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Gamma knife surgery in the management of brain
metastases from lung carcinoma: a retrospective analysis of survival, local
tumor control, and freedom from new brain metastasis
Jawahar A, Matthew RE, Minagar A, Shukla D, Zhang JH, Willis BK, Ampil F,
Nanda A
Department of Neurosurgery, Louisiana State University Health
Sciences Center, Shreveport, Louisiana 71130-3932, USA.
Object. The objective of this retrospective study was to analyze the
results of stereotactic radiosurgery performed using a gamma knife in the
treatment of 44 consecutive patients with brain metastases from lung
carcinoma.
Methods. Forty-four patients with lung carcinoma were treated for
metastatic brain tumors by performing radiosurgery with a Leksell Gamma
Knife.
Twenty-one patients (47.7%) were women and 23 were men.
The mean age of the patients was 56 years (range 35-77 years).
Twenty-two patients (50%) had solitary tumors and the rest had multiple tumors
(two-six lesions).
Eighteen patients (40.9%) presented with a recurrent and/or progressive brain
disease that previously had been treated with other modalities (surgery,
external-beam radiotherapy, or both).
Fifteen patients had controlled lung disease and 19 patients had systemic
metastases (in lymph nodes, liver, and/or bones) at the time of
radiosurgery.
The median follow-up period was 18.25 months.
All patients were followed up for three different end points: 1) death caused by
the disease; 2) clinical and/or radiological evidence of progression of the
tumor that had been treated with radiosurgery; and 3) appearance of new
lesions.
At the last follow-up review, 17 patients (38.6%) were alive and 27 (61.4%) had
died.
Ten patients (22.7%) died as a result of brain disease (failure of local control
or new metastases).
Controlled primary disease at the time of detection of metastases and the
ability to achieve local tumor control after radiosurgery significantly improved
the patient survival (p < 0.01).
Control of the treated tumor(s) was achieved in 32 of 44 patients (72 tumors)
and 10 patients experienced treatment failure.
In addition to the 44 patients comprising the study population, two other
patients were treated, but died of lung disease too early in the follow-up
period to have been assessed.
As of the last follow-up review, no new brain metastasis had occurred in 36
patients (81.8% [includes surviving and nonsurviving patients]).
The median duration of overall survival was 7 months, the median period of
controlled brain disease was 21 months, and the median period of freedom from
new brain metastases was 17 months (95% confidence interval 13-19 months).
Conclusions. Gamma knife surgery has significantly reduced the
incidence of mortality from brain disease by effectively accomplishing local
tumor control in patients with metastatic lung cancer.
Local control and freedom from new brain metastases is not influenced by prior
external-beam radiotherapy.
PMID: 15137603 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15137603
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