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Purpose <p>This study aimed to compare leptomeningeal seeding (LMS) incidence, local failure rates, and survival outcomes between neoadjuvant and adjuvant gamma knife surgery (GKS) in patients with brain metastases.</p> Methods <p>We retrospectively analyzed 120 patients treated at a single institution from 2008 to 2022. Overall survival (OS), progression‑free survival (PFS), LMS occurrence, local failure, and key clinical prognostic variables were compared between the neoadjuvant and adjuvant GKS groups.</p> Results <p>Seventy patients received neoadjuvant GKS, while 50 received adjuvant GKS. Baseline differences in primary tumor origin, preoperative Karnofsky Performance Score, and extracranial metastasis were statistically significant. No significant differences were observed in OS (<i>p</i> = 0.21), PFS (<i>p</i> = 0.27), radiation induced edema (<i>p</i> = 0.219) or local failure (<i>p</i> = 0.19) between groups. LMS incidence was significantly lower in the neoadjuvant group (<i>p</i> = 0.043), with this advantage maintained after propensity score matching (<i>p</i> = 0.046).</p> Conclusions <p>Neoadjuvant GKS yields survival and local failure outcomes comparable to adjuvant GKS, while significantly reducing the risk of LMS. These findings support the potential clinical advantage of neoadjuvant GKS in the management of brain metastases.</p>

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Neoadjuvant gamma knife surgery for metastatic brain tumor: clinical use and impact on leptomeningeal seeding

  • 期刊论文

  • 发表日期：

    2025年11月28日

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  • Jihwan Yoo,
  • In-Ho Jung,
  • Won Seok Chang,
  • Hyun Ho Jung,
  • Hun Ho Park,
  • Ju Hyung Moon,
  • Eui Hyun Kim,
  • Seok-Gu Kang,
  • Jong Hee Chang

摘要

Purpose

This study aimed to compare leptomeningeal seeding (LMS) incidence, local failure rates, and survival outcomes between neoadjuvant and adjuvant gamma knife surgery (GKS) in patients with brain metastases.

Methods

We retrospectively analyzed 120 patients treated at a single institution from 2008 to 2022. Overall survival (OS), progression‑free survival (PFS), LMS occurrence, local failure, and key clinical prognostic variables were compared between the neoadjuvant and adjuvant GKS groups.

Results

Seventy patients received neoadjuvant GKS, while 50 received adjuvant GKS. Baseline differences in primary tumor origin, preoperative Karnofsky Performance Score, and extracranial metastasis were statistically significant. No significant differences were observed in OS (p = 0.21), PFS (p = 0.27), radiation induced edema (p = 0.219) or local failure (p = 0.19) between groups. LMS incidence was significantly lower in the neoadjuvant group (p = 0.043), with this advantage maintained after propensity score matching (p = 0.046).

Conclusions

Neoadjuvant GKS yields survival and local failure outcomes comparable to adjuvant GKS, while significantly reducing the risk of LMS. These findings support the potential clinical advantage of neoadjuvant GKS in the management of brain metastases.