{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T12:48:49Z","timestamp":1783774129857,"version":"3.55.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,8]]},"abstract":"\nObject<\/jats:title>\nTo better establish the role of stereotactic radiosurgery (SRS) in treating patients with 10 or more intracranial metastases, the authors assessed clinical outcomes and identified prognostic factors associated with survival and tumor control in patients who underwent radiosurgery using the Leksell Gamma Knife Perfexion (LGK PFX) unit.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nThe authors retrospectively reviewed data in all patients who had undergone LGK PFX surgery to treat 10 or more brain metastases in a single session at the University of Pittsburgh. Posttreatment imaging studies were used to assess tumor response, and patient records were reviewed for clinical follow-up data. All data were collected by a neurosurgeon who had not participated in patient care.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nSixty-one patients with 10 or more brain metastases underwent SRS for the treatment of 806 tumors (mean 13.2 lesions). Seven patients (11.5%) had no previous therapy. Stereotactic radiosurgery was the sole prior treatment modality in 8 patients (13.1%), 22 (36.1%) underwent whole-brain radiation therapy (WBRT) only, and 16 (26.2%) had prior SRS and WBRT. The total treated tumor volume ranged from 0.14 to 40.21 cm3<\/jats:sup>, and the median radiation dose to the tumor margin was 16 Gy. The median survival following SRS for 10 or more brain metastases was 4 months, with improved survival in patients with fewer than 14 brain metastases, a nonmelanomatous primary tumor, controlled systemic disease, a better Karnofsky Performance Scale score, and a lower recursive partitioning analysis (RPA) class. Prior cerebral treatment did not influence survival. The median survival for a patient with fewer than 14 brain metastases, a nonmelanomatous primary tumor, and controlled systemic disease was 21.0 months. Sustained local tumor control was achieved in 81% of patients. Prior WBRT predicted the development of new adverse radiation effects.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nStereotactic radiosurgery safely and effectively treats intracranial disease with a high rate of local control in patients with 10 or more brain metastases. In patients with fewer metastases, a nonmelanomatous primary lesion, controlled systemic disease, and a low RPA class, SRS may be most valuable. In selected patients, it can be considered as first-line treatment.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.4.jns11870","type":"journal-article","created":{"date-parts":[[2012,5,25]],"date-time":"2012-05-25T13:58:45Z","timestamp":1337954325000},"page":"237-245","source":"Crossref","is-referenced-by-count":98,"title":["Stereotactic radiosurgery using the Leksell Gamma Knife Perfexion unit in the management of patients with 10 or more brain metastases"],"prefix":"10.3171","volume":"117","author":[{"given":"Ramesh","family":"Grandhi","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Kondziolka","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Radiation Oncology;"},{"name":"Center for Image-Guided Neurosurgery; and"},{"name":"University of Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Panczykowski","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward A.","family":"Monaco","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Kano","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Center for Image-Guided Neurosurgery; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Niranjan","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Center for Image-Guided Neurosurgery; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Flickinger","sequence":"additional","affiliation":[{"name":"Radiation Oncology;"},{"name":"Center for Image-Guided Neurosurgery; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Dade","family":"Lunsford","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Radiation Oncology;"},{"name":"Center for Image-Guided Neurosurgery; and"},{"name":"University of Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns11870","series-title":"Lancet","first-page":"1665","article-title":"Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial","volume":"363","author":"Andrews","year":"2004"},{"key":"b2-jns11870","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"},{"key":"b3-jns11870","series-title":"Int J Radiat Oncol Biol Phys","first-page":"898","article-title":"Stereotactic radiosurgery for four or more intracranial metastases","volume":"64","author":"Bhatnagar","year":"2006"},{"key":"b4-jns11870","series-title":"Ann Neurol","first-page":"529","article-title":"Radiation therapy for brain metastases","volume":"7","author":"Cairncross","year":"1980"},{"key":"b5-jns11870","series-title":"Lancet Oncol","first-page":"1037","article-title":"Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial","volume":"10","author":"Chang","year":"2009"},{"key":"b6-jns11870","series-title":"Int J Radiat Oncol Biol Phys","first-page":"223","article-title":"A report of the consensus workshop panel on the treatment of brain metastases","volume":"23","author":"Coia","year":"1992"},{"key":"b7-jns11870","series-title":"Int J Radiat Oncol Biol Phys","first-page":"745","article-title":"Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials","volume":"37","author":"Gaspar","year":"1997"},{"key":"b8-jns11870","series-title":"Johns Hopkins Med J","first-page":"377","article-title":"Management of cerebral metastasis from bronchogenic carcinoma","volume":"130","author":"Hazra","year":"1972"},{"key":"b9-jns11870","series-title":"Int J Radiat Oncol Biol Phys","first-page":"165","article-title":"The optimun schedule for palliative radiotherapy for metastatic brain cancer","volume":"2","author":"Hendrickson","year":"1977"},{"key":"b10-jns11870","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":"b11-jns11870","series-title":"Int J Radiat Oncol Biol Phys","first-page":"53","article-title":"A randomized phase III protocol for the evaluation of misonidazole combined with radiation in the treatment of patients with brain metastases (RTOG-7916)","volume":"20","author":"Komarnicky","year":"1991"},{"key":"b12-jns11870","series-title":"Am J Clin Oncol","first-page":"173","article-title":"Radiosurgery with or without whole-brain radiotherapy for brain metastases: the patients' perspective regarding complications","volume":"28","author":"Kondziolka","year":"2005"},{"key":"b13-jns11870","series-title":"Int J Radiat Oncol Biol Phys","first-page":"427","article-title":"Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases","volume":"45","author":"Kondziolka","year":"1999"},{"key":"b14-jns11870","series-title":"J Neurooncol","first-page":"299","article-title":"Microsurgery plus whole brain irradiation versus Gamma Knife surgery alone for treatment of single metastases to the brain: a randomized controlled multicentre phase III trial","volume":"87","author":"Muacevic","year":"2008"},{"key":"b15-jns11870","series-title":"N Engl J Med","first-page":"494","article-title":"A randomized trial of surgery in the treatment of single metastases to the brain","volume":"322","author":"Patchell","year":"1990"},{"key":"b16-jns11870","series-title":"Int J Radiat Oncol Biol Phys","first-page":"339","article-title":"Results of a randomized comparison of radiotherapy and bromodeoxyuridine with radiotherapy alone for brain metastases: report of RTOG trial 89-05","volume":"33","author":"Phillips","year":"1995"},{"key":"b17-jns11870","series-title":"Clin Bull","first-page":"47","article-title":"Diagnosis and treatment of metastases to the brain","volume":"4","author":"Posner","year":"1974"},{"key":"b18-jns11870","series-title":"Eur J Cancer","first-page":"400","article-title":"Whole brain radiotherapy plus stereotactic radiosurgery (WBRT+SRS) versus surgery plus whole brain radiotherapy (OP+WBRT) for 1\u20133 brain metastases: results of a matched pair analysis","volume":"45","author":"Rades","year":"2009"},{"key":"b19-jns11870","series-title":"Int J Radiat Oncol Biol Phys","first-page":"711","article-title":"Neurocognitive outcome in brain metastases patients treated with accelerated-fractionation vs. accelerated-hyperfractionated radiotherapy: an analysis from Radiation Therapy Oncology Group Study 91-04","volume":"51","author":"Regine","year":"2001"},{"key":"b20-jns11870","series-title":"Am J Clin Oncol","first-page":"427","article-title":"Solitary brain metastasis: results of an RTOG\/SWOG protocol evaluation surgery + RT versus RT alone","volume":"13","author":"Sause","year":"1990"},{"key":"b21-jns11870","series-title":"J Neurooncol","first-page":"163","article-title":"Gamma knife surgery for 1\u201310 brain metastases without prophylactic whole-brain radiation therapy: analysis of cases meeting the Japanese prospective multi-institute study (JLGK0901) inclusion criteria","volume":"98","author":"Serizawa","year":"2010"},{"issue":"Suppl 3","key":"b22-jns11870","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":"b23-jns11870","series-title":"J Neurol","first-page":"1357","article-title":"Management of brain metastases","volume":"249","author":"Soffietti","year":"2002"},{"key":"b24-jns11870","series-title":"N Engl J Med","first-page":"1119","article-title":"Stereotactic radiosurgery for the management of brain metastases","volume":"362","author":"Suh","year":"2010"},{"key":"b25-jns11870","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1279","article-title":"Gamma Knife radiosurgery for numerous brain metastases: is this a safe treatment?","volume":"53","author":"Yamamoto","year":"2002"},{"key":"b26-jns11870","series-title":"Cancer","first-page":"384","article-title":"Intracerebral metastases in solid-tumor patients: natural history and results of treatment","volume":"48","author":"Zimm","year":"1981"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/117\/2\/article-p237.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/117\/2\/article-p237.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/117\/2\/article-p237.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T23:22:26Z","timestamp":1679872946000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/117\/2\/article-p237.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2012,8]]},"references-count":26,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2012.4.jns11870","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,8]]}}}