Acta Neurochirurgica

, Volume 160, Issue 12, pp 2379–2386 | Cite as

The influence of histology on the response of brain metastases to gamma knife radiosurgery: a propensity score-matched study

  • Kyung Hwan Kim
  • Min Ho Lee
  • Kyung-Rae Cho
  • Jung-Won Choi
  • Doo-Sik Kong
  • Ho Jun Seol
  • Do-Hyun Nam
  • Jung-Il LeeEmail author
Original Article - Brain Tumors
Part of the following topical collections:
  1. Brain tumors



In terms of response to fractionated radiotherapy, metastatic brain tumors of certain origins are considered radioresistant.


To determine the influence of “radioresistant” histology on outcomes of brain metastases treated with radiosurgery.


Between 2001 and 2017, 121 patients with brain metastases from renal cell carcinoma (RCC) and 2151 from non-small cell lung cancer (NSCLC) were reviewed. Eighty-seven pairs were derived using propensity score matching. Local progression-free survival (PFS), progression patterns, distant PFS, and overall survival were investigated.


The median follow-up period was 13.7 months (range, 1.6–78.4 months). A total of 536 lesions were treated using gamma knife radiosurgery (GKS), with a median dose of 20 Gy (range, 12–28 Gy). The actuarial local PFS rates in the RCC group were 91% and 89% at 6 and 12 months, respectively, and did not differ from the NSCLC group (97% and 83% at 6 and 12 months, respectively). Continuous progression, without response to GKS, was noted in seven of the eight progressed RCCs. However, six of the seven progressed NSCLCs showed transient shrinkage before progression. The median distant PFS was 9.3 months (95% CI, 6.3–12.2) in the RCC group and 8.0 months (95% CI, 5.5–10.4) in the NSCLC group. The median overall survival was 16.1 months (95% CI, 11.3–20.8) and 14.9 months (95% CI, 11.9–17.8) in RCC and NSCLC groups, respectively.


Histological differences had no effect on local control in the single high-dose range used for radiosurgery. However, changes in tumor volume during progression varied across tumor histology.


Brain metastasis Propensity score matching Radioresistant Radiosurgery 



Whole brain radiotherapy


Renal cell carcinoma


Magnetic resonance imaging


Stereotactic radiosurgery


Non-small cell lung cancer


Gamma knife radiosurgery


Propensity score matching


Karnofski performance score


Standardized mean difference


Leptomeningeal seeding


Progression-free survival


Overall survival


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statements

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. This study was approved by the institutional review boards (No. 2017-10-067); For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea

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