Gamma knife radiosurgery for the treatment of cystic cerebral metastases

Julius Ebinu, Shelly Lwu, Eric Monsalves, Mandana Arayee, Caroline Chung, Normand J. Laperriere, Abhaya V. Kulkarni, Pablo Goetz, Gelareh Zadeh

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Purpose: To assess the role of Gamma Knife radiosurgery (GKRS) in the treatment of nonsurgical cystic brain metastasis, and to determine predictors of response to GKRS. Methods: We reviewed a prospectively maintained database of brain metastases patients treated at our institution between 2006 and 2010. All lesions with a cystic component were identified, and volumetric analysis was done to measure percentage of cystic volume on day of treatment and consecutive follow-up MRI scans. Clinical, radiologic, and dosimetry parameters were reviewed to establish the overall response of cystic metastases to GKRS as well as identify potential predictive factors of response. Results: A total of 111 lesions in 73 patients were analyzed; 57% of lesions received prior whole-brain radiation therapy (WBRT). Lung carcinoma was the primary cancer in 51% of patients, 10% breast, 10% colorectal, 4% melanoma, and 26% other. Fifty-seven percent of the patients were recursive partitioning analysis class 1, the remainder class 2. Mean target volume was 3.3 mL (range, 0.1-23 mL). Median prescription dose was 21 Gy (range, 15-24 Gy). Local control rates were 91%, 63%, and 37% at 6, 12, and 18 months, respectively. Local control was improved in lung primary and worse in patients with prior WBRT (univariate). Only lung primary predicted local control in multivariate analysis, whereas age and tumor volume did not. Lesions with a large cystic component did not show a poorer response compared with those with a small cystic component. Conclusions: This study supports the use of GKRS in the management of nonsurgical cystic metastases, despite a traditionally perceived poorer response. Our local control rates are comparable to a matched cohort of noncystic brain metastases, and therefore the presence of a large cystic component should not deter the use of GKRS. Predictors of response included tumor subtype. Prior WBRT decreased effectiveness of SRS for local control rates.

Original languageEnglish (US)
Pages (from-to)667-671
Number of pages5
JournalInternational Journal of Radiation Oncology Biology Physics
Volume85
Issue number3
DOIs
StatePublished - Mar 1 2013
Externally publishedYes

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Radiosurgery
metastasis
brain
Neoplasm Metastasis
lesions
Brain
lungs
radiation therapy
Radiotherapy
Lung
volumetric analysis
Therapeutics
tumors
cancer
predictions
Tumor Burden
breast
dosimeters
Prescriptions
Melanoma

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Gamma knife radiosurgery for the treatment of cystic cerebral metastases. / Ebinu, Julius; Lwu, Shelly; Monsalves, Eric; Arayee, Mandana; Chung, Caroline; Laperriere, Normand J.; Kulkarni, Abhaya V.; Goetz, Pablo; Zadeh, Gelareh.

In: International Journal of Radiation Oncology Biology Physics, Vol. 85, No. 3, 01.03.2013, p. 667-671.

Research output: Contribution to journalArticle

Ebinu, J, Lwu, S, Monsalves, E, Arayee, M, Chung, C, Laperriere, NJ, Kulkarni, AV, Goetz, P & Zadeh, G 2013, 'Gamma knife radiosurgery for the treatment of cystic cerebral metastases', International Journal of Radiation Oncology Biology Physics, vol. 85, no. 3, pp. 667-671. https://doi.org/10.1016/j.ijrobp.2012.06.043
Ebinu, Julius ; Lwu, Shelly ; Monsalves, Eric ; Arayee, Mandana ; Chung, Caroline ; Laperriere, Normand J. ; Kulkarni, Abhaya V. ; Goetz, Pablo ; Zadeh, Gelareh. / Gamma knife radiosurgery for the treatment of cystic cerebral metastases. In: International Journal of Radiation Oncology Biology Physics. 2013 ; Vol. 85, No. 3. pp. 667-671.
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AU - Ebinu, Julius

AU - Lwu, Shelly

AU - Monsalves, Eric

AU - Arayee, Mandana

AU - Chung, Caroline

AU - Laperriere, Normand J.

AU - Kulkarni, Abhaya V.

AU - Goetz, Pablo

AU - Zadeh, Gelareh

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