Stereotactic Drainage And Gamma Knife Radiosurgery Of Cystic Brain Metastasis

Alberto Franzin1, Piero Picozzi, MD2, Davide Milani3, Carlo Serra3, Alberto Vimercati3, Angelo Bolognesi3, Antonella Del Vecchio4, Lorenzo Gioia3, Camillo da Ferrari3, Pietro Mortini3

1Milano, Italy 2Department of Neurosurgery, IRCCS San Raffaele 3RCCS S. Raffaele, Milano, Italia 4Milan, Italy

Keywords: cyst, gamma knife, brain metastasis, aspiration, outcome

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       Treatment options for patients with brain metastasis include tumor resection, whole-brain radiation therapy and radiosurgery. Single treatment is not useful in cases of multiple tumors, of which at least one is a cystic tumor.
     The purpose of this study was to asses the role of stereotactic drainage and gamma knife radiosurgery in the treatment of cystic brain metastasis.
     Study inclusive criteria were: no prior whole-brain radiation therapy or surgical resection, a maximum number of five lesions on pre-op MRI scan, at least one cystic lesion, KPS > 70, histological diagnosis of malignant tumor. Between February 2001 and December 2007, 41 patients were included in this study (24 male, 17 female; mean age 64 yrs; range 34-79 yrs). The primary cancer in most patients was lung (NSCLC; 27 pts, 66%). A single metastasis was present in 13 pts (43.3%). The total number of tumors was 102, of those 34 were cystic. 16 patients (39 %) were in RPA class I, 20 (61%) were in class II.
     Gamma Knife, The mean prescription dose to the tumor margin was 19.5 Gy (range 12-25 Gy).
     Before drainage the mean tumor volume was 21.8 ml (3.8-68 ml); after drainage and before Gamma Knife the mean tumor volume was 10.1 ml (1.2-32 ml). The mean prescription dose to the tumor margin was 19.5 Gy (range 12-25 Gy). Overall median survival was 14 months. One and two year survival rates were 54% (95% C.I. 45.3-64.1%) and 33% (95% C.I. 23.1-45.3%). Local tumor control was achieved in 94.5%.
     This is a retrospective study.
     This study supports the use of a multiple stereotactic approach in cases of multiple and cystic brain metastasis. 


Project Roles:

A. Franzin (), P. Picozzi (), D. Milani (), C. Serra (), A. Vimercati (), A. Bolognesi (), A. Del Vecchio (), L. Gioia (), C. da Ferrari (), P. Mortini ()