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Efficacy and limitations of salvage gamma knife radiosurgery for brain metastases of small-cell lung cancer after whole-brain radiotherapy

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Abstract

Background

The efficacy and limitations of salvage gamma knife surgery (GKS) have not been thoroughly described. This study evaluated the efficacy of GKS for treating brain metastases associated with small-cell lung cancer (SCLC) after whole-brain radiotherapy (WBRT) as the first-line radiation therapy.

Methods

Forty-four patients with recurrent or new SCLC-associated brain metastases underwent GKS after receiving WBRT (median age, 62 years; median duration between WBRT and first GKS, 8.8 months). The median Karnofsky performance status (KPS) score was 100 (range, 40–100), and the median number of brain metastases at the first GKS was five. Ten patients who partially or completely responded to chemotherapy received prophylactic cranial irradiation (PCI) for limited disease.

Results

The median prescribed dose and number of lesions treated with the initial GKS were 20.0 Gy and 3.5, respectively, and the tumor control rate was 95.8 % (median follow-up period, 4.0 months). The 6-month new lesion-free survival, functional preservation rates, and overall survival were 50.0 %, 94.7 %, and 5.8 months, respectively. Neurological death occurred in 17.9 % of cases. The poor prognostic factors for new lesion-free survival time and functional preservation were >5 brain metastases and carcinomatous meningitis, respectively. Poor prognostic factors for survival time were KPS <70, >10 brain metastases, diameter of the largest tumor >20 mm, and carcinomatous meningitis. Median overall survival time from brain metastasis diagnosis was 16.9 months.

Conclusions

GKS may be an effective option for controlling SCLC-associated brain metastases after WBRT and for preventing neurological death in patients without carcinomatous meningitis.

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Authors and Affiliations

  1. Department of Neurosurgery, Brain Attack Center, Ota Memorial Hospital, 3-6-28 Okinogami, Fukuyama, Hiroshima, 720-0825, Japan

    Kiyoshi Nakazaki

  2. Department of Neurological Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan

    Yoshinori Higuchi

  3. Gamma Knife House, Chiba Cardiovascular Center, 575, Tsurumai, Ichihara-ku, Chiba, 290-0512, Japan

    Osamu Nagano & Toru Serizawa

  4. Tsukiji Neurologic Clinic, Tokyo Gamma Unit Center, 1-9-9 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Toru Serizawa

Authors
  1. Kiyoshi Nakazaki
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  2. Yoshinori Higuchi
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  3. Osamu Nagano
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  4. Toru Serizawa
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Corresponding author

Correspondence to Kiyoshi Nakazaki.

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Comment

The authors present a series of 44 patients whose brain metastases were complicating small-cell lung cancer. This is a highly unusual series for several reasons. This pathology is usually considered to be unsuitable because of the disseminated nature of this particular cancer, and indeed 38 of their patients had uncontrolled systemic disease. Their patient selection allowed patients with simultaneously existing carcinomatous meningitis (5 cases) and up to 36 metastases in one treatment. With retreatment up to five times, they treated up to 69 tumors in one patient, and in some cases treated large tumors in three stages with the Gamma Knife. Despite this approach they found that radiosurgery was, in itself, safe. The systemic disease is of course beyond the reach of the Gamma Knife, but such an aggressive approach may be able to delay or even prevent neurological death.

Andras Kemeny

Sheffield, UK

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Nakazaki, K., Higuchi, Y., Nagano, O. et al. Efficacy and limitations of salvage gamma knife radiosurgery for brain metastases of small-cell lung cancer after whole-brain radiotherapy. Acta Neurochir 155, 107–114 (2013). https://doi.org/10.1007/s00701-012-1520-0

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  • DOI: https://doi.org/10.1007/s00701-012-1520-0

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