Is Gamma Knife Surgery, Omitting Adjunct Whole Brain Radiation Treatment, Feasible for Patients with 20 or More Brain Metastases?

Overview

Journal Neurooncol Adv

Publisher Oxford University Press

Date 2024 Jun 14

PMID 38873531

Authors

Sherry Liu Jiani

Bengt Karlsson

Balamurugan Vellayappan

Yvonne Ang

Peng Wu

Tseng Tsai Yeo

Vincent Nga

Affiliations

Soon will be listed here.

Abstract

Background: The importance of the number of brain metastases (BM) when deciding between whole brain radiation treatment (WBRT) and radiosurgery is controversial. We hypothesized that the number of BM is of limited importance when deciding radiation strategy, and offered Gamma Knife surgery (GKS) also for selected patients with 20 or more BM.

Methods: The outcome following single session GKS for 75 consecutive patients harboring 20 or more (20+) BM was analyzed. Data was collected both retro- and prospectively.

Results: The median survival time was 9 months. Two grade 3 complications occurred, 1 resolved and 1 did not. Sex and clinical condition at the time of GKS (ECOG value) were the only parameters significantly related to survival time. Eighteen patients developed leptomeningeal dissemination with or without distant recurrences (DR), and another 32 patients developed DR a total of 73 times. DR was managed with GKS 24 times, with WBRT 3 times and with systemic treatment or best supportive care 46 times. The median time to developing DR was unrelated to the number of BM, but significantly longer for patients older than 65 years, as well as for patients with NSCLC.

Conclusions: GKS is a reasonable treatment option for selected patients with 20 or more BM. It is better to decide the optimal management of post-GKS intracranial disease progression once it occurs rather than trying to prevent it by using adjunct WBRT.

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