scholarly journals BRAF Mutation Is Associated with Improved Local Control of Melanoma Brain Metastases Treated with Gamma Knife Radiosurgery

2016 ◽  
Vol 6 ◽  
Author(s):  
Ian S. Gallaher ◽  
Yoichi Watanabe ◽  
Todd E. DeFor ◽  
Kathryn E. Dusenbery ◽  
Chung K. Lee ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Local Control ◽  
Braf Mutation ◽  
Gamma Knife Radiosurgery ◽  
Melanoma Brain Metastases

GAMMA KNIFE RADIOSURGERY IN THE MANAGEMENT OF MALIGNANT MELANOMA BRAIN METASTASES

Neurosurgery ◽  
2007 ◽  
Vol 60 (3) ◽  
pp. 471-482 ◽  
Author(s):  
David Mathieu ◽  
Douglas Kondziolka ◽  
Patrick B. Cooper ◽  
John C. Flickinger ◽  
Ajay Niranjan ◽  
...  
Keyword(s):  
Malignant Melanoma ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Local Control ◽  
Tumor Volume ◽  
Systemic Disease ◽  
Gamma Knife Radiosurgery ◽  
Karnofsky Performance Score ◽  
Performance Score ◽  
Melanoma Brain Metastases

Abstract OBJECTIVE Radiosurgery is increasingly used to manage malignant melanoma brain metastases. We reviewed our series of patients who underwent radiosurgery for melanoma brain metastases to assess clinical outcomes and identify prognostic factors for survival and cerebral disease control. METHODS Two hundred forty-four patients had radiosurgery for the management of 754 metastatic tumors. A mean of 2.6 tumors were irradiated per procedure. The median tumor volume was 4.4 cm3. The median margin and maximum doses used were 18 and 32 Gy, respectively. RESULTS The median survival was 5.3 months after radiosurgery (mean, 10 mo; range, 0.2–114.3 mo). Patients survived a median of 7.8 months (mean, 13.4 mo) from the diagnosis of brain metastases and 44.9 months (mean, 69 mo) after the diagnosis of the primary tumor. Survival was better in patients with controlled systemic disease (12.7 mo), single brain metastasis (6.8 mo), and a Karnofsky performance score of 90 or 100% (6.3 mo). Sustained local control was achieved in 86.2% of tumors. Increased tumor volume and previous evidence of hemorrhage increased the risk of local failure. Multiple lesions and failure to provide systemic immunotherapy were predictors for the occurrence of new brain metastases, which developed in 41.7% of the patients. Symptomatic radiation changes occurred in 6.6% of the patients. Overall, 71.4% of the patients improved or remained clinically stable. Brain disease was the cause of death in 40.5% of the patients, usually from the development of new metastases. CONCLUSION Gamma knife radiosurgery for malignant melanoma brain metastases is safe and effective and provides a high rate of durable local control. Improved survival can be achieved in patients with single metastasis, controlled systemic disease, and a high Karnofsky performance score.

Initial treatment of melanoma brain metastases using gamma knife radiosurgery

Cancer ◽  
2004 ◽  
Vol 101 (4) ◽  
pp. 825-833 ◽  
Author(s):  
Andrew E. Radbill ◽  
John F. Fiveash ◽  
Elizabeth T. Falkenberg ◽  
Barton L. Guthrie ◽  
Paul E. Young ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Initial Treatment ◽  
Gamma Knife Radiosurgery ◽  
Melanoma Brain Metastases

Gamma Knife Radiosurgery for Malignant Melanoma Brain Metastases

Neurosurgery ◽  
2006 ◽  
Vol 59 (2) ◽  
pp. 490 ◽  
Author(s):  
David Mathieu ◽  
Douglas S. Kondziolka ◽  
Patrick Cooper ◽  
John C. Flickinger ◽  
Ajay Niranjan ◽  
...  
Keyword(s):  
Malignant Melanoma ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Melanoma Brain Metastases

Gamma knife radiosurgery and brain metastases: local control, survival, and quality of life

2002 ◽  
Vol 97 ◽  
pp. 507-510 ◽  
Author(s):  
Theodor S. Vesagas ◽  
Jose A. Aguilar ◽  
Eduardo R. Mercado ◽  
Manuel M. Mariano
Keyword(s):  
Quality Of Life ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Median Survival ◽  
Local Control ◽  
Gamma Knife Radiosurgery ◽  
Content Type ◽  
Control Survival ◽  
Fine Print

Object. The purpose of this paper was to describe the clinical outcome in patients with brain metastases who underwent gamma knife radiosurgery (GKS). Methods. The authors retrospectively reviewed the clinical courses of 54 patients with brain metastases who underwent 62 GKS procedures. This series covered a 43-month period. A total of 174 lesions were treated: 38 patients harbored solitary whereas 24 patients harbored multiple metastases. The authors assessed outcome by examining local disease control, survival, and quality of life. The overall local control rate was 85%; the mean time to failure of local control was 10.5 months; and median survival was 8.4 months. Median survival, evaluated by the log-rank test, was greater among patients with a single metastasis (p = 0.043), breast cancer (p = 0.021), and those who had undergone multiple GKS procedures for local failure (p = 0.009). The initial Karnofsky Performance Scale (KPS) score and whole-brain radiotherapy were not significantly related to median survival. The KPS scores tended to remain stable through the follow-up period. There were no morbidities or deaths attributable to the procedure. Conclusions. Results in this series suggest that GKS can be an effective tool for the control of brain metastases. A prospective investigation should be performed to validate trends seen in this retrospective study.

Predictors of Survival, Neurologic Death, Local Failure, and Distant Failure After Gamma Knife Radiosurgery for Melanoma Brain Metastases

2014 ◽  
Vol 82 (6) ◽  
pp. 1250-1255 ◽  
Author(s):  
Matthew T. Neal ◽  
Michael D. Chan ◽  
John T. Lucas ◽  
Amritraj Loganathan ◽  
Christine Dillingham ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Local Failure ◽  
Distant Failure ◽  
Melanoma Brain Metastases

Local Control of Newly Diagnosed and Distally Recurrent, Low-Volume Brain Metastases With Fixed-Dose (20 Gy) Gamma Knife Radiosurgery

Neurosurgery ◽  
2011 ◽  
Vol 68 (4) ◽  
pp. 921-931 ◽  
Author(s):  
Robert E. Elliott ◽  
Stephen C. Rush ◽  
Amr Morsi ◽  
Nisha Mehta ◽  
Jeri Spriet ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Local Control ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Gamma Knife Radiosurgery ◽  
Neurological Complications ◽  
Fixed Dose ◽  
Outcome Analysis

Abstract BACKGROUND: Metastases to the brain occur in 20% to 30% of patients with cancer and have been identified on autopsy in as many as 50% of patients. OBJECTIVE: To analyze the efficacy of 20-Gy Gamma Knife radiosurgery (GKR) as initial treatment in patients with 1 to 3 brain metastases ≤ 2 cm in greatest diameter. METHODS: A retrospective analysis of 114 consecutive adults with Karnofsky performance status ≥ 60 who received GKR for 1 to 3 brain metastases ≤ 2 cm in size was performed. Five patients lacked detailed follow-up and were excluded, leaving 109 for outcome analysis (34 men and 75 women; median age, 61.2 years). All metastases received 20 Gy to the 50% isodose line. RESULTS: One hundred nine patients underwent treatment of 164 metastases at initial GKR. Twenty-six patients (23.9%) were alive at last follow-up (median time, 29.9 months; range, 6.6 months to 7.8 years). The median overall survival was 13.8 months (range, 1 day to 7.6 years). Among the 52 patients with distant failure, 33 patients received 20 Gy to 95 new lesions. A total of 259 metastases received 20 Gy, and 4 patients lacked imaging follow-up secondary to death before posttreatment imaging. Local failure occurred in 17 of 255 treated lesions (6.7%), yielding an overall local control rate of 93.3%. Actuarial local control at 6, 12, 24, and 36 months was 96%, 93%, 89%, and 88%, respectively. Permanent neurological complications occurred in 3 patients (2.8%). CONCLUSION: Among patients with 1 to 3 brain metastases ≤ 2 cm in size who have not received whole-brain radiation therapy, GKR with 20 Gy provides high rates of local control with low morbidity and excellent neurological symptom-free survival.

scholarly journals Tumor Histology Predicts Patterns of Failure and Survival in Patients With Brain Metastases From Lung Cancer Treated With Gamma Knife Radiosurgery

Neurosurgery ◽  
2013 ◽  
Vol 73 (4) ◽  
pp. 641-647 ◽  
Author(s):  
J. Griff Kuremsky ◽  
James J. Urbanic ◽  
W. Jeff Petty ◽  
James F. Lovato ◽  
J. Daniel Bourland ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Brain Metastases ◽  
Cell Carcinoma ◽  
Gamma Knife ◽  
Local Control ◽  
Gamma Knife Radiosurgery ◽  
Primary Lung Cancer ◽  
Small Cell ◽  
Tumor Histology ◽  
Distant Failure

Abstract BACKGROUND: We review our experience with lung cancer patients with newly diagnosed brain metastases treated with Gamma Knife radiosurgery (GKRS). OBJECTIVE: To determine whether tumor histology predicts patient outcomes. METHODS: Between July 1, 2000, and December 31, 2010, 271 patients with brain metastases from primary lung cancer were treated with GKRS at our institution. Included in our study were 44 squamous cell carcinoma (SCC), 31 small cell carcinoma (SCLC), and 138 adenocarcinoma (ACA) patients; 47 patients with insufficient pathology to determine subtype were excluded. No non-small cell lung cancer (NSCLC) patients received whole-brain radiation therapy (WBRT) before their GKRS, and SCLC patients were allowed to have prophylactic cranial irradiation, but no previously known brain metastases. A median of 2 lesions were treated per patient with median marginal dose of 20 Gy. RESULTS: Median survival was 10.2 months for ACA, 5.9 months for SCLC, and 5.3 months for SCC patients (P = .008). The 1-year local control rates were 86%, 86%, and 54% for ACA, SCC, and SCLC, respectively (P = .027). The 1-year distant failure rates were 35%, 63%, and 65% for ACA, SCC, and SCLC, respectively (P = .057). The likelihood of dying of neurological death was 29%, 36%, and 55% for ACA, SCC, and SCLC, respectively (P = .027). The median time to WBRT was 11 months for SCC and 24 months for ACA patients (P = .04). Multivariate analysis confirmed SCLC histology as a significant predictor of worsened local control (hazard ratio [HR]: 6.46, P = .025) and distant failure (HR: 3.32, P = .0027). For NSCLC histologies, SCC predicted for earlier time to salvage WBRT (HR: 2.552, P = .01) and worsened overall survival (HR: 1.77, P < .0121). CONCLUSION: Histological subtype of lung cancer appears to predict outcomes. Future trials and prognostic indices should take these histology-specific patterns into account.

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