Stereotactic Radiosurgery for Brainstem Metastases: An International Cooperative Study to Define Response and Toxicity

Daniel M. Trifiletti, Cheng Chia Lee, Hideyuki Kano, Jonathan Cohen, James Janopaul-Naylor, Michelle Alonso-Basanta, John Y.K. Lee, Gabriela Simonova, Roman Liscak, Amparo Wolf, Svetlana Kvint, Inga S. Grills, Matthew Johnson, Kang Du Liu, Chung Jung Lin, David Mathieu, France Héroux, Danilo Silva, Mayur Sharma, Christopher P. CifarelliChristopher N. Watson, Joshua D. Hack, John G. Golfinos, Douglas Kondziolka, Gene Barnett, L. Dade Lunsford, Jason P. Sheehan

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)280-288
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number2
StatePublished - Oct 1 2016

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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