The efficacy of gamma knife radiosurgery for advanced gastric cancer with brain metastases |
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Authors: | Young Seok Park Jong Hee Chang Jin Woo Chang Yong Gou Park |
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Institution: | (1) Department of Neurosurgery, Gamma Knife Clinic, Severance Hospital, Brain Research Institute, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemoon-gu, Seoul, 120-752, Republic of Korea; |
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Abstract: | The aim of this study was to retrospectively investigate the efficacy of gamma knife radiosurgery for brain metastases from
advanced gastric cancer (AGC) comparing whole brain radiotherapy (WBRT). Between January 1991 and May 2008, 56 patients with
brain metastases from AGC, treated with GKR or WBRT, were reviewed to assess prognostic factors affecting survival. Most brain
metastases were diagnosed based on MRI, both metachronous and synchronous brain metastases, adenocarcinoma and signet ring
carcinoma were included, but excluded cases of gastric lymphoma. Fifteen patients with a median age of 54.0 years (range,
42–67 years) were treated with GKR: 11 were treated with GKR only, 2 with surgery plus GKR, 1 with repeated GKR, 1 with GKR
plus WBRT, and the other 1 with WBRT plus GKR. Forty-one were treated with WBRT only. The median number of metastatic brain
lesions was 3 (range, 1–15), and treatment involved 17.0 Gy (range 14–23.6 Gy), or 30 Gy with fractionated radiotherapy. The
median survival after brain metastases for GKR treatment was 40.0 weeks 95% confidence interval (CI) 44.9–132.1 weeks] and
WBRT was 9.0 weeks 95% CI, 8.8–21.9 weeks). The progression free survival of 15 GKR treated patients was 56.5 weeks (95% CI
33.4–79.5 weeks). The recursive partitioning analysis (RPA) (class 2 vs. class 3) and use of GKR were correlated with prolonged
survival in univariate and multivariate analyses. Age, sex, pathology, leptomeningeal seeding, tumor size (≥3 cm), extracranial
metastases, single metastasis, chemotherapy, and synchronous metastases were not correlated with a good prognosis in both
univariate and multivariate analysis. Based on our study, the use of GKR and RPA class 2 resulted in more favorable clinical
outcomes in patients with brain metastases from AGC. |
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