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International Journal of Surgical Oncology
Volume 2012 (2012), Article ID 748284, 5 pages
Clinical Study

Implications of Identifying Additional Cerebral Metastases during Gamma Knife Radiosurgery

1Department of Neurosurgery, Yale University School of Medicine, P.O. Box 208082, New Haven, CT 06520, USA
2Department of Therapeutic Radiology, Yale University School of Medicine, P.O. Box 208040, New Haven, CT 06520, USA
3Yale Cancer Center, Yale University School of Medicine, P.O. Box 208028, New Haven, CT 06520, USA

Received 21 April 2011; Accepted 13 June 2011

Academic Editor: Ganesh Rao

Copyright © 2012 Toral R. Patel et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Gamma Knife radiosurgery (GK-SRS) is commonly used to treat cerebral metastases. Although additional intracranial metastases are often found on the day of GK-SRS, the significance of finding them is unknown. Methods. A retrospective review of 133 patients undergoing GK-SRS for cerebral metastases was performed. The change in number of metastases detected between initial referral magnetic resonance imaging (MRI) and subsequent treatment MRI was quantified. Multivariate and Kaplan-Meier analyses were employed to examine the significance of identifying additional lesions. Results. Additional lesions were identified in 41% of patients. An increasing number of metastases on referral MRI ( 𝑃 = 0 . 0 0 1 ) and the presence of progressive systemic disease ( 𝑃 = 0 . 0 0 3 ) were predictive of identifying additional metastases. Median survival was 6.9 months for patients with additional metastases, compared to 12.1 months for patients without additional metastases (hazard ratio 1.56, 𝑃 = 0 . 0 2 1 ). Conclusions. Identifying additional metastases on the day of GK-SRS may add important prognostic information.