Three-stage Gamma Knife treatment for metastatic brain tumors larger than 10 cm 3

A 2-institute study including re-analyses of earlier results using competing risk analysis

Masaaki Yamamoto, Yoshinori Higuchi, Toru Serizawa, Takuya Kawabe, Osamu Nagano, Yasunori Sato, Takao Koiso, Shinya Watanabe, Hitoshi Aiyama, Hidetoshi Kasuya

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Abstract

OBJECTIVE The results of 3-stage Gamma Knife treatment (3-st-GK-Tx) for relatively large brain metastases have previously been reported for a series of patients in Chiba, Japan (referred to in this study as the C-series). In the current study, the authors reappraised, using a competing risk analysis, the efficacy and safety of 3-st-GK-Tx by comparing their experience with that of the C-series. METHODS This was a retrospective cohort study. Among 1767 patients undergoing GK radiosurgery for brain metastases at Mito Gamma House during the 2005–2015 period, 78 (34 female, 44 male; mean age 65 years, range 35–86 years) whose largest tumor was > 10 cm 3 , treated with 3-st-GK-Tx, were studied (referred to in this study as the M-series). The target volumes were covered with a 50% isodose gradient and irradiated with a peripheral dose of 10 Gy at each procedure. The interval between procedures was 2 weeks. Because competing risk analysis had not been employed in the published C-series, the authors reanalyzed the previously published data using this method. RESULTS The overall median survival time after 3-st-GK-Tx was 8.3 months (95% CI 5.6–12.0 months) in the M-series and 8.6 months (95% CI 5.5–10.6 months) in the C-series (p = 0.41). Actuarial survival rates at the 6th and 12th post–3-st-GK-Tx months were, respectively, 55.1% and 35.2% in the M-series and 62.5% and 26.4% in the C-series (HR 1.175, 95% CI 0.790–1.728, p = 0.42). Cumulative incidences at the 12th post–3-st-GK-Tx, determined by competing risk analyses, of neurological deterioration (14.2% in C-series vs 12.8% in M-series), neurological death (7.2% vs 7.7%), local recurrence (4.8% vs 6.2%), repeat SRS (25.9% vs 18.0%), and SRS-related complications (2.3% vs 5.1%) did not differ significantly between the 2 series. CONCLUSIONS There were no significant differences in post–3-st-GK-Tx results between the 2 series in terms of overall survival times, neurological death, maintained neurological status, local control, repeat SRS, and SRS-related complications. The previously published results (C-series) are considered to be validated by the M-series results.

Original languageEnglish
Pages (from-to)77-85
Number of pages9
JournalJournal of neurosurgery
Volume129
DOIs
Publication statusPublished - 2018 Dec 1

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Brain Neoplasms
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Cohort Studies
Therapeutics
Survival Rate
Retrospective Studies
Safety
Recurrence
Survival
Incidence
Neoplasms

Keywords

  • Brain metastases
  • Gamma Knife
  • Oncology
  • Stereotactic radiosurgery
  • Three-stage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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Three-stage Gamma Knife treatment for metastatic brain tumors larger than 10 cm 3 : A 2-institute study including re-analyses of earlier results using competing risk analysis. / Yamamoto, Masaaki; Higuchi, Yoshinori; Serizawa, Toru; Kawabe, Takuya; Nagano, Osamu; Sato, Yasunori; Koiso, Takao; Watanabe, Shinya; Aiyama, Hitoshi; Kasuya, Hidetoshi.

In: Journal of neurosurgery, Vol. 129, 01.12.2018, p. 77-85.

Research output: Contribution to journalArticle

Yamamoto, Masaaki ; Higuchi, Yoshinori ; Serizawa, Toru ; Kawabe, Takuya ; Nagano, Osamu ; Sato, Yasunori ; Koiso, Takao ; Watanabe, Shinya ; Aiyama, Hitoshi ; Kasuya, Hidetoshi. / Three-stage Gamma Knife treatment for metastatic brain tumors larger than 10 cm 3 : A 2-institute study including re-analyses of earlier results using competing risk analysis. In: Journal of neurosurgery. 2018 ; Vol. 129. pp. 77-85.
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title = "Three-stage Gamma Knife treatment for metastatic brain tumors larger than 10 cm 3: A 2-institute study including re-analyses of earlier results using competing risk analysis",
abstract = "OBJECTIVE The results of 3-stage Gamma Knife treatment (3-st-GK-Tx) for relatively large brain metastases have previously been reported for a series of patients in Chiba, Japan (referred to in this study as the C-series). In the current study, the authors reappraised, using a competing risk analysis, the efficacy and safety of 3-st-GK-Tx by comparing their experience with that of the C-series. METHODS This was a retrospective cohort study. Among 1767 patients undergoing GK radiosurgery for brain metastases at Mito Gamma House during the 2005–2015 period, 78 (34 female, 44 male; mean age 65 years, range 35–86 years) whose largest tumor was > 10 cm 3 , treated with 3-st-GK-Tx, were studied (referred to in this study as the M-series). The target volumes were covered with a 50{\%} isodose gradient and irradiated with a peripheral dose of 10 Gy at each procedure. The interval between procedures was 2 weeks. Because competing risk analysis had not been employed in the published C-series, the authors reanalyzed the previously published data using this method. RESULTS The overall median survival time after 3-st-GK-Tx was 8.3 months (95{\%} CI 5.6–12.0 months) in the M-series and 8.6 months (95{\%} CI 5.5–10.6 months) in the C-series (p = 0.41). Actuarial survival rates at the 6th and 12th post–3-st-GK-Tx months were, respectively, 55.1{\%} and 35.2{\%} in the M-series and 62.5{\%} and 26.4{\%} in the C-series (HR 1.175, 95{\%} CI 0.790–1.728, p = 0.42). Cumulative incidences at the 12th post–3-st-GK-Tx, determined by competing risk analyses, of neurological deterioration (14.2{\%} in C-series vs 12.8{\%} in M-series), neurological death (7.2{\%} vs 7.7{\%}), local recurrence (4.8{\%} vs 6.2{\%}), repeat SRS (25.9{\%} vs 18.0{\%}), and SRS-related complications (2.3{\%} vs 5.1{\%}) did not differ significantly between the 2 series. CONCLUSIONS There were no significant differences in post–3-st-GK-Tx results between the 2 series in terms of overall survival times, neurological death, maintained neurological status, local control, repeat SRS, and SRS-related complications. The previously published results (C-series) are considered to be validated by the M-series results.",
keywords = "Brain metastases, Gamma Knife, Oncology, Stereotactic radiosurgery, Three-stage",
author = "Masaaki Yamamoto and Yoshinori Higuchi and Toru Serizawa and Takuya Kawabe and Osamu Nagano and Yasunori Sato and Takao Koiso and Shinya Watanabe and Hitoshi Aiyama and Hidetoshi Kasuya",
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day = "1",
doi = "10.3171/2018.7.GKS181392",
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TY - JOUR

T1 - Three-stage Gamma Knife treatment for metastatic brain tumors larger than 10 cm 3

T2 - A 2-institute study including re-analyses of earlier results using competing risk analysis

AU - Yamamoto, Masaaki

AU - Higuchi, Yoshinori

AU - Serizawa, Toru

AU - Kawabe, Takuya

AU - Nagano, Osamu

AU - Sato, Yasunori

AU - Koiso, Takao

AU - Watanabe, Shinya

AU - Aiyama, Hitoshi

AU - Kasuya, Hidetoshi

PY - 2018/12/1

Y1 - 2018/12/1

N2 - OBJECTIVE The results of 3-stage Gamma Knife treatment (3-st-GK-Tx) for relatively large brain metastases have previously been reported for a series of patients in Chiba, Japan (referred to in this study as the C-series). In the current study, the authors reappraised, using a competing risk analysis, the efficacy and safety of 3-st-GK-Tx by comparing their experience with that of the C-series. METHODS This was a retrospective cohort study. Among 1767 patients undergoing GK radiosurgery for brain metastases at Mito Gamma House during the 2005–2015 period, 78 (34 female, 44 male; mean age 65 years, range 35–86 years) whose largest tumor was > 10 cm 3 , treated with 3-st-GK-Tx, were studied (referred to in this study as the M-series). The target volumes were covered with a 50% isodose gradient and irradiated with a peripheral dose of 10 Gy at each procedure. The interval between procedures was 2 weeks. Because competing risk analysis had not been employed in the published C-series, the authors reanalyzed the previously published data using this method. RESULTS The overall median survival time after 3-st-GK-Tx was 8.3 months (95% CI 5.6–12.0 months) in the M-series and 8.6 months (95% CI 5.5–10.6 months) in the C-series (p = 0.41). Actuarial survival rates at the 6th and 12th post–3-st-GK-Tx months were, respectively, 55.1% and 35.2% in the M-series and 62.5% and 26.4% in the C-series (HR 1.175, 95% CI 0.790–1.728, p = 0.42). Cumulative incidences at the 12th post–3-st-GK-Tx, determined by competing risk analyses, of neurological deterioration (14.2% in C-series vs 12.8% in M-series), neurological death (7.2% vs 7.7%), local recurrence (4.8% vs 6.2%), repeat SRS (25.9% vs 18.0%), and SRS-related complications (2.3% vs 5.1%) did not differ significantly between the 2 series. CONCLUSIONS There were no significant differences in post–3-st-GK-Tx results between the 2 series in terms of overall survival times, neurological death, maintained neurological status, local control, repeat SRS, and SRS-related complications. The previously published results (C-series) are considered to be validated by the M-series results.

AB - OBJECTIVE The results of 3-stage Gamma Knife treatment (3-st-GK-Tx) for relatively large brain metastases have previously been reported for a series of patients in Chiba, Japan (referred to in this study as the C-series). In the current study, the authors reappraised, using a competing risk analysis, the efficacy and safety of 3-st-GK-Tx by comparing their experience with that of the C-series. METHODS This was a retrospective cohort study. Among 1767 patients undergoing GK radiosurgery for brain metastases at Mito Gamma House during the 2005–2015 period, 78 (34 female, 44 male; mean age 65 years, range 35–86 years) whose largest tumor was > 10 cm 3 , treated with 3-st-GK-Tx, were studied (referred to in this study as the M-series). The target volumes were covered with a 50% isodose gradient and irradiated with a peripheral dose of 10 Gy at each procedure. The interval between procedures was 2 weeks. Because competing risk analysis had not been employed in the published C-series, the authors reanalyzed the previously published data using this method. RESULTS The overall median survival time after 3-st-GK-Tx was 8.3 months (95% CI 5.6–12.0 months) in the M-series and 8.6 months (95% CI 5.5–10.6 months) in the C-series (p = 0.41). Actuarial survival rates at the 6th and 12th post–3-st-GK-Tx months were, respectively, 55.1% and 35.2% in the M-series and 62.5% and 26.4% in the C-series (HR 1.175, 95% CI 0.790–1.728, p = 0.42). Cumulative incidences at the 12th post–3-st-GK-Tx, determined by competing risk analyses, of neurological deterioration (14.2% in C-series vs 12.8% in M-series), neurological death (7.2% vs 7.7%), local recurrence (4.8% vs 6.2%), repeat SRS (25.9% vs 18.0%), and SRS-related complications (2.3% vs 5.1%) did not differ significantly between the 2 series. CONCLUSIONS There were no significant differences in post–3-st-GK-Tx results between the 2 series in terms of overall survival times, neurological death, maintained neurological status, local control, repeat SRS, and SRS-related complications. The previously published results (C-series) are considered to be validated by the M-series results.

KW - Brain metastases

KW - Gamma Knife

KW - Oncology

KW - Stereotactic radiosurgery

KW - Three-stage

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