Gamma knife radiosurgery for brain metastases from gastrointestinal tract cancers

Takuya Kawabe1, Masaaki Yamamoto2, Bierta E Barfod3, Yoichi Urakawa3

1Hitachi-Naka, Japan 2Ibaraki, Japan 3Katsuta Hospital Mito GammaHouse, Hitachi-naka, Japan

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     Brain metastases (METs) from gastrointestinal (GI) tract cancers are relatively uncommon. 
     We evaluated the efficacy of Gamma Knife radiosurgery (GKRS) for brain METs from GI tract cancers.
     Among our consecutive series of 2,550 patients who underwent GKRS for brain METs at the Katsuta Hospital Mito GammaHouse during the 13-year period from July 1998 to July 2011, 301 (11.8%) patients (92 women, 209 men, mean age; 65 range; 25-88 years) with METs from GI tract cancers were selected for this study.
      The most common primary tumor site was the colon (101 patients) followed by the rectum (96), stomach (66), esophagus (39), duodenum (three) and small intestine (two). Mean and median lesion numbers were 4 and 2, respectively, range 1-37. The median volume of the largest tumors was 6.7 (range; 0.02-55.6) cc, and the median peripheral dose was 20 (range; 10-25) Gy. The median period between original cancer diagnosis and brain MET occurrence was 23 (range; 0- 237) months. The median KPS at the time of GKRS was 80% (range 40-100%).
     The median survival time (MST) was 5.1 months overall. MSTs according to Recursive Partitioning Analysis (RPA) were 16.9 months in Class 1 (7 patients), 5.7 in Class 2 (255) and 2.2 in Class 3 (39). Single metastasis, better KPS, synchronous metastasis and well-controlled primary tumors were significant factors favoring survival. Neurological survival and qualitative survival were 94% and 83% at the 6th post-GKRS month and 90% and 70% at the12th post-GKRS month. Follow-up imaging studies were available in 185 patients (61%). The tumor control rates and new lesion-free survival rates per patient were 84% and 45% at the 6th and 69% and 34% at the12th post-GKRS month.
     This was a retrospective review.
     Our present results suggest GKRS to be effective for GI tract cancer brain MET patients of RPA classes 1 and 2.
     This information can help decision making in brain metastases patients.


Project Roles:

T. Kawabe (), M. Yamamoto (), B. Barfod (), Y. Urakawa ()