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Let’s make size not matter: tumor control and toxicity outcomes of hypofractionated Gamma Knife radiosurgery for large brain metastases

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Abstract

Purpose

Management of patients with large brain metastases poses a clinical challenge, with poor local control and high risk of adverse radiation events when treated with single-fraction stereotactic radiosurgery (SF-SRS). Hypofractionated SRS (HF-SRS) may be considered, but clinical data remains limited, particularly with Gamma Knife (GK) radiosurgery. We report our experience with GK to deliver mask-based HF-SRS to brain metastases greater than 10 cc in volume and present our control and toxicity outcomes.

Methods

Patients who received hypofractionated GK radiosurgery (HF-GKRS) for the treatment of brain metastases greater than 10 cc between January 2017 and June 2022 were retrospectively identified. Local failure (LF) and adverse radiation events of CTCAE grade 2 or higher (ARE) were identified. Clinical, treatment, and radiological information was collected to identify parameters associated with clinical outcomes.

Results

Ninety lesions (in 78 patients) greater than 10 cc were identified. The median gross tumor volume was 16.0 cc (range 10.1-56.0 cc). Prior surgical resection was performed on 49 lesions (54.4%). Six- and 12-month LF rates were 7.3% and 17.6%; comparable ARE rates were 1.9% and 6.5%. In multivariate analysis, tumor volume larger than 33.5 cc (p = 0.029) and radioresistant histology (p = 0.047) were associated with increased risk of LF (p = 0.018). Target volume was not associated with increased risk of ARE (p = 0.511).

Conclusions

We present our institutional experience treating large brain metastases using mask-based HF-GKRS, representing one of the largest studies implementing this platform and technique. Our LF and ARE compare favorably with the literature, suggesting that target volumes less than 33.5 cc demonstrate excellent control rates with low ARE. Further investigation is needed to optimize treatment technique for larger tumors.

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Data availability

All data and analysis script(s) generated during the current study are available from the corresponding author on reasonable request.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Radiation Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA

    Akash Mishra, Daniel Koffler, Emel Calugaru, Niara Rowe, Sirisha Devi Viswanatha, Sabrina Begley, Vikram Bajaj & Anuj Goenka

  2. Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA

    Akash Mishra, Sabrina Begley & Michael Schulder

Authors
  1. Akash Mishra
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  2. Daniel Koffler
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  3. Emel Calugaru
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  9. Anuj Goenka
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Contributions

Akash Mishra, Daniel Koffler, Michael Schulder and Anuj Goenka contributed to study conception and design. Data collection was performed by Akash Mishra, Daniel Koffler, Emel Calugaru, Niara Rowe, Sirisha Devi Viswanatha, Sabrina Begley, and Vikram Bajaj. Data analysis was performed by Akash Mishra. The first draft of the manuscript was written by Akash Mishra, Daniel Koffler, and Anuj Goenka. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Anuj Goenka.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

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The database utilized for the current study was approved by the Northwell Health Institutional Review Board.

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This retrospective database analysis did not require patient consent to participate as determined by the Northwell Health Institutional Review Board.

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Mishra, A., Koffler, D., Calugaru, E. et al. Let’s make size not matter: tumor control and toxicity outcomes of hypofractionated Gamma Knife radiosurgery for large brain metastases. J Neurooncol 163, 587–595 (2023). https://doi.org/10.1007/s11060-023-04365-9

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