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Outcomes of gamma knife radiosurgery, bi-modality & tri-modality treatment regimens for patients with one or multiple brain metastases: the Columbia University Medical Center experience
- Source :
- Journal of Neuro-Oncology. 122:399-408
- Publication Year :
- 2015
- Publisher :
- Springer Science and Business Media LLC, 2015.
-
Abstract
- Optimal treatment of brain metastases (BMs) is debatable. However, surgery or gamma knife radiosurgery (GKRS) improves survival when combined with whole brain radiotherapy (WBRT) versus WBRT alone. We retrospectively reviewed an institutional database of patients treated with GKRS for BMs from 1998 to 2013 to explore effects of single or multi-modality therapies on survival. There were 528 patients with median age 62 years. Histologies included 257 lung, 102 breast, 62 melanoma, 40 renal cell, 29 gastrointestinal, and 38 other primary cancers. Treatments included: 206 GKRS alone, 111 GKRS plus WBRT, 109 GKRS plus neurosurgical resection (NSG), and 102 all three modalities. Median overall survival (mOS) was 16.6 months. mOS among patients with one versus multiple metastasis was 17.2 versus 16.0 months respectively (p = 0.825). For patients with one BM, mOS following GKRS alone, GKRS plus WBRT, GKRS plus NSG, and all three modalities was 9.0, 19.1, 25.5, and 25.0 months, respectively, and for patients with multiple BMs, mOS was 8.6, 20.4, 20.7, 24.5 months for the respective groups. Among all patients, multivariate analysis confirmed that tri-modality group had the longest survival (HR 0.467; 95 % CI 0.350-0.623; p < 0.001) compared to GKRS alone; however, this was not significantly different than bi-modality approaches. Uncontrolled primary extra-CNS disease, age and KPS were also independent predictors of survival. Patients treated with GKRS plus NSG, GKRS plus WBRT, or all three modalities had improved OS versus GKRS alone. In our analysis, resection and GKRS allowed avoidance of WBRT without shortening survival.
- Subjects :
- Adult
Male
Cancer Research
medicine.medical_specialty
Lung Neoplasms
Neurology
medicine.medical_treatment
Breast Neoplasms
Kaplan-Meier Estimate
Radiosurgery
Metastasis
Young Adult
Carcinoma
Humans
Medicine
Combined Modality Therapy
Karnofsky Performance Status
Young adult
Carcinoma, Renal Cell
Melanoma
Aged
Gastrointestinal Neoplasms
Retrospective Studies
Aged, 80 and over
Brain Neoplasms
business.industry
Retrospective cohort study
Middle Aged
medicine.disease
Surgery
Oncology
Multivariate Analysis
Female
Neurology (clinical)
Cranial Irradiation
business
Subjects
Details
- ISSN :
- 15737373 and 0167594X
- Volume :
- 122
- Database :
- OpenAIRE
- Journal :
- Journal of Neuro-Oncology
- Accession number :
- edsair.doi.dedup.....0f8466d9259ea68408c1af8da4605658