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Journal of Neuro-Oncology

, Volume 103, Issue 3, pp 513–521 | Cite as

The efficacy of gamma knife radiosurgery for advanced gastric cancer with brain metastases

  • Young Seok Park
  • Jong Hee Chang
  • Jin Woo Chang
  • Yong Gou Park
Clinical Study – Patient Study

Abstract

The aim of this study was to retrospectively investigate the efficacy of gamma knife radiosurgery for brain metastases from advanced gastric cancer (AGC) comparing whole brain radiotherapy (WBRT). Between January 1991 and May 2008, 56 patients with brain metastases from AGC, treated with GKR or WBRT, were reviewed to assess prognostic factors affecting survival. Most brain metastases were diagnosed based on MRI, both metachronous and synchronous brain metastases, adenocarcinoma and signet ring carcinoma were included, but excluded cases of gastric lymphoma. Fifteen patients with a median age of 54.0 years (range, 42–67 years) were treated with GKR: 11 were treated with GKR only, 2 with surgery plus GKR, 1 with repeated GKR, 1 with GKR plus WBRT, and the other 1 with WBRT plus GKR. Forty-one were treated with WBRT only. The median number of metastatic brain lesions was 3 (range, 1–15), and treatment involved 17.0 Gy (range 14–23.6 Gy), or 30 Gy with fractionated radiotherapy. The median survival after brain metastases for GKR treatment was 40.0 weeks [95% confidence interval (CI) 44.9–132.1 weeks] and WBRT was 9.0 weeks 95% CI, 8.8–21.9 weeks). The progression free survival of 15 GKR treated patients was 56.5 weeks (95% CI 33.4–79.5 weeks). The recursive partitioning analysis (RPA) (class 2 vs. class 3) and use of GKR were correlated with prolonged survival in univariate and multivariate analyses. Age, sex, pathology, leptomeningeal seeding, tumor size (≥3 cm), extracranial metastases, single metastasis, chemotherapy, and synchronous metastases were not correlated with a good prognosis in both univariate and multivariate analysis. Based on our study, the use of GKR and RPA class 2 resulted in more favorable clinical outcomes in patients with brain metastases from AGC.

Keywords

Gastric cancer Metastasis Radio surgery Radiotherapy Survival 

Notes

Acknowledgments

The authors thank Mi Kyung Eom (RN), Hana Kang (RN), and Gi Hong Kim (Radiology technician, BS) for data acquisition and assistance with this manuscript.

References

  1. 1.
    Ferlay J, Bray F, Pisani P, Parkin DM (2004) GLOBOCAN 2002: cancer incidence. Mortality and Prevalence Worldwide. IARC CancerBase No. 5, version2.0. IARC Press, LyonGoogle Scholar
  2. 2.
    Lee JL, Kang YK, Kim TW, Chang HM, Lee GW, Ryu MH, Kim E, Oh SJ, Lee JH, Kim SB, Kim SW, Suh C, Lee KH, Lee JS, Kim WK, Kim SH (2004) Leptomeningeal carcinomatosis in gastric cancer. J Neurooncol 66:167–174PubMedCrossRefGoogle Scholar
  3. 3.
    Ministry of Health and Welfare (2003) Ministry of Health and Welfare 2002 Annual report of the Korea Central Cancer Registry, SeoulGoogle Scholar
  4. 4.
    York JE, Stringer J, Ajani JA, Wildrick DM, Gokaslan ZL (1999) Gastric cancer and metastasis to the brain. Ann Surg Oncol 6:771–776PubMedCrossRefGoogle Scholar
  5. 5.
    Kasakura Y, Fujii M, Mochizuki F, Suzuki T, Takahashi T (2000) Clinicopathological study of brain metastasis in gastric cancer patients. Surg Today 30:485–490PubMedCrossRefGoogle Scholar
  6. 6.
    Kim M (1999) Intracranial involvement by metastatic advanced gastric carcinoma. J Neurooncol 43:59–62PubMedCrossRefGoogle Scholar
  7. 7.
    Hasegawa T, Kondziolka D, Flickinger JC, Lunsford LD (2003) Stereotactic radiosurgery for brain metastases from gastrointestinal tract cancer. Surg Neurol 60: 506-514; Discussion: 514–505Google Scholar
  8. 8.
    Han JH, Kim DG, Chung HT, Kim CY, Park CK, Chung YS, Paek SH, Yoo MW, Kim BH, Jung HW (2010) Radiosurgery for brain metastasis from advanced gastric cancer. Acta Neurochir (Wien) 152(5):605–610Google Scholar
  9. 9.
    Lutterbach J, Weissenberger C, Momm F, Bartelt S (2004) Patients with brain metastases from gastrointestinal tract cancer treated with whole brain radiation therapy: prognostic factors and survival. World J Gastroenterol 10:3345–3348PubMedGoogle Scholar
  10. 10.
    Da Silva AN, Nagayama K, Schlesinger DJ, Sheehan JP (2009) Gamma knife surgery for brain metastases from gastrointestinal cancer. J Neurosurg 111:423–430PubMedCrossRefGoogle Scholar
  11. 11.
    Mizumatsu S, Nishimura T, Sakai K, Goto M, Sugatani H, Higashi T (2006) A case of brain metastasis from gastric cancer involving bilateral middle cerebellar peduncles. No Shinkei Geka 34:955–960PubMedGoogle Scholar
  12. 12.
    Hizawa K, Nagata Y, Taniguchi M, Nakamori M, Matsumoto T, Iida M (2008) Case of gastric cancer with isolated brain metastasis successfully managed by gamma knife radiotherapy and chemotherapy. Nippon Shokakibyo Gakkai Zasshi 105:1200–1204PubMedGoogle Scholar
  13. 13.
    Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, Markesbery WR, Macdonald JS, Young B (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494–500PubMedCrossRefGoogle Scholar
  14. 14.
    Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three radiation therapy oncology group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751PubMedCrossRefGoogle Scholar
  15. 15.
    Rades D, Pluemer A, Veninga T, Hanssens P, Dunst J, Schild SE (2007) Whole-brain radiotherapy versus stereotactic radiosurgery for patients in recursive partitioning analysis classes 1 and 2 with 1 to 3 brain metastases. Cancer 110:2285–2292PubMedCrossRefGoogle Scholar
  16. 16.
    Rades D, Bohlen G, Pluemer A, Veninga T, Hanssens P, Dunst J, Schild SE (2007) Stereotactic radiosurgery alone versus resection plus whole-brain radiotherapy for 1 or 2 brain metastases in recursive partitioning analysis class 1 and 2 patients. Cancer 109:2515–2521PubMedCrossRefGoogle Scholar
  17. 17.
    Weltman E, Salvajoli JV, Brandt RA, de Morais Hanriot R, Prisco FE, Cruz JC, de Oliveira Borges SR, Wajsbrot DB (2000) Radiosurgery for brain metastases: a score index for predicting prognosis. Int J Radiat Oncol Biol Phys 46:1155–1161PubMedCrossRefGoogle Scholar
  18. 18.
    Nieder C, Nestle U, Motaref B, Walter K, Niewald M, Schnabel K (2000) Prognostic factors in brain metastases: should patients be selected for aggressive treatment according to recursive partitioning analysis (RPA) classes? Int J Radiat Oncol Biol Phys 46:297–302PubMedCrossRefGoogle Scholar
  19. 19.
    Cooper JS, Steinfeld AD, Lerch IA (1990) Cerebral metastases: value of reirradiation in selected patients. Radiology 174:883–885PubMedGoogle Scholar
  20. 20.
    Hazuka MB, Kinzie JJ (1988) Brain metastases: results and effects of re-irradiation. Int J Radiat Oncol Biol Phys 15:433–437PubMedCrossRefGoogle Scholar
  21. 21.
    Kurup P, Reddy S, Hendrickson FR (1980) Results of re-irradiation for cerebral metastases. Cancer 46:2587–2589PubMedCrossRefGoogle Scholar
  22. 22.
    Shehata WM, Hendrickson FR, Hindo WA (1974) Rapid fractionation technique and re-treatment of cerebral metastases by irradiation. Cancer 34:257–261PubMedCrossRefGoogle Scholar
  23. 23.
    Wong WW, Schild SE, Sawyer TE, Shaw EG (1996) Analysis of outcome in patients reirradiated for brain metastases. Int J Radiat Oncol Biol Phys 34:585–590PubMedCrossRefGoogle Scholar
  24. 24.
    Hizawa K, Nagata Y, Taniguchi M, Nakamori M, Matsumoto T, Iida M (2008) Case of gastric cancer with isolated brain metastasis successfully managed by gamma knife radiotherapy and chemotherapy. Nippon Shokakibyo Gakkai Zasshi 105:1200–1204PubMedGoogle Scholar
  25. 25.
    Hlatky R, Suki D, Sawaya R (2004) Carcinoid metastasis to the brain. Cancer 101:2605–2613PubMedCrossRefGoogle Scholar
  26. 26.
    Lisenko Y, Kumar AJ, Yao J, Ajani J, Ho L (2003) Leptomeningeal carcinomatosis originating from gastric cancer: report of eight cases and review of the literature. Am J Clin Oncol 26:165–170PubMedCrossRefGoogle Scholar
  27. 27.
    Lee HG, Lee B, Kim SM, Suh BJ, Yu HJ (2007) A case of gastric adenocarcinoma presenting as meningeal carcinomatosis. Korean J Intern Med 22:304–307PubMedCrossRefGoogle Scholar
  28. 28.
    Grossman SA, Krabak MJ (1999) Leptomeningeal carcinomatosis. Cancer Treat Rev 25:103–119PubMedCrossRefGoogle Scholar
  29. 29.
    Kitayama Y, Yoden Y, Okamoto N (2006) A case of effective paclitaxel therapy for gastric cancer with brain metastasis. Gan To Kagaku Ryoho 33:981–984PubMedGoogle Scholar
  30. 30.
    Rino Y, Sekino Y, Yamada T, Nakayama T, Arai H, Kanari M, Saeki H, Yukawa N, Wada N, Masuda M, Higashida T, Imada T (2007) Irinotecan + cisplatin and irradiation are effective for brain metastases of gastric cancer–two case reports. Gan To Kagaku Ryoho 34:1095–1098PubMedGoogle Scholar
  31. 31.
    Lutterbach J, Bartelt S, Ostertag C (2002) Long-term survival in patients with brain metastases. J Cancer Res Clin Oncol 128:417–425PubMedCrossRefGoogle Scholar
  32. 32.
    Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, Werner-Wasik M, Demas W, Ryu J, Bahary JP, Souhami L, Rotman M, Mehta MP, Curran WJ Jr (2004) Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 363:1665–1672PubMedCrossRefGoogle Scholar
  33. 33.
    Chidel MA, Suh JH, Reddy CA, Chao ST, Lundbeck MF, Barnett GH (2000) Application of recursive partitioning analysis and evaluation of the use of whole brain radiation among patients treated with stereotactic radiosurgery for newly diagnosed brain metastases. Int J Radiat Oncol Biol Phys 47:993–999PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Young Seok Park
    • 1
  • Jong Hee Chang
    • 1
  • Jin Woo Chang
    • 1
  • Yong Gou Park
    • 1
  1. 1.Department of Neurosurgery, Gamma Knife Clinic, Severance Hospital, Brain Research InstituteYonsei University College of MedicineSeoulRepublic of Korea

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