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Authors = Alexander R. MacKay

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12 pages, 701 KiB  
Article
Retrospective Study of Metastatic Melanoma and Renal Cell Carcinoma to the Brain with Multivariate Analysis of Prognostic Pre-Treatment Clinical Factors
by Ethan A. Ferrel, Andrew T. Roehrig, Erin A. Kaya, Jonathan D. Carlson, Benjamin C. Ling, Aaron Wagner, Alexander R. MacKay, Jason A. Call, John J. Demakas, Wayne T. Lamoreaux, Robert K. Fairbanks, Barton S. Cooke, Ben Peressini and Christopher M. Lee
Int. J. Mol. Sci. 2016, 17(3), 400; https://doi.org/10.3390/ijms17030400 - 18 Mar 2016
Cited by 11 | Viewed by 6124
Abstract
Patients with brain metastasis from renal cell carcinoma (RCC) or melanoma have historically had very poor prognoses of less than one year. Stereotactic radiosurgery (SRS) can be an effective treatment for patients with these tumors. This study analyzes the effect of pretreatment prognostic [...] Read more.
Patients with brain metastasis from renal cell carcinoma (RCC) or melanoma have historically had very poor prognoses of less than one year. Stereotactic radiosurgery (SRS) can be an effective treatment for patients with these tumors. This study analyzes the effect of pretreatment prognostic factors on overall survival (OS) for RCC and melanoma patients with metastasis to the brain treated with SRS. A total of 122 patients with brain metastases from either RCC or melanoma were grouped by age at brain metastasis diagnosis, whether they received whole brain radiation therapy (WBRT) in addition to SRS, or they underwent surgical resection, Karnofsky Performance Score (KPS), number of brain metastases, and primary tumor. Median survival times for melanoma patients and RCC patients were 8.20 ± 3.06 and 12.70 ± 2.63 months, respectively. Patients with >5 metastases had a significantly shorter median survival time (6.60 ± 2.45 months) than the reference group (1 metastasis, 10.70 ± 13.40 months, p = 0.024). Patients with KPS ≤ 60 experienced significantly shorter survival than the reference group (KPS = 90–100), with median survival times of 5.80 ± 2.46 months (p < 0.001) and 45.20 ± 43.52 months, respectively. We found a median overall survival time of 12.7 and 8.2 months for RCC and melanoma, respectively. Our study determined that a higher number of brain metastases (>5) and lower KPS were statistically significant predictors of a lower OS prognosis. Full article
(This article belongs to the Special Issue Brain Metastasis 2016)
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14 pages, 240 KiB  
Article
Gamma Knife Treatment of Brainstem Metastases
by Halloran E. Peterson, Erik W. Larson, Robert K. Fairbanks, Alexander R. MacKay, Wayne T. Lamoreaux, Jason A. Call, Jonathan D. Carlson, Benjamin C. Ling, John J. Demakas, Barton S. Cooke, Ben Peressini and Christopher M. Lee
Int. J. Mol. Sci. 2014, 15(6), 9748-9761; https://doi.org/10.3390/ijms15069748 - 30 May 2014
Cited by 25 | Viewed by 9341
Abstract
The management of brainstem metastases is challenging. Surgical treatment is usually not an option, and chemotherapy is of limited utility. Stereotactic radiosurgery has emerged as a promising palliative treatment modality in these cases. The goal of this study is to assess our single [...] Read more.
The management of brainstem metastases is challenging. Surgical treatment is usually not an option, and chemotherapy is of limited utility. Stereotactic radiosurgery has emerged as a promising palliative treatment modality in these cases. The goal of this study is to assess our single institution experience treating brainstem metastases with Gamma Knife radiosurgery (GKRS). This retrospective chart review studied 41 patients with brainstem metastases treated with GKRS. The most common primary tumors were lung, breast, renal cell carcinoma, and melanoma. Median age at initial treatment was 59 years. Nineteen (46%) of the patients received whole brain radiation therapy (WBRT) prior to or concurrent with GKRS treatment. Thirty (73%) of the patients had a single brainstem metastasis. The average GKRS dose was 17 Gy. Post-GKRS overall survival at six months was 42%, at 12 months was 22%, and at 24 months was 13%. Local tumor control was achieved in 91% of patients, and there was one patient who had a fatal brain hemorrhage after treatment. Karnofsky performance score (KPS) >80 and the absence of prior WBRT were predictors for improved survival on multivariate analysis (HR 0.60 (p = 0.02), and HR 0.28 (p = 0.02), respectively). GKRS was an effective treatment for brainstem metastases, with excellent local tumor control. Full article
(This article belongs to the Special Issue Brain Metastasis 2014)
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