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Molecular Biology of Brain Metastasis
Open AccessArticle

Gamma Knife Treatment of Brainstem Metastases

Gamma Knife of Spokane, 910 W 5th Ave, Suite 102, Spokane, WA 99204, USA
Cancer Care Northwest, 910 W 5th Ave, Suite 102, Spokane, WA 99204, USA
School of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98185, USA
MacKay & Meyer MDs, 711 S Cowley St, Suite 210, Spokane, WA 99202, USA
Inland Neurosurgery & Spine Associates, 105 W 8th Ave, Suite 200, Spokane, WA 99204, USA
Spokane Brain & Spine, 801 W 5th Ave, Suite 210, Spokane, WA 99204, USA
DataWorks Northwest, LLC, Coeur D'Alene, ID 83814, USA
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Int. J. Mol. Sci. 2014, 15(6), 9748-9761;
Received: 30 March 2014 / Revised: 1 May 2014 / Accepted: 5 May 2014 / Published: 30 May 2014
(This article belongs to the Special Issue Brain Metastasis 2014)
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. View Full-Text
Keywords: brainstem metastases; Gamma Knife; radiosurgery brainstem metastases; Gamma Knife; radiosurgery
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Peterson, H.E.; Larson, E.W.; Fairbanks, R.K.; MacKay, A.R.; Lamoreaux, W.T.; Call, J.A.; Carlson, J.D.; Ling, B.C.; Demakas, J.J.; Cooke, B.S.; Peressini, B.; Lee, C.M. Gamma Knife Treatment of Brainstem Metastases. Int. J. Mol. Sci. 2014, 15, 9748-9761.

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