Salvage treatment of distant recurrent brain metastases with Gamma Knife surgery and a classification system for distant recurrencesKeywords: brain metastasis, recurrent disease, gamma knife, grading system, outcomeInteractive Manuscript
Ask Questions of this Manuscript:
What is the background behind your study?
Radiosurgery can be repeated if initial treatment fails for a brain metastasis.
What is the purpose of your study?
The aim of the study was to analyze the results following salvage Gamma Knife® surgery (GKS) for distant recurrent brain metastases in patients earlier treated with GKS for brain metastases.
Describe your patient group.
251 patients were included.
Describe what you did.
Survival time and freedom from new distant recurrences (DR) were studied in 251 patients treated with salvage GKS for brain metastases that had developed following a first GKS. The patients were followed prospectively and the results related to a number of patient parameters as well as the results following the first GKS.
Describe your main findings.
The median survival time was 9.6 months after salvage GKS and the median time of freedom for developing DR was 7.5 months. Survival time was unrelated to age, gender, prior WBRT, and primary disease (Lung ca vs. non-lung ca). The survival time was significantly longer in patients with single DR at salvage GKS as compared to those with multiple ones (16 versus 8.3 months, P= 0.0011). Patients with 2-4 DR lived longer than those with > 4 lesions, 10 versus 5.8 months (P<0.0001). The survival was significantly longer following salvage GKS as compared to following first GKS (P=0.0013). There were no difference in survival following salvage WBRT as compared to no treatment. The prognosis of a patient with DR seems to be less ominous than earlier assumed. A classification system for DR based on their clinical impact and treatability is therefore suggested. The survival was significantly longer following salvage GKS as compared to following first GKS (P=0.0013). There were no difference in survival following salvage WBRT as compared to no treatment. The prognosis of a patient with DR seems to be less ominous than earlier assumed. A classification system for DR based on their clinical impact and treatability is therefore suggested.
Describe the main limitation of this study.
This was a retrospective study.
Describe your main conclusion.
The longer survival following salvage GKS as compared to following the first GKS challenges the desolate attitude towards the poor prognosis of patients with DR. Our findings suggest that the prognostic impact of DR differs from patient to patient, which should be reflected in the management.
Describe the importance of your findings and how they can be used by others.
A classification system of DR based on the clinical condition of the patient and the need for and goals of additional radiation treatments is suggested.
Radiosurgery can be repeated if initial treatment fails for a brain metastasis.
The aim of the study was to analyze the results following salvage Gamma Knife® surgery (GKS) for distant recurrent brain metastases in patients earlier treated with GKS for brain metastases.
251 patients were included.
Survival time and freedom from new distant recurrences (DR) were studied in 251 patients treated with salvage GKS for brain metastases that had developed following a first GKS. The patients were followed prospectively and the results related to a number of patient parameters as well as the results following the first GKS.
The median survival time was 9.6 months after salvage GKS and the median time of freedom for developing DR was 7.5 months. Survival time was unrelated to age, gender, prior WBRT, and primary disease (Lung ca vs. non-lung ca). The survival time was significantly longer in patients with single DR at salvage GKS as compared to those with multiple ones (16 versus 8.3 months, P= 0.0011). Patients with 2-4 DR lived longer than those with > 4 lesions, 10 versus 5.8 months (P<0.0001). The survival was significantly longer following salvage GKS as compared to following first GKS (P=0.0013). There were no difference in survival following salvage WBRT as compared to no treatment. The prognosis of a patient with DR seems to be less ominous than earlier assumed. A classification system for DR based on their clinical impact and treatability is therefore suggested. The survival was significantly longer following salvage GKS as compared to following first GKS (P=0.0013). There were no difference in survival following salvage WBRT as compared to no treatment. The prognosis of a patient with DR seems to be less ominous than earlier assumed. A classification system for DR based on their clinical impact and treatability is therefore suggested.
This was a retrospective study.
The longer survival following salvage GKS as compared to following the first GKS challenges the desolate attitude towards the poor prognosis of patients with DR. Our findings suggest that the prognostic impact of DR differs from patient to patient, which should be reflected in the management.
A classification system of DR based on the clinical condition of the patient and the need for and goals of additional radiation treatments is suggested.
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