Experiences on two different stereotactic radiosurgery modalities of Gamma Knife and Cyberknife in treating brain metastases.

Abstract:

BACKGROUND:In this study, we compared the dosimetric properties between Gamma Knife (GK) and Cyberknife (CK), and investigated the clinical implications in treating brain metastases (BMs). METHODS:Between 2011 and 2013, 77 patients treated with either single-fraction GK for small BMs (n = 40) or fractionated CK for large BMs >3 cm (n = 37) were analyzed. Among a total of 160 lesions, 81 were treated with GK (median, 22 Gy) and 38 (large lesions) with three- or five-fraction CK (median, 35 Gy). The median tumor volume was 1.0 cc (IQR, 0.12-4.4 cc) for GK and 17.6 cc (IQR, 12.8-23.7 cc) for fractionated CK. A lesion-to-lesion dosimetric comparison was performed using the identical contour set in both systems. RESULTS:The mean dose to tumor was significantly higher in GK by 1.25-fold (P < 0.001), whereas normal tissue volume receiving 90-10 % of prescription dose was significantly larger in CK by 1.26-fold (P < 0.001). Nevertheless, no differences were observed in local tumor control (rates at 1 year, 89.7 % vs 87.0 %; P = 0.594) and overall survival (median, 14 vs 16 months; P = 0.493) between GK and fractionated CK groups. The incidences of radiation necrosis were also not different (12.3 % vs 15.8 %; P = 0.443). CONCLUSIONS:Despite slightly inferior dosimetric properties of CK, fractionated CK for large BMs appears to be as effective and safe as single-fraction GK for small BMs, representing fractionation as an effective strategy for enhancing efficacy and moderating toxicity in stereotactic radiosurgery for BMs.

journal_name

Acta Neurochir (Wien)

journal_title

Acta neurochirurgica

authors

Cho YH,Lee JM,Lee D,Park JH,Yoon K,Kim SO,Kwon DH,Kim JH,Kim CJ,Roh SW

doi

10.1007/s00701-015-2585-3

subject

Has Abstract

pub_date

2015-11-01 00:00:00

pages

2003-9; discussion 2009

issue

11

eissn

0001-6268

issn

0942-0940

pii

10.1007/s00701-015-2585-3

journal_volume

157

pub_type

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