Journal of the Korean Society of Stereotactic and Functional Neurosurgery 2014;10(1):19-23.
Published online June 30, 2014.
Clinical Outcome of Gama Knife Radiosurgery for Clivus Metastasis
Hyun Seok Park, Eun Suk Park, Do Hee Lee, Do Hoon Kwon
Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Metastasis to clivus is a rare and usually encountered late in the disease process of cancer patients. Surgical resection has limitation in terms of surgical morbidity caused by multiple medical comorbidities. Most patients treated by palliative radiotherapy. But there is no clear consensus concerning the treatment of clivus metastasis due to the rarity of such lesion. This study analyzed clinical outcomes of clivus metastasis treated with gamma knife radiosurgery (GKRS) as a primary treatment modality. Material and Methods: Retrospective review of clinical record for 8 consecutive patients (5 male and 3 female, a median age of 54 years) was performed. The primary cancer of clivus metastases was lung cancer in 3, breast cancer in 1, thyroid cancer in 1, gastric cancer in 1, hepatoma in 1, and alveolar soft part sarcoma in 1. The median tumor volume was 3.1cm3 (range, 0.3-8.1cm3). GKRS were performed with median tumor marginal dose (23Gy, range 18-28Gy) and the median isodose line was 50%. Patients were assessed clinically and radiographically every 1 or 2 month until death following GKRS.
All of the patients experienced symptomatic response to treatment with decreased pain shortly after treatment. For tumor control, complete response (33%) and partial response (66%) were observed on follow-up exam. During follow-up period, all patients died of systemic disease progression. The median survival time was 7 months (range 1-22 months). In all patients, there was no treatment related complication including new cranial neuropathies.
The present results indicate that GKRS offers a high rate of local tumor control and neurological preservation in patients with clivus metastasis. It can be a good therapeutic option for the treatment of clivus metastasis. However, we should be aware of their poor prognosis when clivus metastasis present with the late event in the course of systemic cancer.
Key Words: Neoplasm metastasis, Radiosurgery, Skull base, Skull base neoplasms.

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