Abstract
Background:Gamma knife radiosurgery (GKRS) has emerged as an important treatment option for metastasis brain tumors (MBTs). However, the long-term outcome of GKRS on MBTs originating from lung carcinoma is not well understood. The treatment of MBTs derived from lung cancer with GKRS at our institution is reviewed.Methods:We performed a retrospective review (2000-2013) of 173 patients with MBTs from lung cancer who received GKRS. Out of 173 patients, 38 patients had recurrent tumors after microsurgical resection and whole brain radiotherapy (WBT).Results:GKRS in MBTs metastasized from lung carcinoma showed significant variations in tumor growth control (decreased in 79 [45.7%] patients, arrested growth in 54 [31.2%] patients, and increased tumor size in 40 [23.1%] patients). The median survival in the study population was 14 months. Overall survival after 3 years was 25%, whereas progression-free survival after 3 years was 45%. The predictive factors for improving survival in the patients with MBTs were recursive partitioning analysis (RPA) class I (P = 0.005), absence of hydrocephalus (P = 0.001), Karnofsky performance scale (KPS) >70 (P = 0.007), age ≤65 (P = 0.041), tumor size ≤3 cm (P = 0.023), controlled primary tumor (P = 0.049), and single number of MBTS (P = 0.044).Conclusion:Long-term follow-up revealed that GKRS offers a high rate of tumor control and good overall survival period in both new and recurrent patients with MBTs originating from lung carcinoma. Thus, GKRS is an effective treatment option for new patients with MBTs from lung cancer, as well as an adjuvant therapy in patients with recurrent MBTs derived from lung cancer.
Highlights
Gamma knife radiosurgery (GKRS) has emerged as an important treatment option for metastasis brain tumors (MBTs)
We evaluated our experience in the management and long‐term outcomes of GKRS on MBTs derived from lung carcinoma, focused on tumor control, survival, and predictive factors of survival
Our study showed that the median survival of patients with MBTs after GKRS was 14 months, which is very consistent with previous reports.[7,19,21,22,23,25]
Summary
We performed a retrospective review (2000-2013) of 173 patients with MBTs from lung cancer who received GKRS. Information related to clinical history, surgery, neuroimaging, and outcomes of the patients with MBTs originated from lung cancer between 2000 and 2013 were collected retrospectively by review of the patient’s case notes, follow‐up chart, and radiology reports. Thirty‐eight (22%) patients had recurrence brain metastases. According to recursive partitioning analysis (RPA classification), 107 (61.8%) had class I MBTs, 60 (34.7%) had class II MBTs, and 6 (3.5%) had class III MBTs. Fifty‐eight (33.5%) patients had single MBTs and 115 (66.5%) had multiple MBTs. Brain metastases were located in the following order including 48 (27.8%) cases in the frontal lobe, 34 (19.6%) in the parietal lobe, 23 (13.3%) in the temporal lobe, 22 (12.7%) in the occipital lobe, and 42 (24.3%) in the cerebellum. Thirty‐one (17.9%) patients had extra‐cranial metastasis and eight (4.6%) cases had hydrocephalus [Tables 1 and 2]
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