, Dershan ; McAleer, Mary F. ; Rao, Ganesh ; Guha-Thakurta, Nandita ; Likhacheva, Anna ; Ghia, Amol J. ; Brown, Paul D. ; Li, Jing. / Gamma knife stereotactic radiosurgery in the treatment of brainstem metastases : The MD Anderson experience. In: Neuro-Oncology Practice. 2015 ; Vol. 2, No. 1. pp. 40-47.
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abstract = "Background. Brainstem metastases (BSMs) represent a significant treatment challenge. Stereotactic radiosurgery (SRS) is often used to treat BSM. We report our experience in the treatment of BSM with Gamma Knife SRS (GK_SRS). Methods. The records of 1962 patients with brain metastases treated with GK_SRS between 2009 and 2013 were retrospectively reviewed. Seventy-four patients with 77 BSMs and follow-up brain imaging were identified. Local control (LC), overall survival (OS), progression-free survival (PFS), and toxicity were assessed. Results. Median follow-up was 5.5 months (range, 0.2-48.5 months). Median tumor volume was 0.13 cm3 (range, 0.003-5.58 cm3). Median treatment dose was 16 Gy (range, 10-20 Gy) prescribed to 50{\%} isodose line (range, 40{\%}-86{\%}). Crude LC was 94{\%} (72/77). Kaplan-Meier estimate of median OS was 8.5 months (95{\%} CI, 5.6-9.4 months). Symptomatic lesions and larger lesions, especially size ≥2 cm3, were associated with worse LC (HR = 8.70, P = .05; HR = 14.55, P = .02; HR = 62.81, P,.001) and worse OS (HR = 2.00, P = .02; HR = 2.14, P = .03; HR = 2.81, P = .008). Thirty-six percent of BSMs were symptomatic, of which 36{\%} (10/28) resolved after SRS and 50{\%} (14/28) had stable or improved symptoms. Actuarial median PFS was 3.9 months (95{\%} CI, 2.7-4.9 months). Midbrain location was significant for worse PFS (HR = 2.29, P = .03). Toxicity was low (8{\%}, 6/74), with size and midbrain location associated with increased toxicity (HR 1.57, P = .05; HR = 5.25, P = .045). Conclusions. GK_SRS is associated with high LC (94{\%}) and low toxicity (8{\%}) for BSMs. Presence of symptoms or lesion size ≥ 2 cm3 was predictive of worse LC and OS.",
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T1 - Gamma knife stereotactic radiosurgery in the treatment of brainstem metastases

T2 - The MD Anderson experience

AU - Voong, Khinh

AU - Farnia, Benjamin

AU - Wang, Qianghu

AU - Luo, Dershan

AU - McAleer, Mary F.

AU - Rao, Ganesh

AU - Guha-Thakurta, Nandita

AU - Likhacheva, Anna

AU - Ghia, Amol J.

AU - Brown, Paul D.

AU - Li, Jing

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background. Brainstem metastases (BSMs) represent a significant treatment challenge. Stereotactic radiosurgery (SRS) is often used to treat BSM. We report our experience in the treatment of BSM with Gamma Knife SRS (GK_SRS). Methods. The records of 1962 patients with brain metastases treated with GK_SRS between 2009 and 2013 were retrospectively reviewed. Seventy-four patients with 77 BSMs and follow-up brain imaging were identified. Local control (LC), overall survival (OS), progression-free survival (PFS), and toxicity were assessed. Results. Median follow-up was 5.5 months (range, 0.2-48.5 months). Median tumor volume was 0.13 cm3 (range, 0.003-5.58 cm3). Median treatment dose was 16 Gy (range, 10-20 Gy) prescribed to 50% isodose line (range, 40%-86%). Crude LC was 94% (72/77). Kaplan-Meier estimate of median OS was 8.5 months (95% CI, 5.6-9.4 months). Symptomatic lesions and larger lesions, especially size ≥2 cm3, were associated with worse LC (HR = 8.70, P = .05; HR = 14.55, P = .02; HR = 62.81, P,.001) and worse OS (HR = 2.00, P = .02; HR = 2.14, P = .03; HR = 2.81, P = .008). Thirty-six percent of BSMs were symptomatic, of which 36% (10/28) resolved after SRS and 50% (14/28) had stable or improved symptoms. Actuarial median PFS was 3.9 months (95% CI, 2.7-4.9 months). Midbrain location was significant for worse PFS (HR = 2.29, P = .03). Toxicity was low (8%, 6/74), with size and midbrain location associated with increased toxicity (HR 1.57, P = .05; HR = 5.25, P = .045). Conclusions. GK_SRS is associated with high LC (94%) and low toxicity (8%) for BSMs. Presence of symptoms or lesion size ≥ 2 cm3 was predictive of worse LC and OS.

AB - Background. Brainstem metastases (BSMs) represent a significant treatment challenge. Stereotactic radiosurgery (SRS) is often used to treat BSM. We report our experience in the treatment of BSM with Gamma Knife SRS (GK_SRS). Methods. The records of 1962 patients with brain metastases treated with GK_SRS between 2009 and 2013 were retrospectively reviewed. Seventy-four patients with 77 BSMs and follow-up brain imaging were identified. Local control (LC), overall survival (OS), progression-free survival (PFS), and toxicity were assessed. Results. Median follow-up was 5.5 months (range, 0.2-48.5 months). Median tumor volume was 0.13 cm3 (range, 0.003-5.58 cm3). Median treatment dose was 16 Gy (range, 10-20 Gy) prescribed to 50% isodose line (range, 40%-86%). Crude LC was 94% (72/77). Kaplan-Meier estimate of median OS was 8.5 months (95% CI, 5.6-9.4 months). Symptomatic lesions and larger lesions, especially size ≥2 cm3, were associated with worse LC (HR = 8.70, P = .05; HR = 14.55, P = .02; HR = 62.81, P,.001) and worse OS (HR = 2.00, P = .02; HR = 2.14, P = .03; HR = 2.81, P = .008). Thirty-six percent of BSMs were symptomatic, of which 36% (10/28) resolved after SRS and 50% (14/28) had stable or improved symptoms. Actuarial median PFS was 3.9 months (95% CI, 2.7-4.9 months). Midbrain location was significant for worse PFS (HR = 2.29, P = .03). Toxicity was low (8%, 6/74), with size and midbrain location associated with increased toxicity (HR 1.57, P = .05; HR = 5.25, P = .045). Conclusions. GK_SRS is associated with high LC (94%) and low toxicity (8%) for BSMs. Presence of symptoms or lesion size ≥ 2 cm3 was predictive of worse LC and OS.

KW - Brainstem metastases

KW - Gamma Knife

KW - Radiosurgery

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