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"Gamma knife" treatment can extend cancer survival

Posted on: Thursday, 12 January 2006, 12:19 CST

By Will Boggs, MD

NEW YORK (Reuters Health) - Many patients can survive for years after undergoing effective gamma knife radiosurgery for cancers that have spread to the brain, according to a new report.

As many as 40 percent of patients with systemic malignancies have cancers that spread (metastasize) to the brain, the authors explain, and radiosurgery of these metastases can extend survival to 13 months or longer, depending on the tumor type.

Dr. Douglas Kondziolka from the University of Pittsburgh Medical Center, Pennsylvania and colleagues assessed 44 patients who survived more than four years after undergoing radiosurgery to determine clinical and treatment patterns that affect the outcome.

Gamma knife radiosurgery, which requires no surgical incision, directs concentrated gamma radiation to a specific target, reaching brain tumors once considered inoperable.

The study patients represented 6.5 percent of the patients with brain metastases who underwent radiosurgery between 1988 and 2000 at their institution. The average survival time of these patients was 68 months, and 16 patients remained alive at the time of last follow-up, with a maximum survival of 156 months so far.

At the last follow-up, 99 of 133 (74.4 percent) brain metastases had regressed, 22 remained unchanged in volume (16.5 percent), and 12 (9 percent) had enlarged, researchers report in the medical journal Cancer.

Twenty-one of the patients required additional radiosurgery procedures, the researchers note, with one patient (who lived for more than 10 years) requiring seven radiosurgeries.

Compared with patients who died within the first three months after radiosurgery, the survivors had no differences in age; sex; percentage of lung cancer, melanoma, or kidney cancer. There were also no differences in radiosurgery dose; use of prior whole brain radiation therapy; volume of the largest tumor; or total tumor volume.

Patients who lived more than four years had higher pre-treatment scores on physical functioning; fewer metastases, and less cancer in other parts of the body than did patients who died soon after radiosurgery, the investigators observe.

"Despite our traditional methods to predict how patients with cancer will fare (cancer type, extent of cancer), some patients 'beat the odds' and do much better than anyone might have predicted," Kondziolka told Reuters Health.

To increase the number of these patients, "we should continue to offer comprehensive cancer care, whenever appropriate," even for patients with poor prognostic factors, such as brain metastases, Kondziolka added. "When I discuss things with patients, I offer them hope that perhaps they will do much better than the textbooks might predict."

SOURCE: Cancer, December 15, 2005.

Source: REUTERS

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