Management of brain metastases by using repeat gamma knife surgery

ABSTRACT

To assess if repeat Gamma Knife surgery [GKS] is an option to radiosurgery + up-front whole brain radiation therapy [WBRT] in the management of brain metastases. The results from 130 consecutive patients treated with GKS for brain metastases are reported. The patients were monitored every 3 months with magnetic resonance imaging. New cerebral lesions were managed with repeat GKS, WBRT or no treatment, depending on imaging finding and clinical situation. The likelihood to develop new brain metastases after the first treatment was 25%, as compared to 30% after the second treatment. There was no relation between the number of patients developing new lesions and the number of brain metastases at the first treatment. The mean time to develop a new lesion was longer after the first treatment as compared to the second. Whole brain radiation therapy was deemed necessary for 7% of the patients. Repeat radiosurgery could control the brain manifestation of a malignant disease in 92% of the patients. The benefit from up-front WBRT seems limited and it may be favourable to monitor the patient with serial imaging and to select the management option if and when new lesions are diagnosed