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Salvage gamma knife radiosurgery for active brain metastases from small-cell lung cancer after whole-brain radiation therapy: a retrospective multi-institutional study (JLGK1701)

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Abstract

Purpose

To evaluate the efficacy of gamma knife radiosurgery (GKS) for brain metastases (BMs) from small-cell lung cancer after whole-brain radiotherapy (WBRT).

Methods

We retrospectively analyzed the usefulness and safety of GKS in 163 patients from 15 institutions with 1–10 active BMs after WBRT. The usefulness and safety of GKS were evaluated using statistical methods.

Results

The median age was 66 years, and 79.1% of patients were men. The median number and largest diameter of BM were 2.0 and 1.4 cm, respectively. WBRT was administered prophylactically in 46.6% of patients. The median overall survival (OS) was 9.3 months, and the neurologic mortality was 20.0%. Crude incidences of local control failure and new lesion appearance were 36.6% and 64.9%, respectively. A BM diameter ≥ 1.0 cm was a significant risk factor for local progression (hazard ratio [HR] 2.556, P = 0.039) and neurologic death (HR 4.940, P = 0.031). Leukoencephalopathy at the final follow-up was more prevalent in the therapeutic WBRT group than in the prophylactic group (P = 0.019). The symptom improvement rate was 61.3%, and neurological function was preserved for a median of 7.6 months. Therapeutic WBRT was not a significant risk factor for OS, neurological death, local control, or functional deterioration (P = 0.273, 0.490, 0.779, and 0.560, respectively). Symptomatic radiation-related adverse effects occurred in 7.4% of patients.

Conclusions

GKS can safely preserve neurological function and prevent neurologic death in patients with 1–10 small, active BMs after prophylactic and therapeutic WBRT.

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Acknowledgements

We are grateful to Kana Inoue and Tomoko Fukushima at the Brain Attack Ota Memorial Hospital for their help with managing the database.

Funding

This study did not receive financial support.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, 3-6-28 Okinogami, Fukuyama, Hiroshima, 7200825, Japan

    Kiyoshi Nakazaki

  2. Department of Neurosurgery, Aizawa Hospital, Matsumoto, Nagano, Japan

    Shoji Yomo

  3. Department of Neurosurgery, Shinsuma General Hospital, Kobe, Hyogo, Japan

    Takeshi Kondoh

  4. Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo, Japan

    Toru Serizawa

  5. Department of Neurosurgery, Nagatomi Neurosurgical Hospital, Oita, Japan

    Hiroyuki Kenai

  6. Jiro Suzuki Memorial GammaHouse, Furukawa Seiryo Hospital, Osaki, Miyagi, Japan

    Jun Kawagishi

  7. Department of Neurosurgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Koriyama, Fukushima, Japan

    Sonomi Sato

  8. Gamma Knife House, Chiba Cerebral and Cardiovascular Center, Ichihara, Chiba, Japan

    Osamu Nagano

  9. Katsuta Hospital Mito GammaHouse, Hitachi-naka, Ibaraki, Japan

    Hitoshi Aiyama

  10. Department of Neurosurgery, Research Institute for Brain and Blood-Vessels-Akita, Akita, Japan

    Hideya Kawai

  11. Department of Neurosurgery, Komaki City Hospital, Komaki, Aichi, Japan

    Toshinori Hasegawa

  12. Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan

    Yoshiyasu Iwai

  13. Department of Neurosurgery, Kouseikai Takai Hospital, Tenri, Nara, Japan

    Yasushi Nagatomo

  14. Department of Neurosurgery, Ookuma Hospital, Nagoya, Japan

    Yoshihisa Kida

  15. Department of Human Health Sciences, School of Medicine, Kyoto University, Kyoto, Japan

    Masakazu Nishigaki

Authors
  1. Kiyoshi Nakazaki
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  2. Shoji Yomo
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Corresponding author

Correspondence to Kiyoshi Nakazaki.

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Conflict of interest

The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Brain Attack Center Ota Memorial Hospital institutional review board [approval number 133]) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”

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Informed consent was obtained from all individual participants included in the study.

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Nakazaki, K., Yomo, S., Kondoh, T. et al. Salvage gamma knife radiosurgery for active brain metastases from small-cell lung cancer after whole-brain radiation therapy: a retrospective multi-institutional study (JLGK1701). J Neurooncol 147, 67–76 (2020). https://doi.org/10.1007/s11060-020-03397-9

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