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Hypofractionated frameless gamma knife radiosurgery for large metastatic brain tumors

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Abstract

Hypofractionated stereotactic radiosurgery has become an alternative for metastatic brain tumors (METs). We aimed to analyze the efficacy and safety of frameless hypofractionated Gamma Knife radiosurgery (hfGKRS) in the management of unresected, large METs. All patients who were managed with hfGKRS for unresected, large METs (> 4 cm3) between June 2017 and June 2020 at a single center were reviewed in this retrospective study. Local control (LC), progression-free survival (PFS), overall survival (OS), and toxicities were investigated. A total of 58 patients and 76 METs with regular follow-up were analyzed. LC rate was 98.5% at six months, 96.0% at one year, and 90.6% at 2 years during a median follow-up of 12 months (range, 2–37). The log-rank test indicated no difference in the distribution of LC for any clinical or treatment variable. PFS was 86.7% at 6 months, 66.6% at 1 year, and 58.5% at 2 years. OS was 81% at 6 months, 63.6% at one year, and 50.7% at 2 years. On the log-rank test, clinical parameters such as control status of primary cancer, presence of extracranial metastases, RTOG-RPA class, GPA group, and ds-GPA group were significantly associated with PFS and OS. Patients presented with grade 1 (19.0%), grade 2 (3.5%) and grade 3 (5.2%) side effects. Radiation necrosis was not observed in any patients. Our current results suggest that frameless hfGKRS for unresected, large METs is a rational alternative in selected patients with promising results.

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Authors and Affiliations

  1. Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey

    Yavuz Samanci

  2. School of Medicine, Koç University, Istanbul, Turkey

    Uluman Sisman, Alara Altintas, Sebile Sarioglu & Samira Sharifi

  3. Department of Radiation Oncology, Koç University Hospital, Istanbul, Turkey

    Ali İhsan Atasoy

  4. Department of Radiation Oncology, School of Medicine, Koç University, Istanbul, Turkey

    Yasemin Bolukbasi

  5. Department of Neurosurgery, School of Medicine, Koç University, Davutpasa Caddesi No:4, 34010, Zeytinburnu/İstanbul, Turkey

    Selcuk Peker

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  1. Yavuz Samanci
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  8. Selcuk Peker
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All authors contributed to the conception and design, or analysis and interpretation of data, and drafting the article or revising it critically for important intellectual content. All authors read and approved the final manuscript.

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Correspondence to Selcuk Peker.

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This study was approved by the Ethics Committee of Koç University (2020.190.IRB1.058).

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Samanci, Y., Sisman, U., Altintas, A. et al. Hypofractionated frameless gamma knife radiosurgery for large metastatic brain tumors. Clin Exp Metastasis 38, 31–46 (2021). https://doi.org/10.1007/s10585-020-10068-6

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