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Metastatic brain tumors

Why Gamma Knife treatment

The Gamma Knife produces over 200 precise beams of low-dose radiation that all focus and intersect directly on the tumor, killing the tumor, yet keeping normal healthy brain tissue safe.

The head is fixed in a frame that keeps the brain stable and secure, setting up a GPS-like coordinate system that allows the doctors to target the tumor with sub-millimeter precision. The surgeon numbs up the areas where the frame is placed (much like a dentist numbs the gums) so there is little discomfort. Other treatments that do not use a head frame simply are not as accurate, and therefore more normal brain tissue is at risk.

Also, unlike other forms of treatment, it will only take us one day to treat these tumors and get patients back to their medical oncologist.

For this reason, we recommend that lung cancer patients have an MRI of their brain immediately upon diagnosis, before beginning chemotherapy. It is possible to have metastatic brain tumors without having symptoms. Gamma Knife of Spokane can treat these brain tumors and systemic treatment of the lung cancer can start as soon as the next day. However, once chemotherapy has begun, Gamma Knife treatment must wait.

Why Gamma Knife of Spokane

You are in good hands at Gamma Knife of Spokane. As one of the top 10 Gamma Knife treatment centers in the country for the number of patients treated, no one in the region has more experience in treating brain tumors. No one. Over 60% of the patients we have treated at Gamma Knife of Spokane have come to us with brain metastases.

With Gamma Knife of Spokane, patients have access to a $5 million, 45,000 pound cancer-killing machine that can, in a few hours, deliver a dose of radiation that can stop the growth of most tumors or even eliminate tumors altogether.

In addition to our experience of over a decade treating patients, we have one of the most prolific clinical research departments in the country (7th of 130 centers). We are frequently asked to write book chapters for oncology textbooks. The national medical community considers us experts in the field of brain tumor research and treatment.

Clinical Outcomes of Gamma Knife Treatment

The incidence of metastatic brain tumors has increased proportionate to the survival of patients with primary cancer. Studies show up to 15% of patients with primary cancer will develop a secondary cancer in the brain, affecting about 200,000 people a year. Whether for a cure or as palliative care, more and more brain tumor patients are choosing Gamma Knife treatment.

For lung cancer, we recommend a treatment pathway where the patient has an immediate MRI of their brain upon diagnosis, even if there are no symptoms indicating metastatic brain tumors. This is important because early detection and treatment of these tumors, which are often asymptomatic at this stage, is crucial to patient survival. Metastatic brain tumors can be treated immediately by Gamma Knife of Spokane, if detected before chemotherapy starts. Systemic treatment (chemotherapy) for the lung cancer can start as soon as the next day. However, if systemic treatment has already started, gamma knife treatment of the brain tumors will have to wait, which means the tumors have more time to grow.

Below are some of the cases we've treated and the results of those procedures. In June of 2002 we started with our first patients and were quite conservative in our approach. Based upon positive outcomes and seeing the resulting quality of life improvements for some very sick patients, our team has steadily, although within the confines of good medicine, increased the application of gamma knife technology. The focus is always on what is best for the patient - what will provide this patient with an extended life span and a better quality of life.

Single Lung Met

This is a Single Lung Metastasis showing results 4 months after treatment.

Day of treatment
4 Months Later

Single Met

This is a Single Metastasis showing results 3 months following treatment.

Day of treatment
3 Months Later

Breast Met

This is a Breast Metastasis showing results 2 months following treatment.

Day of treatment
2 Months Later

Single Brain Met

This is a Single Brain Metastasis showing results 7 weeks following treatment.

Day of treatment
7 Weeks Later

CLINICAL RESEARCH

Joint Solution

Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases.


Kondziolka D, Patel A, Lunsford LD, Kassam A, Flickinger JC.


Int J Radiat Oncol Biol Phys 1999 Sep 1;45(2):427-34


Department of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh, PA, USA.


PURPOSE: Multiple brain metastases are a common health problem, frequently diagnosed in patients with cancer. The prognosis, even after treatment with whole brain radiation therapy (WBRT), is poor with average expected survivals less than 6 months. Retrospective series of stereotactic radiosurgery have shown local control and survival benefits in case series of patients with solitary brain metastases. We hypothesized that radiosurgery plus WBRT would provide improved local brain tumor control over WBRT alone in patients with two to four brain metastases.

METHODS: Patients with two to four brain metastases (all <=25 mm diameter and known primary tumor type) were randomized to initial brain tumor management with WBRT alone (30 Gy in 12 fractions) or WBRT plus radiosurgery. Extent of extracranial cancer, tumor diameters on MRI scan, and functional status were recorded before and after initial care.

RESULTS: The study was stopped at an interim evaluation at 60% accrual. Twenty-seven patients were randomized (14 to WBRT alone and 13 to WBRT plus radiosurgery). The groups were well matched to age, sex, tumor type, number of tumors, and extent of extracranial disease. The rate of local failure at 1 year was 100% after WBRT alone but only 8% in patients who had boost radiosurgery. The median time to local failure was 6 months after WBRT alone (95% confidence interval [CI], 3.5-8.5) in comparison to 36 months (95% CI, 15.6-57) after WBRT plus radiosurgery (p = 0.0005). The median time to any brain failure was improved in the radiosurgery group (p = 0.002). Tumor control did not depend on histology (p = 0.85), number of initial brain metastases (p = 0.25), or extent of extracranial disease (p = 0.26). Patients who received WBRT alone lived a median of 7.5 months, while those who received WBRT plus radiosurgery lived 11 months (p = 0.22). Survival did not depend on histology or number of tumors, but was related to extent of extracranial disease (p = 0.02). There was no neurologic or systemic morbidity related to stereotactic radiosurgery.

CONCLUSIONS: Combined WBRT and radiosurgery for patients with two to four brain metastases significantly improves control of brain disease. WBRT alone does not provide lasting and effective care for most patients.

Gamma Knife Solution

Multimodality treatment of brain metastases: an institutional survival analysis of 275 patients


Ameer L Elaimy1,2, Alexander R Mackay1,3, Wayne T Lamoreaux1,2, Robert K Fairbanks1,2, John J Demakas1,4, Barton S Cooke1, Benjamin J Peressini5, John T Holbrook2 and Christopher M Lee1,2*


Elaimy et al. World Journal of Surgical Oncology 2011, 9:69


Abstract Background: Whole brain radiation therapy (WBRT), surgical resection, stereotactic radiosurgery (SRS), and combinations of the three modalities are used in the management of patients with metastatic brain tumors. We present the previously unreported survival outcomes of 275 patients treated for newly diagnosed brain metastases at Cancer Care Northwest and Gamma Knife of Spokane between 1998 and 2008.

Methods: The effects treatment regimen, age, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS), primary tumor histology, number of brain metastases, and total volume of brain metastases have on patient overall survival were analyzed. Statistical analysis was performed using Kaplan-Meier survival curves, Andersen 95% confidence intervals, approximate confidence intervals for log hazard-ratios, and multivariate Cox proportional hazard models.

Results: The median clinical follow up time was 7.2 months. On multivariate analysis, survival statistically favored patients treated with SRS alone when compared to patients treated with WBRT alone (p < 0.001), patients treated with resection with SRS when compared to patients treated with SRS alone (p = 0.020), patients in ECOG-PS class 0 when compared to patients in ECOG-PS classes 2 (p = 0.04), 3 (p < 0.001), and 4 (p < 0.001), patients in the non- small-cell lung cancer group when compared to patients in the combined melanoma and renal-cell carcinoma group (p < 0.001), and patients with breast cancer when compared to patients with non-small-cell lung cancer (p < 0.001).

The overall patient median survival time was deter- mined to be 7.9 months. The median survival time for patients treated with WBRT alone was 4.3 months (95% CI, 3.30-5.38), 9.4 months (95% CI, 6.41-12.45) for patients treated with SRS alone, 10 months (95% CI, 8.17-12.15) for patients treated with resection with WBRT, 12 months (95% CI, 8.74-15.98) for patients treated with WBRT with SRS, 13 months (95% CI, 9.70- 16.54) for patients treated with resection + WBRT + SRS, and 24 months (95% CI, 1.73-45.55) for patients treated with resection with SRS. Patients < 65 years of age survived a median time of 11 months (95% CI, 8.42- 12.88), while patients ≥65 years of age survived a med- ian time of 5.7 months (95% CI, 4.29-7.09).

Conclusions: In our analysis, patients benefited from a combined modality treatment approach and physicians must consider patient age, performance status, and primary tumor histology when recommending specific treatments regimens.

Peer-reviewed Journals

Long-term survival in a patient with multiple brain metastases from small-cell lung cancer treated with gamma knife radiosurgery on four occasions: a case report. Elaimy AL, Thumma SR, Lamm AF, Mackay AR, Lamoreaux WT, Fairbanks RK, Demakas JJ, Cooke BS, Lee CM. Case Rep Neurol Med. 2012;2012:276189. doi: 10.1155/2012/276189. Epub 2012 Oct 4. View PDF
Long-Term Survival of a Patient with Brainstem and Recurrent Brain Metastasis from Stage IV Nonsmall Cell Lung Cancer Treated with Multiple Gamma Knife Radiosurgeries and Craniotomies: A Case Report and Review of the Literature. Lamm AF, Elaimy AL, Mackay AR, Fairbanks RK, Demakas JJ, Cooke BS, Lee CM, Taylor BS, Lamoreaux WT. Case Rep Oncol Med. 2012;2012:621641. doi: 10.1155/2012/621641. Epub 2012 Sep 29. View PDF
A concise review of the efficacy of stereotactic radiosurgery in the management of melanoma and renal cell carcinoma brain metastases. Hanson PW, Elaimy AL, Lamoreaux WT, Demakas JJ, Fairbanks RK, Mackay AR, Taylor B, Cooke BS, Thumma SR, Lee CM. World J Surg Oncol. 2012 Aug 29;10:176. doi: 10.1186/1477-7819-10-176. View PDF
Multimodality treatment of brain metastases: an institutional survival analysis of 275 patients. Elaimy AL, Mackay AR, Lamoreaux WT, Fairbanks RK, Demakas JJ, Cooke BS, Peressini BJ, Holbrook JT, Lee CM. World J Surg Oncol. 2011 Jul 5;9(1):69. More Information. View PDF
Clinical outcomes of stereotactic radiosurgery in the treatment of patients with metastatic brain tumors. Elaimy AL, Mackay AR, Lamoreaux WT, Fairbanks RK, Demakas JJ, Cooke BS, Lee CM. World Neurosurg. 2011 May-Jun;75(5-6):673-83. View PDF
Brain metastases: clinical outcomes for stereotactic radiosurgery (method). Elaimy AL, Mackay AR, Lamoreaux WT, Fairbanks RK, Demakas JJ, Cooke BS, Arthurs BJ, Lee CM. Tumors of the Central Nervous System. Ed. M.A. Hayat. Vol. 3. Springer: New York, 2011. More Information.

The content of this web site is for informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider. If you have a medical problem or a health-related question, consult your physician or call our center at 509.473.3800 for an appointment with one of our neurosurgeons.

Gamma Knife: The best solution

Caring with precision

Treating brain tumors and other conditions in the brain requires absolute precision, because every bit of healthy tissue helps make you who you are. And nothing provides more precision than Gamma Knife stereotactic radiosurgery, especially in the hands of a caring, superbly skilled and experienced team of neurosurgeons and radiation oncologists.

In fact, Gamma Knife of Spokane ranks in the top 10 Gamma Knife Centers in the U.S. for published clinical research and patient volumes.

It's YOUR brain. Call us at 1.800.927.5051 and we can help you determine whether Gamma Knife treatment is a helpful option for you.

Let us help you get on with living.

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