Abstract
Purpose
Clival metastatic cancer is rare and has limited literature to guide management. We describe management of clival metastasis with Gamma Knife radiosurgery (GKRS). We augment our findings with a systematic review of all forms of radiation therapy for clival metastasis.
Methods
Records of 14 patients with clival metastasis who underwent GKRS at the University of Pittsburgh Medical Center from 2002 to 2023 were reviewed. Treatment parameters and clinical outcomes were assessed. A systematic review was conducted using evidence-based guidelines.
Results
The average age was 61 years with male predominance (n = 10) and average follow-up of 12.4 months. The most common primary cancers were prostate (n = 3) and lung (n = 3). The average time from cancer diagnosis to clival metastasis was 34 months. The most common presenting symptoms were headache (n = 9) and diplopia (n = 7). Five patients presented with abducens nerve palsies, and two presented with oculomotor nerve palsies. The median tumor volume was 9.3 cc, and the median margin dose was 15 Gy. Eleven patients achieved tumor control after one procedure, and three with progression obtained tumor control after repeat GKRS. One patient recovered abducens nerve function. The median survival from cancer diagnosis and GKRS were 49.7 and 15.3 months, respectively. The cause of death was progression of systemic cancer in six patients, clival metastasis in one, and unknown in four. The systematic review included 31 studies with heterogeneous descriptions of treatment and outcomes.
Conclusion
Clival metastasis is rare and associated with poor prognosis. GKRS is a safe, effective treatment for clival metastasis.
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Data availability
The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Abbreviations
- GKRS:
-
Gamma Knife radiosurgery
- PRISMA:
-
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- CT:
-
computed tomography
- MRI:
-
magnetic resonance imaging
- EBRT:
-
external beam radiotherapy
- SD:
-
standard deviation
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Acknowledgements
We thank the UPMC Center for Image-Guided Neurosurgery for helpful comments and edits.
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Conceptualization: SH, AN, CGH, LDLMethodology: OB, HAAnalysis: SHInvestigation: SH, RMS, SA, OBData Curation: SH, RMS, SA, OBWriting– original draft: SH, HAWriting– review and editing: All authorsSupervision: LDL, AN, CGH.
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Based on the EQUATOR Network reporting guidelines decision tree, we followed the Preferred Reporting of Case Series in Surgery (PROCESS) guidelines for this study.
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L. Dade Lunsford is a stockholder in Elekta AB and is a consultant for Insightec, Inc. Constantinos Hadjipanayis is a paid consultant for Stryker Corp., Synaptive Medical, and Hemerion Therapeutics. All other authors have no disclosures and declare no competing interests with respect to this work.
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Huq, S., Shanahan, R.M., Adida, S. et al. Gamma knife radiosurgery for clival metastasis: case series and systematic review. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04648-9
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DOI: https://doi.org/10.1007/s11060-024-04648-9