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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

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Feasibility, safety and outcome of frameless robotic radiosurgery for brain metastases

Meeting Abstract

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  • M. Kufeld - Cyberknife Zentrum München
  • A. Muacevic - Cyberknife Zentrum München
  • B. Wowra - Cyberknife Zentrum München
  • J.-C. Tonn - Neurochirurgische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMI.07-01

doi: 10.3205/09dgnc212, urn:nbn:de:0183-09dgnc2121

Published: May 20, 2009

© 2009 Kufeld et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: To analyze the feasibility and outcome of frameless robotic radiosurgery (RS) for treatment of brain metastases.

Methods: During a 3-year period, 365 patients with 850 brain metastases of various histologies underwent 430 outpatient stereotactic robotic radiosurgery procedures. 200 (55%) patients had multiple brain metastases. The median tumor volume was 1cm³ (range: 0.1 – 27cm³; mean 2.6cm³). Median prescribed tumor dose was 18Gy (range: 15 – 24). Local/distant tumor recurrences were addressed by additional radiosurgical treatment for patients with stable systemic disease. All cases were categorized according to the RTOG classification. Survival time and freedom from local and distant tumor recurrence was analyzed with the Kaplan-Meier method. Prognostic factors were obtained by the Cox proportional hazard model.

Results: Median survival after SRS was 10.6 months. Local tumor recurrence was observed in 25/ 850 metastases (3%). New distant brain metastases were observed in 77 patients (21%). Taking into account salvage treatments with the CyberKnife, the overall intracranial tumor control was 81% at 12 months. 125 patients died due to systemic cancer progress (70%). A Karnofsky Performance Score (KPS) > 70 was related to prolonged survival in the univariate and multivariate analysis. RPA class I and II was related to prolonged survival only in the univariate analysis. Age, WBRT, prior surgery, number of metastases, chemotherapy, and latency period from diagnosis of the primary to the development of brain metastases did not reach prognostic relevance. Patients of RPA class I, II and III survived 15.7 months, 11.6 months and 3.3 months, respectively. There was no permanent morbidity or mortality. 11 patients (3%) showed transient symptomatic treatment-related complications.

Conclusions: Frameless robotic radiosurgery is a feasible and safe treatment concept for selected patients with brain metastases of various primary tumors. There seems to be no difference in patient selection, adverse effects or treatment outcomes compared to frame based treatment concepts.