{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T22:19:20Z","timestamp":1776377960195,"version":"3.51.2"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2013,8]]},"abstract":"\nObject<\/jats:title>\nThe goal of this study was to evaluate outcomes in patients with \u2265 10 CNS metastases treated with Gamma Knife stereotactic radiosurgery (GK-SRS).<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nPatients with \u2265 10 brain metastases treated using GK-SRS during the period between 2004 and 2010 were identified. Overall survival and local and regional control as well as necrosis rates were determined. The influence of age, sex, histological type, extracranial metastases, whole-brain radiation therapy, and number of brain metastases was analyzed using the Kaplan-Meier method. Univariate (log-rank) analyses were performed, with a p value of < 0.05 considered significant.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nFifty-three patients with \u2265 10 brain metastases were treated between 2004 and 2010. All had a Karnofsky Performance Status score of \u2265 70. Seventy-two percent had either non\u2013small cell lung cancer (38%) or breast cancer (34%); melanoma, small cell lung cancer, renal cell carcinoma, and testicular, colon, and ovarian cancer contributed the remaining 28%. On average, 10.9 lesions were treated in a single session. Sixty-four percent of patients received prior whole-brain radiation therapy. The median survival was 6.5 months. One-year overall survival was 42% versus 14% when comparing breast cancer and other histological types, respectively (p = 0.074). Age, extracranial metastases, number of brain metastases, and previous CNS radiation therapy were not significant prognostic factors. Although the median time to local failure was not reached, the median time to regional failure was 3 months. Female sex was associated with longer time to regional failure (p = 0.004), as was breast cancer histological type (p = 0.089). No patient experienced symptomatic necrosis.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nPatients with \u2265 10 brain metastases who received prior CNS radiation can safely undergo repeat treatment with GK-SRS. With median survival exceeding 6 months, aggressive local treatment remains an option; however, rapid CNS failure is to be expected. Although numbers are limited, patients with breast cancer represent one group of individuals who would benefit most, with prolonged survival and extended time to CNS recurrence.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2013.4.jns121751","type":"journal-article","created":{"date-parts":[[2013,5,10]],"date-time":"2013-05-10T14:10:49Z","timestamp":1368195049000},"page":"457-462","source":"Crossref","is-referenced-by-count":50,"title":["Survival among patients with 10 or more brain metastases treated with stereotactic radiosurgery"],"prefix":"10.3171","volume":"119","author":[{"given":"Paul","family":"Rava","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Tufts Medical Center, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kara","family":"Leonard","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Tufts Medical Center, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shirin","family":"Sioshansi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce","family":"Curran","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David E.","family":"Wazer","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Tufts Medical Center, Boston;"},{"name":"Departments of Radiation Oncology and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G. Rees","family":"Cosgrove","sequence":"additional","affiliation":[{"name":"Neurosurgery, Rhode Island Hospital, Providence, Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georg","family":"Nor\u00e9n","sequence":"additional","affiliation":[{"name":"Neurosurgery, Rhode Island Hospital, Providence, Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaroslaw T.","family":"Hepel","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Tufts Medical Center, Boston;"},{"name":"Departments of Radiation Oncology and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns121751","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/s11060-009-0055-6","article-title":"The role of retreatment in the management of recurrent\/progressive brain metastases: a systematic review and evidence-based clinical practice guideline","volume":"96","author":"Ammirati","year":"2010"},{"key":"b2-jns121751","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"1665","DOI":"10.1016\/S0140-6736(04)16250-8","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":"b3-jns121751","series-title":"JAMA","doi-asserted-by":"publisher","first-page":"2483","DOI":"10.1001\/jama.295.21.2483","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":"b4-jns121751","series-title":"Lancet Oncol","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1016\/S1470-2045(09)70263-3","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"},{"issue":"Suppl","key":"b5-jns121751","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"73","DOI":"10.3171\/2010.8.GKS10994","article-title":"Analysis of radiosurgical results in patients with brain metastases according to the number of brain lesions: is stereotactic radiosurgery effective for multiple brain metastases? 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