A recent study was published in Lancet Oncology in which more than 1,000 patients received single session Gamma Knife radiosurgery (GKRS) for anywhere from one to 10 brain metastases (reference). The research suggests that patients treated for five to 10 tumors have the same benefit as patients with only two to four tumors. This finding is important as, to date, there remains an oncology debate as to whether GKRS is appropriate in high-functioning patients with five or more tumors.
One critical aspect of this study was that whole brain radiation therapy (WBRT) was not given. WBRT was withheld because evidence has shown that it can injure a patient’s cognitive function within four months.
The North American Gamma Knife Consortium is currently investigating this exact issue in a randomized study in which high-functioning patients with five or more brain metastases are being treated with single-session GKRS. In this trial, neurocognitive testing is being performed in all patients throughout their treatment. Hopefully, this randomized, prospective, multi-institution study will clarify the role of GKRS and WBRT in functionally independent patients harboring as many as 10 brain metastases.
At The Valley Hospital’s Gamma Knife Center, a patient’s treatment strategy is designed specifically for the individual. All aspects of a person’s medical history, independence and quality of life are taken into consideration in addition to the number of brain metastases present on his or her MRI. Our approach is comprehensive, and we feel strongly that the healthy parts of a person’s brain must be protected at all costs. Therefore, we have been using GKRS alone in appropriate patients since we opened our doors in 2011. Memory, language and personality make people who they are, and these important functions reside in specific parts of the brain. If we can successfully treat multiple brain metastases without risking injury to these critical parts of the brain using GKRS only, that’s exactly what we do.
We’re excited about the results as published by Yamamoto et. al. and look forward to the results of the North American Gamma Knife Consortium in hopes that, as a field, we continue to provide the most effective and patient-centered care with the best outcomes possible.