Radiosurgery for brainstem metastases

Keywords: brain stem, gamma knife, brain metastasis, radiosurgery, outcome

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     Uncontrolled brainstem metastasis is associated with significant morbidity and mortality. As the brainstem is a critical normal structure, there has been hesitation to treat these lesions with radiosurgery.  
     We report our single institutional experience of radiosurgery treatment for brain metastases located in the brainstem.
     From Jan 2006 – Dec 2010, 27 patients with 28 brainstem metastases were treated with radiosurgery.
     All patients treated with radiosurgery (Perfexion unit) between Jan 2006-Dec 2010 for brainstem metastasis were selected for retrospective chart review. Baseline patient characteristics including patient age, tumor histology, total number of brain metastases, radiation treatment details and follow-up clinical and radiological response data were captured.
     Histologies of these metastases included: 10 breast, 8 lung, 1 melanoma, 1 renal and 9 other (colorectal, gynaecological, sarcomatous). Doses were prescribed to the 50% isodose and ranged from 12 Gy (n=3 lesions), 15 Gy (n=24) up to 22 Gy (n=1). One patient had 2 brainstem lesions treated concurrently with 12Gy and 1 patient received repeat radiosurgery to the same lesion with 12Gy following an initial radiosurgery treatment with 15Gy. Most patients (n=25) received at least 1 course of whole brain radiotherapy (20Gy/5# or 30Gy/10#) prior to or following radiosurgery and 5 patients received a second course of WBRT (15Gy/5# - 25Gy/10#). Out of 27 patients, 11 were discharged to the community and 16 had ongoing follow-up at our hospital with a median follow-up of 78 days after treatment of the brainstem metastasis. Of the followed patients, 9 had partial response, 6 had stable disease and 1 had progression of the treated brainstem metastasis. However, intracranial disease was controlled in only 6 patients and uncontrolled in 10 patients.
     This was a retrospective study.
     Brainstem metastasis radiosurgery was well tolerated and effective.
     Remote new metastases continued to be a patient problem.


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