Comparison of treatment results between 3- And 2-stage Gamma Knife radiosurgery for large brain metastases: A retrospective multi-institutional study

Toru Serizawa, Yoshinori Higuchi, Masaaki Yamamoto, Shigeo Matsunaga, Osamu Nagano, Yasunori Sato, Kyoko Aoyagi, Shoji Yomo, Takao Koiso, Toshinori Hasegawa, Kiyoshi Nakazaki, Akihito Moriki, Takeshi Kondoh, Yasushi Nagatomo, Hisayo Okamoto, Yukihiko Kohda, Hideya Kawai, Satoka Shidoh, Toru Shibazaki, Shinji OnoueHiroyuki Kenai, Akira Inoue, Hisae Mori

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Abstract

Objective: In order to obtain better local tumor control for large (i.e., > 3 cm in diameter or > 10 cm3 in volume) brain metastases (BMs), 3-stage and 2-stage Gamma Knife surgery (GKS) procedures, rather than a palliative dose of stereotactic radiosurgery, have been proposed. Here, authors conducted a retrospective multi-institutional study to compare treatment results between 3-stage and 2-stage GKS for large BMs. Methods: This retrospective multi-institutional study involved 335 patients from 19 Gamma Knife facilities in Japan. Major inclusion criteria were 1) newly diagnosed BMs, 2) largest tumor volume of 10.0-33.5 cm3, 3) cumulative intracranial tumor volume ≤ 50 cm3, 4) no leptomeningeal dissemination, 5) no more than 10 tumors, and 6) Karnofsky Performance Status 70% or better. Prescription doses were restricted to between 9.0 and 11.0 Gy in 3-stage GKS and between 11.8 and 14.2 Gy in 2-stage GKS. The total treatment interval had to be within 6 weeks, with at least 12 days between procedures. There were 114 cases in the 3-stage group and 221 in the 2-stage group. Because of the disproportion in patient numbers and the pre-GKS clinical factors between these two GKS groups, a case-matched study was performed using the propensity score matching method. Ultimately, 212 patients (106 from each group) were selected for the case-matched study. Overall survival, tumor progression, neurological death, and radiation-related adverse events were analyzed. Results: In the case-matched cohort, post-GKS median survival time tended to be longer in the 3-stage group (15.9 months) than in the 2-stage group (11.7 months), but the difference was not statistically significant (p = 0.65). The cumu-lative incidences of tumor progression (21.6% vs 16.7% at 1 year, p = 0.31), neurological death (5.1% vs 6.0% at 1 year, p = 0.58), or serious radiation-related adverse events (3.0% vs 4.0% at 1 year, p = 0.49) did not differ significantly. Conclusions: This retrospective multi-institutional study showed no differences between 3-stage and 2-stage GKS in terms of overall survival, tumor progression, neurological death, and radiation-related adverse events. Both 3-stage and 2-stage GKS performed according to the aforementioned protocols are good treatment options in selected patients with large BMs.

Original languageEnglish
Pages (from-to)227-237
Number of pages11
JournalJournal of neurosurgery
Volume131
Issue number1
DOIs
Publication statusPublished - 2019 Jan 1
Externally publishedYes

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Keywords

  • Case-matched study
  • Competing risk analysis
  • Large brain metastases
  • Multi-institutional cooperative study
  • Oncology
  • Staged Gamma Knife surgery
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Serizawa, T., Higuchi, Y., Yamamoto, M., Matsunaga, S., Nagano, O., Sato, Y., Aoyagi, K., Yomo, S., Koiso, T., Hasegawa, T., Nakazaki, K., Moriki, A., Kondoh, T., Nagatomo, Y., Okamoto, H., Kohda, Y., Kawai, H., Shidoh, S., Shibazaki, T., ... Mori, H. (2019). Comparison of treatment results between 3- And 2-stage Gamma Knife radiosurgery for large brain metastases: A retrospective multi-institutional study. Journal of neurosurgery, 131(1), 227-237. https://doi.org/10.3171/2018.4.JNS172596