| Combined Treatment for Large Cystic Brain Metastasis : Radiosurgery and Stereotactic Aspiration |
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Moinay Kim, Do Hoon Kwon, Jeong Hoon Kim, Won Hyoung Park, Do Hee Lee, Chang Jin Kim |
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Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan College of Medicine, Seoul, Korea |
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| Abstract |
Objective
To evaluate the efficacy of stereotactic aspiration prior to gamma knife radiosurgery (GKRS) in the treatment of large cystic brain metastases.
Methods
From January 2002 to January 2012, 52 patients with large cystic brain metastases were referred to our hospital for GKRS ; 32 of these patients had single large cystic brain metastases. Of the 52 included patients, there were 30 men and 22 women, with a mean age of 57.7 years (range : 27-83 years). The most common primary tumor was non-small cell lung cancer (24 patients, 46.2%). Stereotactic cystic drainage, with or without Ommaya reservoir insertion, was aseptically performed by neurosurgeons in the operating room.
Results
Of the 52 patients analyzed, 29 (55.8%) showed tumor control and 23 (44.2%) showed tumor progression ; 10 (19.2%) locally and 13 (25.0%) remotely. Locally progressed patients underwent either repeat GKRS or whole brain radiotherapy (WBRT) or surgery. The overall median survival after GKRS was 18.9 months (range : 1-65 months) ; 20.8 months for patients in recursive partitioning analysis(RPA) class 1, 12.3 months for patients in RPA class 2, and 7.8 months for patients in RPA class 3. Median progression-free survival after treatment was 15.9 months.
Conclusions
Stereotactic cyst aspiration prior to radiosurgery is a safety and efficient treatment for brain metastases. By reducing the volume of the cystic tumor, a lower radiation dosage can be delivered, enabling radiation toxicity to be avoided. Also this will give a chance of higher prescription dose which will lead to a better tumor control. |
| Key Words:
Brain metastases, Gamma knife radiosurgery, Stereotactic aspiration. |
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