Gamma Knife radiosurgery for brain metastases from gastrointestinal primary

Brandi R. Page, Edina C. Wang, Lance White, Emory McTyre, Ann Peiffer, Angela Alistar, Frank Mu, Amritraj Loganathan, John Daniel Bourland, Adrian W. Laxton, Stephen B. Tatter, Michael D. Chan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: In this study, we assessed clinical outcomes of patients with brain metastases from a gastrointestinal (GI) primary cancer and patterns of failure after stereotactic radiosurgery including failure within the radiosurgical volume, distant failure and leptomeningeal failure (LMF). We also assessed other factors associated with the patients’ neurologic and extraneuraxial disease that may affect clinical outcomes. Methods: We reviewed our institutional series of 62 consecutive patients with brain metastases treated with stereotactic radiosurgery, which included 17 patients with oesophageal, 44 patients with colorectal and one patient with anal canal primary. The median marginal dose to the radiosurgery volume was 17 Gy (range 10–24 Gy). Thirteen patients were treated with whole-brain radiotherapy (WBRT) prior to GKS. Results: The median dose delivered to the margin of the tumour was 17 Gy (range: 10–24 Gy). The median largest tumour diameter was 2.7 cm (range: 0.60–6.1 cm). The median overall survival (OS) was 7.1 months with a median follow-up of 6.1 months and a range of 0–31.7 months. Freedom from local failure was 86.5% and 62.2% at 6 and 12 months respectively. Freedom from distant failure was 73.2% and 42.2% at 6 and 12 months, respectively, and 40% of patients died of neurologic death. LMF occurred in seven patients, all of whom had colorectal primaries. Multivariate analysis revealed that craniotomy for resection of brain metastasis (HR = 2.63, P < 0.02), an absence of extracranial disease (HR = 2.28, P < 0.03), and prolonged time to distant brain failure (HR = 2.85, P < 0.01) predicted for improved survival. Conclusions: Colorectal cancer metastases tend to have a higher rate of leptomeningeal failure than other types of GI cancer metastases. Radiosurgical management of brain metastases from GI primary represents an acceptable management option. Neurologic death remains problematic.

Original languageEnglish (US)
Pages (from-to)522-527
Number of pages6
JournalJournal of Medical Imaging and Radiation Oncology
Volume61
Issue number4
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Fingerprint

Radiosurgery
Neoplasm Metastasis
Brain
Gastrointestinal Neoplasms
Nervous System
Survival
Craniotomy
Anal Canal
Nervous System Diseases
Colorectal Neoplasms
Neoplasms
Radiotherapy
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Page, Brandi R. ; Wang, Edina C. ; White, Lance ; McTyre, Emory ; Peiffer, Ann ; Alistar, Angela ; Mu, Frank ; Loganathan, Amritraj ; Bourland, John Daniel ; Laxton, Adrian W. ; Tatter, Stephen B. ; Chan, Michael D. / Gamma Knife radiosurgery for brain metastases from gastrointestinal primary. In: Journal of Medical Imaging and Radiation Oncology. 2017 ; Vol. 61, No. 4. pp. 522-527.
@article{765917dca86a466292d6d61bf555635e,
title = "Gamma Knife radiosurgery for brain metastases from gastrointestinal primary",
abstract = "Introduction: In this study, we assessed clinical outcomes of patients with brain metastases from a gastrointestinal (GI) primary cancer and patterns of failure after stereotactic radiosurgery including failure within the radiosurgical volume, distant failure and leptomeningeal failure (LMF). We also assessed other factors associated with the patients’ neurologic and extraneuraxial disease that may affect clinical outcomes. Methods: We reviewed our institutional series of 62 consecutive patients with brain metastases treated with stereotactic radiosurgery, which included 17 patients with oesophageal, 44 patients with colorectal and one patient with anal canal primary. The median marginal dose to the radiosurgery volume was 17 Gy (range 10–24 Gy). Thirteen patients were treated with whole-brain radiotherapy (WBRT) prior to GKS. Results: The median dose delivered to the margin of the tumour was 17 Gy (range: 10–24 Gy). The median largest tumour diameter was 2.7 cm (range: 0.60–6.1 cm). The median overall survival (OS) was 7.1 months with a median follow-up of 6.1 months and a range of 0–31.7 months. Freedom from local failure was 86.5{\%} and 62.2{\%} at 6 and 12 months respectively. Freedom from distant failure was 73.2{\%} and 42.2{\%} at 6 and 12 months, respectively, and 40{\%} of patients died of neurologic death. LMF occurred in seven patients, all of whom had colorectal primaries. Multivariate analysis revealed that craniotomy for resection of brain metastasis (HR = 2.63, P < 0.02), an absence of extracranial disease (HR = 2.28, P < 0.03), and prolonged time to distant brain failure (HR = 2.85, P < 0.01) predicted for improved survival. Conclusions: Colorectal cancer metastases tend to have a higher rate of leptomeningeal failure than other types of GI cancer metastases. Radiosurgical management of brain metastases from GI primary represents an acceptable management option. Neurologic death remains problematic.",
author = "Page, {Brandi R.} and Wang, {Edina C.} and Lance White and Emory McTyre and Ann Peiffer and Angela Alistar and Frank Mu and Amritraj Loganathan and Bourland, {John Daniel} and Laxton, {Adrian W.} and Tatter, {Stephen B.} and Chan, {Michael D.}",
year = "2017",
month = "8",
day = "1",
doi = "10.1111/1754-9485.12584",
language = "English (US)",
volume = "61",
pages = "522--527",
journal = "Journal of Medical Imaging and Radiation Oncology",
issn = "1754-9477",
publisher = "Wiley-Blackwell",
number = "4",

}

Page, BR, Wang, EC, White, L, McTyre, E, Peiffer, A, Alistar, A, Mu, F, Loganathan, A, Bourland, JD, Laxton, AW, Tatter, SB & Chan, MD 2017, 'Gamma Knife radiosurgery for brain metastases from gastrointestinal primary', Journal of Medical Imaging and Radiation Oncology, vol. 61, no. 4, pp. 522-527. https://doi.org/10.1111/1754-9485.12584

Gamma Knife radiosurgery for brain metastases from gastrointestinal primary. / Page, Brandi R.; Wang, Edina C.; White, Lance; McTyre, Emory; Peiffer, Ann; Alistar, Angela; Mu, Frank; Loganathan, Amritraj; Bourland, John Daniel; Laxton, Adrian W.; Tatter, Stephen B.; Chan, Michael D.

In: Journal of Medical Imaging and Radiation Oncology, Vol. 61, No. 4, 01.08.2017, p. 522-527.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Gamma Knife radiosurgery for brain metastases from gastrointestinal primary

AU - Page, Brandi R.

AU - Wang, Edina C.

AU - White, Lance

AU - McTyre, Emory

AU - Peiffer, Ann

AU - Alistar, Angela

AU - Mu, Frank

AU - Loganathan, Amritraj

AU - Bourland, John Daniel

AU - Laxton, Adrian W.

AU - Tatter, Stephen B.

AU - Chan, Michael D.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Introduction: In this study, we assessed clinical outcomes of patients with brain metastases from a gastrointestinal (GI) primary cancer and patterns of failure after stereotactic radiosurgery including failure within the radiosurgical volume, distant failure and leptomeningeal failure (LMF). We also assessed other factors associated with the patients’ neurologic and extraneuraxial disease that may affect clinical outcomes. Methods: We reviewed our institutional series of 62 consecutive patients with brain metastases treated with stereotactic radiosurgery, which included 17 patients with oesophageal, 44 patients with colorectal and one patient with anal canal primary. The median marginal dose to the radiosurgery volume was 17 Gy (range 10–24 Gy). Thirteen patients were treated with whole-brain radiotherapy (WBRT) prior to GKS. Results: The median dose delivered to the margin of the tumour was 17 Gy (range: 10–24 Gy). The median largest tumour diameter was 2.7 cm (range: 0.60–6.1 cm). The median overall survival (OS) was 7.1 months with a median follow-up of 6.1 months and a range of 0–31.7 months. Freedom from local failure was 86.5% and 62.2% at 6 and 12 months respectively. Freedom from distant failure was 73.2% and 42.2% at 6 and 12 months, respectively, and 40% of patients died of neurologic death. LMF occurred in seven patients, all of whom had colorectal primaries. Multivariate analysis revealed that craniotomy for resection of brain metastasis (HR = 2.63, P < 0.02), an absence of extracranial disease (HR = 2.28, P < 0.03), and prolonged time to distant brain failure (HR = 2.85, P < 0.01) predicted for improved survival. Conclusions: Colorectal cancer metastases tend to have a higher rate of leptomeningeal failure than other types of GI cancer metastases. Radiosurgical management of brain metastases from GI primary represents an acceptable management option. Neurologic death remains problematic.

AB - Introduction: In this study, we assessed clinical outcomes of patients with brain metastases from a gastrointestinal (GI) primary cancer and patterns of failure after stereotactic radiosurgery including failure within the radiosurgical volume, distant failure and leptomeningeal failure (LMF). We also assessed other factors associated with the patients’ neurologic and extraneuraxial disease that may affect clinical outcomes. Methods: We reviewed our institutional series of 62 consecutive patients with brain metastases treated with stereotactic radiosurgery, which included 17 patients with oesophageal, 44 patients with colorectal and one patient with anal canal primary. The median marginal dose to the radiosurgery volume was 17 Gy (range 10–24 Gy). Thirteen patients were treated with whole-brain radiotherapy (WBRT) prior to GKS. Results: The median dose delivered to the margin of the tumour was 17 Gy (range: 10–24 Gy). The median largest tumour diameter was 2.7 cm (range: 0.60–6.1 cm). The median overall survival (OS) was 7.1 months with a median follow-up of 6.1 months and a range of 0–31.7 months. Freedom from local failure was 86.5% and 62.2% at 6 and 12 months respectively. Freedom from distant failure was 73.2% and 42.2% at 6 and 12 months, respectively, and 40% of patients died of neurologic death. LMF occurred in seven patients, all of whom had colorectal primaries. Multivariate analysis revealed that craniotomy for resection of brain metastasis (HR = 2.63, P < 0.02), an absence of extracranial disease (HR = 2.28, P < 0.03), and prolonged time to distant brain failure (HR = 2.85, P < 0.01) predicted for improved survival. Conclusions: Colorectal cancer metastases tend to have a higher rate of leptomeningeal failure than other types of GI cancer metastases. Radiosurgical management of brain metastases from GI primary represents an acceptable management option. Neurologic death remains problematic.

UR - http://www.scopus.com/inward/record.url?scp=85011320154&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85011320154&partnerID=8YFLogxK

U2 - 10.1111/1754-9485.12584

DO - 10.1111/1754-9485.12584

M3 - Article

C2 - 28139076

AN - SCOPUS:85011320154

VL - 61

SP - 522

EP - 527

JO - Journal of Medical Imaging and Radiation Oncology

JF - Journal of Medical Imaging and Radiation Oncology

SN - 1754-9477

IS - 4

ER -