Local control and toxicity outcomes in brainstem metastases treated with single fraction radiosurgery: Is there a volume threshold for toxicity?

Jeremy M. Kilburn, Thomas L. Ellis, James F. Lovato, James J. Urbanic, J. Daniel Bourland, Michael T. Munley, Allan F. Deguzman, Kevin P. McMullen, Edward G. Shaw, Stephen B. Tatter, Michael D. Chan

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

Gamma Knife Radiosurgery (GKRS) has been reported in the treatment of brainstem metastases while dose volume toxicity thresholds remain mostly undefined. A retrospective review of 52 brainstem metastases in 44 patients treated with GKRS was completed. A median dose of 18 Gy (range 10-22 Gy) was prescribed to the tumor margin (median 50 % isodose). 25 patients had undergone previous whole brain radiation therapy. Toxicity was graded by the LENT-SOMA scale. Mean and median follow-up was 10 and 6 months. Only 3 of the 44 patients are living. Multiple brain metastases were treated in 75 % of patients. Median size of lesions was 0.134 cc, (range 0.013-6.600 cc). Overall survival rate at 1 year was 32 % (95 % CI 51.0-20.1 %) with a median survival time of 6 months (95 % CI 5.0-16.5). Local control rate at 6 months and 1 year was 88 % (95 % CI 70-95 %) and 74 % (95 % CI 52-87 %). Cause of death was neurologic in 17 patients, non-neurologic in 20 patients, and unknown in four. Four patients experienced treatment related toxicities. Univariate analysis of tumor volume revealed that volume greater than 1.0 cc predicted for toxicity. A strategy of using lower marginal doses with GKRS to brain stem metastases appears to lead to a lower local control rate than seen with lesions treated within the standard dose range in other locations. Tumor size greater than 1.0 cc predicted for treatment-related toxicity.

Original languageEnglish (US)
Pages (from-to)167-174
Number of pages8
JournalJournal of Neuro-Oncology
Volume117
Issue number1
DOIs
StatePublished - 2014

Keywords

  • Brainstem
  • Gamma Knife
  • Metastasis
  • Radiosurgery
  • Toxicity

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

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    Kilburn, J. M., Ellis, T. L., Lovato, J. F., Urbanic, J. J., Daniel Bourland, J., Munley, M. T., Deguzman, A. F., McMullen, K. P., Shaw, E. G., Tatter, S. B., & Chan, M. D. (2014). Local control and toxicity outcomes in brainstem metastases treated with single fraction radiosurgery: Is there a volume threshold for toxicity? Journal of Neuro-Oncology, 117(1), 167-174. https://doi.org/10.1007/s11060-014-1373-x