Abstract
Purpose
We retrospectively evaluated the survival of patients with brain metastases from advanced gastric cancer (AGC) after radiosurgery (RS).
Methods
Between 1998 and 2007, a total of 11 patients (median age, 61 years; range, 36–70) were diagnosed with brain metastasis from AGC and treated with RS. Each of five (46%) patients had two brain metastases. The median volume of the 16 lesions was 2.9 cm3 (range, 0.1–33.8). The median marginal dose prescribed was 20 Gy (range, 10–25) at the 50% isodose line. RS was the primary treatment for brain metastases in six patients.
Results
As of February 28, 2008, eight (73%) patients had died, and three (27%) were living with stable disease. The median survival time was 17.0 ± 3.9 months (95% CI, 9.4–24.6). The median progression-free survival time was 9.0 ± 2.5 months (95% CI, 4.2–13.8). Patients who did not undergo WBRT died within 8 months, and the other six patients treated with WBRT at various time intervals from the diagnosis of brain metastases survived, with a median survival time of 19.0 ± 3.4 months (95% CI, 12.4–25.6).
Conclusions
Radiosurgery seems to be a good alternative to surgical resection for patients with brain metastases from AGC, when performed in conjunction with WBRT.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Al-Shamy G, Sawaya R (2009) Management of brain metastases: the indispensable role of surgery. J Neurooncol 92:275–282
Bono P, Bartoloni Saint Omer F (1994) A rare case of bilateral metastasis in the cerebellopontine angle. Pathologica 86:324–328
Han JH, Kim DG, Chung HT, Park CK, Paek SH, Kim CY, Jung HW (2008) Gamma knife radiosurgery for skull base meningiomas: long-term radiologic and clinical outcome. Int J Radiat Oncol Biol Phys 72:1324–1332
Hasegawa T, Kondziolka D, Flickinger JC, Lunsford LD (2003) Stereotactic radiosurgery for brain metastases from gastrointestinal tract cancer. Surg Neurol 60:506–514 discussion 514–505
Kakar A, Sethi PK, Agarwal CS, Bhalla S, Mahajan M (1998) Leptomeningeal and brain metastasis in a young patient of signet ring cell carcinoma of stomach. J Assoc Phys India 46:320–321
Kasakura Y, Fujii M, Mochizuki F, Suzuki T, Takahashi T (2000) Clinicopathological study of brain metastasis in gastric cancer patients. Surg Today 30:485–490
Kim M (1999) Intracranial involvement by metastatic advanced gastric carcinoma. J Neurooncol 43:59–62
Kobayashi M, Araki K, Matsuura K, Kawai S, Moriki T (2002) Early gastric cancer giving rise to bone and brain metastases–a review of the Japanese literature. Hepatogastroenterology 49:1751–1754
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 66:167–174
Nomura T, Yoshikawa T, Kato H, Nikkuni K, Sasaki K, Shirai Y, Hatakeyama K (1997) Early gastric cancer manifested as brain metastasis: report of a case. Surg Today 27:334–336
Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655
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 322:494–500
Schwesinger G, Pusinelli WD (1974) Acoustic neurinoma with metastases of a carcinoma of the stomach (author's transl). Zentralbl Allg Pathol 118:473–475
York JE, Stringer J, Ajani JA, Wildrick DM, Gokaslan ZL (1999) Gastric cancer and metastasis to the brain. Ann Surg Oncol 6:771–776
Acknowledgement
This study was supported by grant no. 11-2008-027 from the SNUBH Research fund and was partially supported by Nuclear Research & Development Program of the Korea Science and Engineering Foundation (KOSEF) grant funded by the Korean government (MEST) (grant no. M20090078163). The statistical analysis was supported by the Medical Research Collaborating Center, Seoul National University Hospital.
Author information
Authors and Affiliations
Corresponding author
Additional information
Comment
The authors describe their experience with Gamma Knife treatment of 11 patients with cerebral metastases from one of the most aggressive type of cancer, advanced gastric cancer. It has been reasonably well established that survival of patients with cerebral metastases depends largely on the systemic disease; there is relatively limited information available in the literature regarding this particular type of cancer. As quoted in the introduction of this paper, median survival is usually less than 2 1/2 months. Also, whole-brain radiotherapy alone has been a very poor choice of management as the response is very limited.
Owing to the minimally invasive nature of Gamma Knife radiosurgery, it was possible for this group to treat a small batch of patients with advanced gastric cancer. Their data collection and analysis are sound. The "proof of concept" is proven: there is no reason why the pathology would rule out radiosurgery, and it can be done for patients in poor general state. The problem is the low number of cases. Each of the 11 seems to have had a different path, some with chemotherapy, re-treatments, etc. The stated conclusion of using GKRS and WBRT is in keeping with previous findings, but the paper does not necessarily offer proof. More sophisticated studies are indeed necessary, as stated by the authors.
Andras Kemeny
Sheffield, UK
Rights and permissions
About this article
Cite this article
Han, J.H., Kim, D.G., Chung, HT. et al. Radiosurgery for brain metastasis from advanced gastric cancer. Acta Neurochir 152, 605–610 (2010). https://doi.org/10.1007/s00701-009-0554-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-009-0554-4