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Evaluation of new lesions and symptoms after gamma knife radiosurgery for brain metastases: a retrospective cohort study

  • Original Article - Brain Tumors
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Abstract

Background

Symptomatic new lesions that appear after gamma knife radiosurgery (GKRS) for brain metastases have not been thoroughly described.

Methods

Among 238 patients who underwent a single session of GKRS without whole-brain radiotherapy or surgery for brain metastases between 2009 and 2014, a total of 165 (69.3%) patients underwent follow-up magnetic resonance imaging (MRI). Their electrical health records were reviewed retrospectively. The median age was 68 years, and 62.4% patients were men. The median number of brain metastases was 2. The most frequent primary organ site was the lung (71.5%). Then, we evaluated predictors for the symptoms of new lesions.

Results

New lesions and leptomeningeal dissemination were observed in 101 (61.2%) and 23 (14.2%) patients, respectively. The median number of new lesions was 2; moreover, 20 of 101 patients (19.8%) with new lesions had tumours with the largest diameters of > 1 cm. Among 101 patients with new lesions, 13 were symptomatic (12.9%). Patients with larger new lesions (> 1 cm of the largest diameter) experienced symptoms more frequently (odds ratio 7.6, P < 0.01). Symptoms resolved after salvage GKRS in seven of 11 patients who abided by the recommended follow-up MRI schedule. No significant risk factors were found for symptoms of new lesions.

Conclusions

The incidence of symptomatic new lesions that appeared after GKRS was low, and more than half of the patients showed improvements in their symptoms after salvage GKRS. However, careful MRI-based assessments and salvage GKRS are critical for the quality of life.

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Authors and Affiliations

  1. Department of Neurosurgery, Brain Attack Center, Ota Memorial Hospital, 3-6-28 Okinogami, Fukuyama, Hiroshima, 720-0825, Japan

    Kiyoshi Nakazaki

  2. Department of Human Health Sciences, School of Medicine, Kyoto University, Kyoto, Japan

    Masakazu Nishigaki

Authors
  1. Kiyoshi Nakazaki
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  2. Masakazu Nishigaki
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Correspondence to Kiyoshi Nakazaki.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Nakazaki, K., Nishigaki, M. Evaluation of new lesions and symptoms after gamma knife radiosurgery for brain metastases: a retrospective cohort study. Acta Neurochir 160, 1461–1471 (2018). https://doi.org/10.1007/s00701-018-3524-x

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  • DOI: https://doi.org/10.1007/s00701-018-3524-x

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