Gamma Knife Radiosurgery For Treatment Of Cerebral Metastases From Non-small Cell Lung CancerPiero Picozzi, MD1, Luca Attuati2, Antonella Del Vecchio3, Micaela Motta4, Cesare Cozzarini4, Angelo Bolognesi4, Alberto Franzin5, Daniele Milani2, Pietro Mortini21Department of Neurosurgery, IRCCS San Raffaele 2Gamma Knife Unit 3Milan, Italy 4 Dept of Radiation Oncology 5Mi, Italy Keywords: brain metastasis, gamma knife, lung cancer, outcome, radiosurgery
Aim of this retrospective study is to evaluate efficacy and safety of Gamma Knife radiosurgery (GKRS) for treatment of brain metastases from NSCLC.
Between 2001 and 2006, 373 patients (298 men and 75 women, mean age 64.9 years) with brain metastases from NSCLC underwent GKRS. All of them had KPS=60, number of brain mets =8, confirmed histopathological diagnosis and recent tumor stadiation (<3 months). 35 patients were in RPA class I, 307 patients were in RPA class II, 7 patients were in RPA class III. Mean tumor volume was 3.6 cm3.
Medial marginal dose was 22.5 Gy with isodose at 50% in most cases; median 10-Gy and 12-Gy isodose volumes were 30.8 cm3and 15.8 cm3 respectively. Follow up with contrast-enhanced brain MRI was performed every three months. Overall survival data were collected from internal database, telephonic interviews and identifying registries.
Median follow-up after GKRS was 8.1 months. Mean overall survival was 14.2 months. Of 373 patients, 29 are still alive at present, 104 died from cerebral progression, 176 died from systemic cause. In 64 cases we were not able to assess the cause. 113 pts were submitted to another treatment before or after GKRS (surgery, WBRT, another GKRS, stereotactic drainage of cystic metastasis). Multivariate analysis with COX regression Hazard ratio based on RPA class, surgery, WBRT, age, sex, number of lesions, mean tumor volume, mean peripheral dose, 10-Gy and 12-Gy volumes, identified RPA class and mean total tumor volume as significant in conditioning overall survival. Clinically evident radionecrosis requiring treatment occurred in 8% of patients.
This is a retrospective study.
GKRS was effective in local disease control in these patients. RPA class was the most important prognostic factor.
These data support the use of GKRS as first line therapy especially for patient in good general condition and controlled systemic disease. Project Roles:
P. Picozzi (), L. Attuati (), A. Del Vecchio (), M. Motta (), C. Cozzarini (), A. Bolognesi (), A. Franzin (), D. Milani (), P. Mortini ()