Journal of Neuro-Oncology

, Volume 117, Issue 1, pp 167–174

Local control and toxicity outcomes in brainstem metastases treated with single fraction radiosurgery: is there a volume threshold for toxicity?

  • Jeremy M. Kilburn
  • Thomas L. Ellis
  • James F. Lovato
  • James J. Urbanic
  • J. Daniel Bourland
  • Michael T. Munley
  • Allan F. deGuzman
  • Kevin P. McMullen
  • Edward G. Shaw
  • Stephen B. Tatter
  • Michael D. Chan
Clinical Study

DOI: 10.1007/s11060-014-1373-x

Cite this article as:
Kilburn, J.M., Ellis, T.L., Lovato, J.F. et al. J Neurooncol (2014) 117: 167. doi:10.1007/s11060-014-1373-x

Abstract

Gamma Knife Radiosurgery (GKRS) has been reported in the treatment of brainstem metastases while dose volume toxicity thresholds remain mostly undefined. A retrospective review of 52 brainstem metastases in 44 patients treated with GKRS was completed. A median dose of 18 Gy (range 10–22 Gy) was prescribed to the tumor margin (median 50 % isodose). 25 patients had undergone previous whole brain radiation therapy. Toxicity was graded by the LENT-SOMA scale. Mean and median follow-up was 10 and 6 months. Only 3 of the 44 patients are living. Multiple brain metastases were treated in 75 % of patients. Median size of lesions was 0.134 cc, (range 0.013–6.600 cc). Overall survival rate at 1 year was 32 % (95 % CI 51.0–20.1 %) with a median survival time of 6 months (95 % CI 5.0–16.5). Local control rate at 6 months and 1 year was 88 % (95 % CI 70–95 %) and 74 % (95 % CI 52–87 %). Cause of death was neurologic in 17 patients, non-neurologic in 20 patients, and unknown in four. Four patients experienced treatment related toxicities. Univariate analysis of tumor volume revealed that volume greater than 1.0 cc predicted for toxicity. A strategy of using lower marginal doses with GKRS to brain stem metastases appears to lead to a lower local control rate than seen with lesions treated within the standard dose range in other locations. Tumor size greater than 1.0 cc predicted for treatment-related toxicity.

Keywords

Gamma Knife Brainstem Metastasis Toxicity Radiosurgery 

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Jeremy M. Kilburn
    • 1
  • Thomas L. Ellis
    • 3
  • James F. Lovato
    • 2
  • James J. Urbanic
    • 1
  • J. Daniel Bourland
    • 1
  • Michael T. Munley
    • 1
  • Allan F. deGuzman
    • 1
  • Kevin P. McMullen
    • 1
  • Edward G. Shaw
    • 1
  • Stephen B. Tatter
    • 3
  • Michael D. Chan
    • 1
  1. 1.Department of Radiation OncologyWake Forest School of MedicineWinston-SalemUSA
  2. 2.Division of Public Health SciencesWake Forest School of MedicineWinston-SalemUSA
  3. 3.Department of NeurosurgeryWake Forest School of MedicineWinston-SalemUSA

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