Gamma Knife Radiosurgery for the Management of More Than 15 Cerebral Metastases

The number of metastases that can be treated safely and effectively with Gamma Knife stereotactic radiosurgery (SRS) remains controversial despite continuing evidence to support its expanded utilization. We endeavored to elucidate the survival outcomes for patients who presented with ≥15 brain metastases at the time of initial SRS. This retrospective analysis reviewed patients treated for ≥15 brain metastases originating from breast cancer, lung cancer, or melanoma. Ninety-three patients met the inclusion criteria. In this study, 3016 tumors were treated. The median number of tumors at the first SRS procedure was 23 (range, 15–67) for breast cancer, 21 (range, 15–48) for lung cancer, and 21 (range, 15–67) for melanoma. The mean aggregate metastases volume was 8.75 cm3 for breast, 6.89 cm3 for lung, and 9.98 cm3 for melanoma. Patients with breast cancer, lung cancer, and melanoma had a median survival after diagnosis of brain metastases of 18.0, 9.4, and 6.3 months, respectively. The survival after SRS was 16 months for breast cancer, 4.6 months for lung cancer, and 3.1 months for melanoma. Patients with breast cancer had significantly longer survival than patients with lung cancer and melanoma after SRS (P = 0.001). A higher Karnofsky Performance Status score was associated with an increase in survival across all tumor types. Repeat SRS for local or distant progression was performed in 56% of patients with breast cancer, 35% of patients with lung cancer, and 24% of patients with melanoma. SRS is an effective means of managing extensive brain metastases, particularly in patients with breast cancer. The primary tumor type, systemic disease, and performance status heavily influence survival outcomes.