Brain Tumor Res Treat.  2016 Oct;4(2):111-115. 10.14791/btrt.2016.4.2.111.

Neurological Change after Gamma Knife Radiosurgery for Brain Metastases Involving the Motor Cortex

• Park CY
• Choi HY
• Lee SR
• Roh TH
• Seo MR
• Kim SH

• KMID: 2356979
• DOI: http://doi.org/10.14791/btrt.2016.4.2.111

Abstract

BACKGROUND
Although Gamma Knife radiosurgery (GKRS) can provide beneficial therapeutic effects for patients with brain metastases, lesions involving the eloquent areas carry a higher risk of neurologic deterioration after treatment, compared to those located in the non-eloquent areas. We aimed to investigate neurological change of the patients with brain metastases involving the motor cortex (MC) and the relevant factors related to neurological deterioration after GKRS.
METHODS
We retrospectively reviewed clinical, radiological and dosimetry data of 51 patients who underwent GKRS for 60 brain metastases involving the MC. Prior to GKRS, motor deficits existed in 26 patients (50.9%). The mean target volume was 3.2 cc (range 0.001-14.1) at the time of GKRS, and the mean prescription dose was 18.6 Gy (range 12-24 Gy).
RESULTS
The actuarial median survival time from GKRS was 19.2±5.0 months. The calculated local tumor control rates at 6 and 12 months after GKRS were 89.7% and 77.4%, respectively. During the median clinical follow-up duration of 12.3±2.6 months (range 1-54 months), 18 patients (35.3%) experienced new or worsened neurologic deficits with a median onset time of 2.5±0.5 months (range 0.3-9.7 months) after GKRS. Among various factors, prescription dose (>20 Gy) was a significant factor for the new or worsened neurologic deficits in univariate (p=0.027) and multivariate (p=0.034) analysis. The managements of 18 patients were steroid medication (n=10), boost radiation therapy (n=5), and surgery (n=3), and neurological improvement was achieved in 9 (50.0%).
CONCLUSION
In our series, prescription dose (>20 Gy) was significantly related to neurological deterioration after GKRS for brain metastases involving the MC. Therefore, we suggest that careful dose adjustment would be required for lesions involving the MC to avoid neurological deterioration requiring additional treatment in the patients with limited life expectancy.

Keyword

Radiosurgery; Radiation dosage; Motor cortex; Neoplasm metastasis; Neurologic deficits

MeSH Terms

Brain*
Follow-Up Studies
Humans
Life Expectancy
Motor Cortex*
Neoplasm Metastasis*
Neurologic Manifestations
Prescriptions
Radiation Dosage
Radiosurgery*
Retrospective Studies
Therapeutic Uses
Therapeutic Uses

Figure

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  Fig. 1 Kaplan-Meier curves for the patients with brain metastases involving the motor cortex after gamma knife radiosurgery. A: Overall survival. B: Recurrence-free survival.

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  Fig. 2 Illustrative case of a 51-year-old male patient with brain metastases involving the motor cortex from hepatocellular carcinoma. He had no pre-existing neurological deficits. GKRS was performed with a prescription dose of 22 Gy at 50% isodose line. Right hemiparesis occurred two months after GKRS, and treated with intravenous corticosteroid. A: Contrast enhanced T1-weighted image at the time of GKRS. B: Enhanced CT image 1 week after GKRS. GKRS, Gamma Knife radiosurgery.

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