Abstract
Intracranial metastatic prostate carcinoma is rare. We sought to determine the clinical outcomes after Gamma Knife® stereotactic radiosurgery (GKSRS) for patients with intracranial prostate carcinoma metastases. We studied data from 10 patients who underwent radiosurgery for 15 intracranial metastases (9 dural-based and 6 parenchymal). Six patients had radiosurgery for solitary tumors and four had multiple tumors. The primary pathology was adenocarcinoma (eight patients) and small cell carcinoma (two patients). All patients received multimodality management for their primary tumor (including resection, radiation therapy, androgen deprivation therapy) and eight patients had evidence of systemic disease at time of radiosurgery. The mean tumor volume was 7.7 cm3 (range 1.1–17.2 cm3) and a median margin dose of 16 Gy was administered. Two patients had progressive intracranial disease in spite of fractionated partial brain radiation therapy (PBRT) prior to SRS. A local tumor control rate of 85% was achieved (including patients receiving boost, upfront and salvage SRS). New remote brain metastases developed in three patients (33%) and one patient had repeat SRS for tumor recurrence. The median survival after radiosurgery was 13 months and the 1-year survival rate was 60%. SRS was a well tolerated and effective therapy either alone or as a boost to fractionated radiation therapy in the management of patients with intracranial prostate carcinoma metastases.
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References
McCutcheon IE, Eng DY, Logothetis CJ (1999) Brain metastasis from prostate carcinoma: antemortem recognition and outcome after treatment. Cancer 86:2301–2311
Tremont-Lukats IW, Bobustuc G, Lagos GK, Lolas K, Kyritsis AP, Puduvalli VK (2003) Brain metastasis from prostate carcinoma: the MD Anderson experience. Cancer 98:363–368
Matschke J, Erbersdobler A (2004) Extensive cerebral metastases from neuroendocrine carcinoma of the prostate. Virchows Arch 444:202–203
Erasmus CE, Verhagen WIM, Wauters CAP, van Lindert EJ (2002) Brain metastasis from prostate small cell carcinoma: not to be neglected. Can J Neurol Sci 29:375–377
Zachariah B, Casey L, Zachariah SB, Baekey P, Greenberg HM (1994) Case report: brain metastasis from primary small cell carcinoma of the prostate. Am J Med Sci 308(3):177–179
Kim S-H, Chao ST, Toms SA et al (2008) Stereotactic radiosurgical treatment of parenchymal brain metastases from prostate adenocarcinoma. Surg Neurol 69:641–646
Kondziolka D, Flickinger JC, Bissonette DJ, Bozik M, Lunsford LD (1997) Survival benefit of stereotactic radiosurgery for patients with malignant glial neoplasms. Neurosurgery 41:776–785
Delattre JY, Krol G, Thaler HT, Posner JB (1988) Distribution of brain metastases. Arch Neurol 45:741–744
Nussbaum ER, Djalilian HR, Cho KH, Hall WA (1996) Brain metastasis: histology, multiplicity, surgery & survival. Cancer 78(8):1781–1788
McDermott RS, Anderson PR, Greenberg RE, Milestone BN, Hudes GR (2004) Cranial nerve deficits in patients with metastatic prostatic carcinoma: clinical features and treatment outcomes. Cancer 101(7):1639–1643
Hasegawa T, Kondziolka D, Flickinger JC, Germanwala A, Lunsford LD (2003) Brain metastases treated with radiosurgery alone: an alternative to whole brain radiotherapy? Neurosurgery 52:1318–1326
Mehta MP, Tsao MN, Whelan TJ et al (2005) The American Society for Therapeutic Radiology and Oncology (ASTRO) evidence-based review of the role of radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys 63:37–46
Warnick RE, Darakchiev BJ, Breneman JC (2004) Stereotactic radiosurgery for patients with solid brain metastases: current status. J Neurooncol 69:125–137
Tetu B, Ro JY, Ayala AG, Johnson DE, Logothetis CJ, Ordonez NG (1987) Small cell carcinoma of the prostate. Part I. A clinico-pathological study of 20 cases. Cancer 59:1803–1809
Amato RJ, Logothetis CJ, Hallinan R, Ro JY, Sella A, Dexeus FH (1992) Chemotherapy for small cell carcinoma of prostate origin. J Urol 147:935–937
Hasegawa T, Kondziolka D, Flickinger JC, Lunsford LD (2003) Stereotactic radiosurgery for brain metastases from gastrointestinal tract cancer. Surg Neurol 60:506–514
Mahmoud-Ahmed AS, Suh JH, Barnett GH, Webster KD, Kennedy AW (2001) Tumor distribution and survival in six patients with brain metastases from cervical carcinoma. Gynecol Oncol 81:196–200
Mahmoud-Ahmed AS, Suh JH, Kupelian PA, Klein EA, Peereboom DM, Dreicer R, Barnett GH (2002) Brain metastases from bladder carcinoma: presentation, treatment and survival. J Urol 167:2419–2422
Acknowledgements
The work described in this report was funded by a grant (to T.F.) from the Irish Institute of Clinical Neuroscience, the Ethicon Foundation Fund Royal College of Surgeons of Edinburgh, Friends of the Royal Travel Fund, Northern Ireland Medical & Dental Training Agency and Congress of Neurological Surgeons Lars Leksell Fellowship.
Conflict of interest/Disclosure
Drs Lunsford, Kondziolka and Niranjan are consultants with AB Elekta. Dr Lunsford is a stockholder in AB Elekta.
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Flannery, T., Kano, H., Niranjan, A. et al. Stereotactic radiosurgery as a therapeutic strategy for intracranial metastatic prostate carcinoma. J Neurooncol 96, 369–374 (2010). https://doi.org/10.1007/s11060-009-9966-5
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DOI: https://doi.org/10.1007/s11060-009-9966-5