Fractionated versus staged gamma knife radiosurgery for mid-to-large brain metastases: a propensity score-matched analysis

Purpose To compare treatment results between fractionated gamma knife radiosurgery (f-GKRS) and staged gamma knife radiosurgery (s-GKRS) for mid-to-large brain metastases (BMs). Methods We retrospectively analyzed data of patients with medium (4–10 mL) to large (> 10 mL) BMs who underwent s-GKRS...

Full description

Saved in:
Bibliographic Details
Published in:Journal of neuro-oncology 2023-08, Vol.164 (1), p.87-96
Main Authors: Noda, Ryuichi, Kawashima, Mariko, Segawa, Masafumi, Tsunoda, Sho, Inoue, Tomohiro, Akabane, Atsuya
Format: Article
Language:English
Subjects:
Brain cancer
Lesions
Magnetic resonance imaging
Medicine
Medicine & Public Health
Metastases
Metastasis
Neuroimaging
Neurology
Oncology
Radiosurgery
Survival
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Purpose To compare treatment results between fractionated gamma knife radiosurgery (f-GKRS) and staged gamma knife radiosurgery (s-GKRS) for mid-to-large brain metastases (BMs). Methods We retrospectively analyzed data of patients with medium (4–10 mL) to large (> 10 mL) BMs who underwent s-GKRS or f-GKRS between March 2008 and September 2022. Patients were treated with (i) s-GKRS before May 2018 and (ii) f-GKRS after May 2018. Patients who underwent follow-up magnetic resonance imaging at least once were enrolled. Case-matched studies were conducted by applying propensity score matching to minimize treatment selection bias and potential confounding. Local control (LC) was set as the primary endpoint and overall survival (OS) as the secondary endpoint. Results This study included 129 patients with 136 lesions and 70 patients with 78 lesions who underwent s-GKRS and f-GKRS, respectively. Overall, 124 lesions (62 lesions in each group) were selected in the case-matched group. No differences were observed in the 6-month and 1-year cumulative incidences of LC failure between the s-GKRS and f-GKRS groups (15.6% vs. 15.9% at 6 months and 25.6% vs. 25.6% at 1 year; p = 0.617). One-year OS rates were 62.6% (95% confidence interval [CI]: 45.4–75.7%) and 73.9% (95% CI: 58.8–84.2%) in the s-GKRS and f-GKRS groups, respectively. The post-GKRS median survival time was shorter in the s-GKRS group than in the f-GKRS group (17 vs. 36 months), without significance (p = 0.202). Conclusions This is the first study to compare f-GKRS and s-GKRS in large BMs. Fractionation is as effective as staged GKRS for treating mid-to-large BMs.
ISSN:0167-594X
1573-7373
DOI:10.1007/s11060-023-04374-8