{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T01:17:23Z","timestamp":1786843043226,"version":"build-2736575974"},"reference-count":37,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"Special_Supplement","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2010,12]]},"abstract":"\nObject<\/jats:title>\nThe goal of this study was to analyze prognostic factors for local tumor control and survival and indications for initial treatment with the Gamma Knife in patients with up to 10 metastatic brain tumors from primary breast cancer.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nOutcomes were retrospectively reviewed in 101 women with a total of 600 tumors, who underwent Gamma Knife surgery (GKS) for metastatic brain tumors between April 1992 and December 2008 at 1 institution. The inclusion criteria were up to 10 brain metastases, maximum diameter of tumor < 3 cm, and total tumor volume < 15 cm3<\/jats:sup>. The exclusion criteria were poor systemic condition, presence of carcinomatous meningitis, and previous whole brain radiation treatment and\/or craniotomy.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nThe mean tumor volume at GKS was 3.7 cm3<\/jats:sup> (range 0.016\u201314.3 cm3<\/jats:sup>). The mean margin dose was 19 Gy (range 8\u201330 Gy). Neuroimaging showed that the local tumor growth control rate was 97%, and the tumor response rate was 82.3%. Larger tumor volume (p = 0.001) and lower margin dose (p = 0.001) were significant adverse prognostic factors for local tumor growth control according to a multivariate analysis. The number of brain metastatic lesions was 4 or fewer in 76 patients and 5 or more in 25 patients. The median overall survival time was 13 months. Multivariate analysis revealed that the presence of extracranial metastases (p = 0.041) and lesions that were not the human epidermal growth factor receptor\u20132 (HER2)\u2013positive type (p = 0.001) were significant adverse prognostic factors for overall survival. The number of brain metastases was not statistically significant, except for a single metastasis. The median new lesion\u2013free survival time after initial GKS was 9 months. Five or more lesions at initial GKS (p = 0.007) and younger patient age (p = 0.008) reduced survival significantly. The prevention of neurological death after GKS was 93.9% at 1 year, and a lower Karnofsky Performance Scale score (p = 0.009) was the only unfavorable factor. Median overall survival associated with the HER2-positive phenotype was significantly longer than survival associated with the other phenotypes (luminal and triple-negative). There were no statistically significant differences between the 3 breast cancer phenotypes for the incidence of new brain metastases after initial GKS.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nInitial GKS resulted in excellent local tumor control rates, which were associated with prolonged survival and a low risk of neurological death for patients with up to 10 metastatic brain tumors from primary breast cancer. The authors recommend periodic clinical and neuroradiological follow-up examinations after GKS in patients with 5 or more lesions at initial GKS, because they carry a high risk of development of new brain metastases, and in patients with the HER2-positive phenotype, because they tend to have a favorable prognosis in overall survival. Last, the authors recommend additional GKS or whole-brain radiation treatment for salvage treatment if new brain metastases occur.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2010.8.gks10932","type":"journal-article","created":{"date-parts":[[2018,11,16]],"date-time":"2018-11-16T01:09:47Z","timestamp":1542330587000},"page":"65-72","source":"Crossref","is-referenced-by-count":37,"title":["Gamma Knife surgery for metastatic brain tumors from primary breast cancer: treatment indication based on number of tumors and breast cancer phenotype"],"prefix":"10.3171","volume":"113","author":[{"given":"Shigeo","family":"Matsunaga","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Yokohama Rosai Hospital, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Shuto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama Rosai Hospital, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobutaka","family":"Kawahara","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medical Sciences, Yokohama City University, Yokohama, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Suenaga","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama Rosai Hospital, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeo","family":"Inomori","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama Rosai Hospital, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyo","family":"Fujino","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama Rosai Hospital, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-1130065","series-title":"Am J Clin Oncol","first-page":"310","article-title":"Stereotactic radiosurgical treatment of cerebral metastases arising from breast cancer","volume":"30","author":"Akyurek","year":"2007"},{"key":"b2-1130065","series-title":"Cancer J","first-page":"88","article-title":"Gamma knife radiosurgery in the treatment of patients with single and multiple brain metastases from carcinoma of the breast","volume":"6","author":"Amendola","year":"2000"},{"key":"b3-1130065","series-title":"JAMA","first-page":"2483","article-title":"Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial","volume":"295","author":"Aoyama","year":"2006"},{"issue":"Suppl 1","key":"b4-1130065","series-title":"Adv Ther","first-page":"S18","article-title":"Treatment of brain metastases in patients with HER2+ breast cancer","volume":"26","author":"Bravo Marques","year":"2009"},{"key":"b5-1130065","series-title":"Strahlenther Onkol","first-page":"590","article-title":"Treatment of cerebral metastases from breast cancer with stereotactic radiosurgery","volume":"180","author":"Combs","year":"2004"},{"key":"b6-1130065","series-title":"Cancer","first-page":"2359","article-title":"Survival in patients with brain metastases from breast cancer: the importance of HER-2 status","volume":"112","author":"Eichler","year":"2008"},{"key":"b7-1130065","series-title":"Strahlenther Onkol","first-page":"63","article-title":"DEGRO Practical Guidelines for palliative radiotherapy of breast cancer patients: brain metastases and leptomeningeal carcinomatosis","volume":"186","author":"Feyer","year":"2010"},{"key":"b8-1130065","series-title":"Ann Surg Oncol","first-page":"333","article-title":"Stereotactic radiosurgery for brain metastases from breast cancer","volume":"7","author":"Firlik","year":"2000"},{"key":"b9-1130065","series-title":"N Engl J Med","first-page":"2733","article-title":"Lapatinib plus capecitabine for HER2-positive advanced breast cancer","volume":"355","author":"Geyer","year":"2006"},{"key":"b10-1130065","series-title":"Am J Ther","first-page":"585","article-title":"Lapatinib plus capecitabine resolved human epidermal growth factor receptor 2-positive brain metastases","volume":"16","author":"Gl\u00fcck","year":"2009"},{"key":"b11-1130065","series-title":"J Neurosurg","first-page":"218","article-title":"Gamma knife surgery for the treatment of intracranial metastases from breast cancer","volume":"103","author":"Goyal","year":"2005"},{"key":"b12-1130065","series-title":"Eur J Cancer","first-page":"2792","article-title":"Triple-negative and HER2-overexpressing breast cancers exhibit an elevated risk and an earlier occurrence of cerebral metastases","volume":"45","author":"Heitz","year":"2009"},{"key":"b13-1130065","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1132","article-title":"Gamma Knife radiosurgery for brain metastases from primary breast cancer","volume":"75","author":"Kased","year":"2009"},{"key":"b14-1130065","series-title":"J Korean Neurosurg Soc","first-page":"358","article-title":"Gamma knife radiosurgery for ten or more brain metastases","volume":"44","author":"Kim","year":"2008"},{"key":"b15-1130065","series-title":"Onkologie","first-page":"146","article-title":"Clinical outcomes and breast cancer subtypes in patients with brain metastases","volume":"33","author":"Kwon","year":"2010"},{"key":"b16-1130065","series-title":"Breast Cancer Res Treat","first-page":"145","article-title":"Fractionated radiosurgery for brain metastases in 43 patients with breast carcinoma","volume":"65","author":"Lederman","year":"2001"},{"key":"b17-1130065","series-title":"Breast Cancer Res Treat","first-page":"523","article-title":"Brain metastases in breast cancer: prognostic factors and management","volume":"111","author":"Lee","year":"2008"},{"issue":"5 Suppl","key":"b18-1130065","series-title":"J Neurosurg","first-page":"663","article-title":"Gamma knife radiosurgery in patients with advanced breast cancer undergoing bone marrow transplant","volume":"97","author":"Levin","year":"2002"},{"key":"b19-1130065","series-title":"Clin Cancer Res","first-page":"1452","article-title":"Multicenter phase II study of lapatinib in patients with brain metastases from HER2-positive breast cancer","volume":"15","author":"Lin","year":"2009"},{"key":"b20-1130065","series-title":"Nat Clin Pract Oncol","first-page":"25","article-title":"New challenges and opportunities in the management of brain metastases in patients with ErbB2-positive metastatic breast cancer","volume":"6","author":"Melisko","year":"2009"},{"key":"b21-1130065","series-title":"J Neurooncol","first-page":"359","article-title":"Brain metastases in breast cancer: clinical and pathologic characteristics associated with improvements in survival","volume":"88","author":"Melisko","year":"2008"},{"key":"b22-1130065","series-title":"Cancer","first-page":"1705","article-title":"Stereotactic radiosurgery for multiple brain metastases from breast carcinoma","volume":"100","author":"Muacevic","year":"2004"},{"key":"b23-1130065","series-title":"Breast Cancer Res","first-page":"R20","article-title":"Breast cancer subtypes and survival in patients with brain metastases","volume":"10","author":"Nam","year":"2008"},{"key":"b24-1130065","series-title":"BMC Cancer","first-page":"105","article-title":"Prognostic scores in brain metastases from breast cancer","volume":"9","author":"Nieder","year":"2009"},{"key":"b25-1130065","series-title":"Ann Oncol","first-page":"942","article-title":"Breast cancer brain metastases: differences in survival depending on biological subtype, RPA RTOG prognostic class and systemic treatment after whole-brain radiotherapy (WBRT)","volume":"21","author":"Niwi\u0144ska","year":"2010"},{"key":"b26-1130065","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1134","article-title":"The effect of early detection of occult brain metastases in HER2-positive breast cancer patients on survival and cause of death","volume":"77","author":"Niwi\u0144ska","year":"2010"},{"key":"b27-1130065","series-title":"Int J Clin Oncol","first-page":"48","article-title":"Brain metastases in patients who receive trastuzumab-containing chemotherapy for HER2-overexpressing metastatic breast cancer","volume":"14","author":"Ono","year":"2009"},{"issue":"Suppl","key":"b28-1130065","series-title":"J Neurosurg","first-page":"128","article-title":"Gamma knife surgery for brain metastases from lung cancer","volume":"102","author":"Pan","year":"2005"},{"key":"b29-1130065","series-title":"Cancer Chemother Pharmacol","first-page":"627","article-title":"Prognostic factor analysis in patients with brain metastases from breast cancer: how can we improve the treatment outcomes?","volume":"63","author":"Park","year":"2009"},{"key":"b30-1130065","series-title":"Br J Cancer","first-page":"894","article-title":"Trastuzumab treatment improves brain metastasis outcomes through control and durable prolongation of systemic extracranial disease in HER2-overexpressing breast cancer patients","volume":"100","author":"Park","year":"2009"},{"key":"b31-1130065","series-title":"Cancer Treat Rev","first-page":"533","article-title":"The management of brain metastases","volume":"29","author":"Patchell","year":"2003"},{"key":"b32-1130065","series-title":"Ann Oncol","first-page":"917","article-title":"Trastuzumab treatment in patients with breast cancer and metastatic CNS disease","volume":"21","author":"Pie\u0144kowski","year":"2010"},{"issue":"Suppl 3","key":"b33-1130065","series-title":"J Neurosurg","first-page":"32","article-title":"Gamma knife treatment for multiple metastatic brain tumors compared with whole-brain radiation therapy","volume":"93","author":"Serizawa","year":"2000"},{"key":"b34-1130065","series-title":"J Neurosurg","first-page":"555","article-title":"Gamma knife surgery for metastatic brain tumors from renal cell carcinoma","volume":"105","author":"Shuto","year":"2006"},{"key":"b35-1130065","series-title":"Oncologist","first-page":"739","article-title":"Central nervous system metastases in HER-2-overexpressing metastatic breast cancer: a treatment challenge","volume":"13","author":"Stemmler","year":"2008"},{"key":"b36-1130065","series-title":"Crit Rev Oncol Hematol","first-page":"212","article-title":"Chemotherapy in breast cancer patients with brain metastases: have new chemotherapic agents changed the clinical outcome?","volume":"68","author":"Tosoni","year":"2008"},{"key":"b37-1130065","series-title":"Prog Neurol Surg","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1159\/000163413","article-title":"Gamma knife radiosurgery for brain metastases of non-lung cancer origin: focusing on multiple brain lesions","volume":"22","author":"Yamamoto","year":"2009"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/113\/Special_Supplement\/article-p65.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/113\/Special_Supplement\/article-p65.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/113\/Special_Supplement\/article-p65.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T04:06:29Z","timestamp":1679889989000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/113\/Special_Supplement\/article-p65.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2010,12]]},"references-count":37,"journal-issue":{"issue":"Special_Supplement"},"URL":"https:\/\/doi.org\/10.3171\/2010.8.gks10932","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,12]]}}}