RO 04. THE Position OF ADJUVANT Entire BRAIN RADIATION Treatment Right after GAMMA KNIFE RADIOSURGERY To the Therapy OF METASTATIC BRAIN TUMORS Jong Hee Chang, Jeong Hwan Kang, Hyun Ho Jung, Dong Seok Kim, and Yong Gou Park, Department of Neurosurgery, Yonsei University University of Medicine, Seoul, Korea The purpose of complete brain radiation therapy combined with gamma knife radiosurgery for your therapy of cerebral metastasis has not been established. For this reason, we determined the effectiveness of adjuvant WBRT in treating metastatic brain tumors that had undergone GKS. From 1992 to 2002, 156 sufferers with metastatic brain tumors were taken care of with GKS. These patients were divided into 2 groups, those taken care of with WBRT prior to or close to the identical time as GKS and these not treated with WBRT. The regional manage price, survival charge, and newly designed lesions had been analyzed.
We classified newly created lesions into 4 groups, missed lesions that have been retrospectively visible on MRI but not recognized at the time of GKS, invisible lesions that had been too tiny to be visualized on MRI at the time of GKS but had been diagnosed as new lesions inside 3 months following GKS, correct new lesions that had been recognized on MRI at greater than ten months just after GKS, and undetermined lesions that devel oped concerning 3 and 10 months right after GKS. selelck kinase inhibitor 5 hundred eighty 7 meta static brain lesions in 156 patients were treated with 177 GKS procedures. The indicate follow up duration was 12. four months. Thirty one of the GKS scenarios underwent WBRT. The neighborhood handle charge, survival charge, and advancement of new lesions had been not considerably affected by WBRT. A follow up MRI to identify new lesions was obtained in 142 instances and 157 new lesions had been present in 38 situations. While in the prior WBRT group, 29 cases had 8 new lesions, 1 invisible, four correct, and three undetermined.
Between the 113 circumstances not handled with WBRT, 39 had new lesions, eight missed, 12 invisible, 12 real, and 13 undetermined. Leptomeningeal seeding was observed right after GKS in 7 situations, none of which had been treated with WBRT, in all cases, the first brain lesion was attached to dura matter. WBRT didn’t impact the neighborhood management price, survival charge, or advancement of new lesion. Missed and invisible lesions tended selleck to get minor in quantity from the WBRT group, but true or undetermined lesions did not vary in between the two groups. Looking at the dosage limitation of additive GKS for lesions that develop just after WBRT and the large threat of radiation necrosis or radiation induced dementia in long term survivors, adjuvant WBRT should be reserved like a final treatment modality for individuals with miliary cerebral metastases. Patients should really undergo MRI three months just after GKS to detect radiologically invisible lesions and lesions missed through the initial GKS, and repeated GKS could possibly be typical treatment method to the individuals with metastatic brain tumors.