PURPOSE: To pool data across multiple institutions internationally and report on the cumulative experience of brainstem stereotactic radiosurgery (SRS). METHODS AND MATERIALS: Data on patients with brainstem metastases treated with SRS were collected through the International Gamma Knife Research Foundation. Clinical, radiographic, and dosimetric characteristics were compared for factors prognostic for local control (LC) and overall survival (OS) using univariate and multivariate analyses. RESULTS: Of 547 patients with 596 brainstem metastases treated with SRS, treatment of 7.4% of tumors resulted in severe SRS-induced toxicity (grade ≥3, increased odds with increasing tumor volume, margin dose, and whole-brain irradiation). Local control at 12 months after SRS was 81.8% and was improved with increasing margin dose and maximum dose. Overall survival at 12 months after SRS was 32.7% and impacted by age, gender, number of metastases, tumor histology, and performance score. CONCLUSIONS: Our study provides additional evidence that SRS has become an option for patients with brainstem metastases, with an excellent benefit-to-risk ratio in the hands of experienced clinicians. Prior whole-brain irradiation increases the risk of severe toxicity in brainstem metastasis patients undergoing SRS.

Department of Neurological Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania

Department of Neurosurgery Cleveland Clinic Cleveland Ohio

Department of Neurosurgery Neurological Institute Taipei Veteran General Hospital Taipei Taiwan People's Republic of China

Department of Neurosurgery New York University Lagone Medical Center New York New York

Department of Radiation and Stereotactic Neurosurgery Na Homolce Hospital Prague Czech Republic

Department of Radiation Oncology Beaumont Health System Royal Oak Michigan

Department of Radiation Oncology University of Pennsylvania Philadelphia Pennsylvania

Department of Radiation Oncology University of Virginia Charlottesville Virginia

Department of Radiation Oncology University of Virginia Charlottesville Virginia; Department of Neurological Surgery University of Virginia Charlottesville Virginia

Departments of Neurosurgery and Radiation Oncology West Virginia University Morgantown West Virginia

Division of Neurosurgery Université de Sherbrooke Centre de recherche du CHUS Sherbrooke Québec Canada

Strahlenther Onkol. 2017 Apr;193(4):347-349. doi: 10.1007/s00066-017-1112-2. PubMed

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