Analysis of 2000 cases treated with gamma knife surgery: validating eligibility criteria for a prospective multi-institutional study of stereotactic radiosurgery alone for treatment of patients with 1-10 brain metastases (JLGK0901) in Japan

Toru Serizawa; Yoshinori Higuchi; Osamu Nagano; Yasunori Sato; Masaaki Yamamoto; Junichi Ono; Naokatsu Saeki; Akifumi Miyakawa; Tatsuo Hirai

Analysis of 2000 cases treated with gamma knife surgery: validating eligibility criteria for a prospective multi-institutional study of stereotactic radiosurgery alone for treatment of patients with 1-10 brain metastases (JLGK0901) in Japan

J Radiosurg SBRT. 2012;2(1):19-27.

Authors

Toru Serizawa¹, Yoshinori Higuchi², Osamu Nagano³, Yasunori Sato⁴, Masaaki Yamamoto⁵, Junichi Ono³, Naokatsu Saeki², Akifumi Miyakawa^{6

7}, Tatsuo Hirai⁶

Affiliations

¹ Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo, Japan.
² Department of Neurological Surgery3, Graduate School of Medicine, Chiba University, Chiba, Japan.
³ Gamma Knife House, Chiba Cardiovascular Center, Ichihara, Japan.
⁴ Clinical Research Center, Chiba University Hospital, Chiba, Japan.
⁵ Mito GammaHouse, Katsuta Hospital, Hitachinaka, Japan.
⁶ Stereotaxis and Gamma Unit Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan.
⁷ Department of Radiology, Graduate School of Medical Science and Medical School, Nagoya City University, Nagoya, Japan.

PMID: 29296339
PMCID: PMC5658850

Abstract

Objective: The Japan Leksell Gamma Knife (JLGK) Society has conducted a prospective multi-institute study (JLGK0901, UNIN000001812) for selected patients in order to prove the effectiveness of stereotactic radiosurgery (SRS) alone using the gamma knife (GK) for 1-10 brain lesions. Herein, we verify the validity of 5 major patient selection criteria for the JLGK0901 trial.

Materials and methods: Between 1998 and 2010, 2246 consecutive cases with 10352 brain metastases treated with GK were analyzed to determine the validity of the following 5 major JLGK0901 criteria; 1) 1-10 brain lesions, 2) less than 10 cm³ volume of the largest tumor, 3) no more than 15 cm³ total tumor volume, 4) no cerebrospinal fluid (CSF) dissemination, 5) Karnofsky performance status (KPS) score ≥70.

Results: For cases with >10 brain metastases, salvage treatments for new lesions were needed more frequently. The tumor control rate for lesions larger than 10 cm³ was significantly lower than that of tumors <10 cm³. Overall, neurological and qualitative survivals (OS, NS, QS) of cases with >15 cm³ total tumor volume or positive magnetic resonance imaging findings of CSF were significantly poorer. Outcomes in cases with KPS <70 were significantly poorer in terms of OS.

Conclusion: Our retrospective results of 2246 GK-treated cases verified the validity of the 5 major JLGK0901 criteria. The inclusion criteria for the JLGK0901 study are appearently good indications for SRS.

Keywords: Metastatic brain tumor; gamma knife surgery; stereotactic radiosurgery; whole brain radiation therapy.