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Gamma knife radiosurgery for clival metastasis: case series and systematic review

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Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Clival metastatic cancer is rare and has limited literature to guide management. We describe management of clival metastasis with Gamma Knife radiosurgery (GKRS). We augment our findings with a systematic review of all forms of radiation therapy for clival metastasis.

Methods

Records of 14 patients with clival metastasis who underwent GKRS at the University of Pittsburgh Medical Center from 2002 to 2023 were reviewed. Treatment parameters and clinical outcomes were assessed. A systematic review was conducted using evidence-based guidelines.

Results

The average age was 61 years with male predominance (n = 10) and average follow-up of 12.4 months. The most common primary cancers were prostate (n = 3) and lung (n = 3). The average time from cancer diagnosis to clival metastasis was 34 months. The most common presenting symptoms were headache (n = 9) and diplopia (n = 7). Five patients presented with abducens nerve palsies, and two presented with oculomotor nerve palsies. The median tumor volume was 9.3 cc, and the median margin dose was 15 Gy. Eleven patients achieved tumor control after one procedure, and three with progression obtained tumor control after repeat GKRS. One patient recovered abducens nerve function. The median survival from cancer diagnosis and GKRS were 49.7 and 15.3 months, respectively. The cause of death was progression of systemic cancer in six patients, clival metastasis in one, and unknown in four. The systematic review included 31 studies with heterogeneous descriptions of treatment and outcomes.

Conclusion

Clival metastasis is rare and associated with poor prognosis. GKRS is a safe, effective treatment for clival metastasis.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

GKRS:

Gamma Knife radiosurgery

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

CT:

computed tomography

MRI:

magnetic resonance imaging

EBRT:

external beam radiotherapy

SD:

standard deviation

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Acknowledgements

We thank the UPMC Center for Image-Guided Neurosurgery for helpful comments and edits.

Funding

The authors declare that no funds, grants, or other support were received that supported or influenced the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA

    Sakibul Huq, Regan M. Shanahan, Samuel Adida, Othman Bin-Alamer, Hussam Abou-Al-Shaar, Ajay Niranjan, Constantinos G. Hadjipanayis & L. Dade Lunsford

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  1. Sakibul Huq
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Contributions

Conceptualization: SH, AN, CGH, LDLMethodology: OB, HAAnalysis: SHInvestigation: SH, RMS, SA, OBData Curation: SH, RMS, SA, OBWriting– original draft: SH, HAWriting– review and editing: All authorsSupervision: LDL, AN, CGH.

Corresponding author

Correspondence to Sakibul Huq.

Ethics declarations

Ethical approval

Study approval was granted by the Institutional Review Board of the University of Pittsburgh Medical Center.

Consent to participate and publish

The waiver of informed consent was approved by the Institutional Review Board of the University of Pittsburgh Medical Center.

Reporting guidelines

Based on the EQUATOR Network reporting guidelines decision tree, we followed the Preferred Reporting of Case Series in Surgery (PROCESS) guidelines for this study.

Competing interests

L. Dade Lunsford is a stockholder in Elekta AB and is a consultant for Insightec, Inc. Constantinos Hadjipanayis is a paid consultant for Stryker Corp., Synaptive Medical, and Hemerion Therapeutics. All other authors have no disclosures and declare no competing interests with respect to this work.

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Huq, S., Shanahan, R.M., Adida, S. et al. Gamma knife radiosurgery for clival metastasis: case series and systematic review. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04648-9

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