Stereotactic aspiration combined with gamma knife radiosurgery for the treatment of cystic brainstem metastasis originating from lung adenosquamous carcinoma: A case report

Du,Chao; Li,Zhaohui; Wang,Zhijia; Wang,Liping; Tian,Yu

doi:10.3892/ol.2015.2968

Stereotactic aspiration combined with gamma knife radiosurgery for the treatment of cystic brainstem metastasis originating from lung adenosquamous carcinoma: A case report

Authors:
- Chao Du
- Zhaohui Li
- Zhijia Wang
- Liping Wang
- Yu Tian
View Affiliations

Affiliations: Department of Neurosurgery, China‑Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China, Department of Radiology, China‑Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China, Department of Pathology, China‑Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
Published online on: February 16, 2015 https://doi.org/10.3892/ol.2015.2968
Pages: 1607-1613
Copyright: © Du et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Brainstem metastases have a poor prognosis and are difficult to manage. The present study describes the first case of histopathologically‑confirmed brainstem metastasis originating from lung adenosquamous carcinoma, and discusses the outcomes of treatment by stereotactic aspiration combined with gamma knife radiosurgery (GKRS). A 59‑year‑old female presented with a cystic mass (15x12x13 mm; volume, 1.3 cm3) located in the pons, two years following surgical treatment for adenosquamous carcinoma of the lung. The patient received initial GKRS for the lesion in the pons with a total dose of 54.0 Gy, however, the volume of the mass subsequently increased to 3.9 cm3 over a period of three months. Computed tomography‑guided stereotactic biopsy and aspiration of the intratumoral cyst were performed, yielding 2.0 cm3 of yellow‑white fluid. Histology confirmed the diagnosis of adenosquamous carcinoma. Aspiration provided immediate symptomatic relief, and was followed one week later by repeat GKRS with a dose of 12.0 Gy. The patient survived for 12 months following the repeat GKRS; however, later succumbed to the disease after lapsing into a two‑week coma. The findings of this case suggest that stereotactic aspiration of cysts may improve the effects of GKRS for the treatment of cystic brainstem metastasis; the decrease in tumor volume allowed a higher radiation dose to be administered with a lower risk of radiation‑induced side effects. Therefore, stereotactic aspiration combined with GKRS may be an effective treatment for brainstem metastasis originating from adenosquamous carcinoma.

View Figures

View References

1	Lamm AF, Elaimy AL, Lamoreaux WT, et al: A review of the clinical outcomes for patients diagnosed with brainstem metastasis and treated with stereotactic radiosurgery. ISRN Surg. 2013:6528952013. View Article : Google Scholar : PubMed/NCBI
2	Huang CF, Kondziolka D, Flickinger JC and Lunsford LD: Stereotactic radiosurgery for brain stem metastases. J Neurosurg. 91:563–568. 1999. View Article : Google Scholar : PubMed/NCBI
3	Shuto T, Fujino H, Asada H, et al: Gamma knife radiosurgery for metastatic tumours in the brain stem. Acta Neurochir (Wien). 145:755–760. 2003. View Article : Google Scholar
4	Fuentes S, Delsanti C, Metellus P, et al: Brain stem metastases: management using gamma knife radiosurgery. Neurosurgery. 58:37–42. 2006. View Article : Google Scholar
5	Yen CP, Sheehan J, Patterson G and Steiner L: Gamma knife surgery for metastatic brain stem tumors. J Neurosurg. 105:213–219. 2006. View Article : Google Scholar
6	Hussain A, Brown PD, Stafford SL and Pollock BE: Stereotactic radiosurgery for brain stem metastases: Survival, tumor control, and patient outcomes. Int J Radiat Oncol Bio Phys. 67:521–524. 2007. View Article : Google Scholar
7	Kased N, Huang K, Nakamura JL, et al: Gamma knife radiosurgery for brainstem metastases: the UCSF experience. J Neurooncol. 86:195–205. 2008. View Article : Google Scholar
8	Lorenzoni JG, Devriendt D, Massager N, et al: Brain stem metastases treated with radiosurgery: prognostic factors of survival and life expectancy estimation. Surg Neurol. 71:188–196. 2009. View Article : Google Scholar
9	Samblás JM, Sallabanda K, Bustos JC, et al: Radiosurgery and whole brain therapy in the treatment of brainstem metastases. Clinical Transl Oncol. 11:677–680. 2009. View Article : Google Scholar
10	Koyfman SA, Tendulkar RD, Chao ST, et al: Stereotactic radiosurgery for single brainstem metastases: the cleveland clinic experience. Int J Radiat Oncol Bio Phys. 78:409–414. 2010. View Article : Google Scholar
11	Yoo TW, Park ES, Kwon do H and Kim CJ: Gamma knife radiosurgery for brainstem metastases. J Korean Neurosurg Soc. 50:299–303. 2011. View Article : Google Scholar : PubMed/NCBI
12	Hatiboglu MA, Chang EL, Suki D, et al: Outcomes and prognostic factors for patients with brainstem metastases undergoing stereotactic radiosurgery. Neurosurgery. 69:796–806. 2011. View Article : Google Scholar : PubMed/NCBI
13	Valery CA, Boskos C, Boisserie G, et al: Minimized doses for linear accelerator radiosurgery of brainstem metastasis. Int J Radiat Oncol Biol Phys. 80:362–368. 2011. View Article : Google Scholar
14	Kelly PJ, Lin YB, Yu AY, et al: Linear accelerator-based stereotactic radiosurgery for brainstem metastases: the Dana-Farber/Brigham and Women’s Cancer Center experience. J Neurooncol. 104:553–557. 2011. View Article : Google Scholar : PubMed/NCBI
15	Li Y, Xu D, Zhang Z, et al: Gamma knife surgery for brainstem metastases. J Neurosurg. 117:13–16. 2012.PubMed/NCBI
16	Kawabe T, Yamamoto M, Sato Y, et al: Gamma Knife surgery for patients with brainstem metastases. J Neurosurg. 117:23–30. 2012.PubMed/NCBI
17	Lin CS, Selch MT, Lee SP, et al: Accelerator-based stereotactic radiosurgery for brainstem metastases. Neurosurgery. 70:953–958. 2012. View Article : Google Scholar
18	Sengöz M, Kabalay IA, Tezcanlı E, Peker S and Pamir N: Treatment of brainstem metastases with gamma-knife radiosurgery. J Neurooncol. 113:33–38. 2013. View Article : Google Scholar : PubMed/NCBI
19	Jung EW, Rakowski JT, Delly F, et al: Gamma Knife radiosurgery in the management of brainstem metastases. Clin Neurol Neurosurg. 115:2023–2028. 2013. View Article : Google Scholar : PubMed/NCBI
20	Kilburn JM, Ellis TL, Lovato JF, et al: Local control and toxicity outcomes in brainstem metastases treated with single fraction radiosurgery: is there a volume threshold for toxicity? J Neurooncol. 117:167–174. 2014. View Article : Google Scholar : PubMed/NCBI
21	Peterson HE, Larson EW, Fairbanks RK, et al: Gamma knife treatment of brainstem metastases. Int J Mol Sci. 15:9748–9761. 2014. View Article : Google Scholar : PubMed/NCBI
22	Maranzano E, Trippa F, Pacchiarini D, et al: Re-irradiation of brain metastases and metastatic spinal cord compression: clinical practice suggestions. Tumori. 91:325–330. 2005.PubMed/NCBI
23	Server A, Josefsen R, Kulle B, et al: Proton magnetic resonance spectroscopy in the distinction of high-grade cerebral gliomas from single metastatic brain tumors. Acta Radiol. 51:316–325. 2010. View Article : Google Scholar : PubMed/NCBI
24	Lü Y, Li C, Liu M, et al: MRI-guided stereotactic aspiration of brain abscesses by use of an optical tracking navigation system. Acta Radiol. 55:121–128. 2014. View Article : Google Scholar
25	Hofmann BM, Höllig A, Strauss C, Buslei R, Buchfelder M and Fahlbusch R: Results after treatment of craniopharyngiomas: further experiences with 73 patients since 1997. J Neurosurg. 116:373–384. 2012. View Article : Google Scholar
26	Higuchi F, Kawamoto S, Abe Y, Kim P and Ueki K: Effectiveness of a 1-day aspiration plus Gamma Knife surgery procedure for metastatic brain tumor with a cystic component. J Neurosurg. 117:17–22. 2012.PubMed/NCBI
27	Kim IY, Yun SJ, Lee JS, et al: Brain metastasis from extramammary Paget’s disease of the scrotum. J Clin Neurosci. 21:694–696. 2014. View Article : Google Scholar
28	Park WH, Jang IS, Kim CJ and Kwon do H: Gamma knife radiosurgery after stereotactic aspiration for large cystic brain metastases. J Korean Neurosurg Soc. 46:360–364. 2009. View Article : Google Scholar : PubMed/NCBI
29	Aung TH, Kwok CK, Mark YF and Mark EG: Computed tomography-guided stereotactic aspiration and biopsy of a cystic metastatic adenocarcinoma of the pons. Hong Kong Med J. 3:232–235. 1997.PubMed/NCBI
30	Matsumoto K, Tada E, Tamesa N, Tomita S and Ohmoto T: Stereotactic brachytherapy for a cystic metastatic brain tumor in the midbrain. Case report. J Neurosurg. 88:141–144. 1998. View Article : Google Scholar : PubMed/NCBI
31	Zhao X, Du C and Tian Y: Results Of Repeat Gamma Knife Treatment: Stereotactic Aspiration Surgery Can Improve the Effect of Gamma Knife Treatment for Cystic Small Brainstem Glioma: Case Report. Neurosurgery Quarterly. 22:22–25. 2012. View Article : Google Scholar
32	Nakagawa K, Yasumitu T, Fukuhara K, Shiono H and Kikui M: Poor prognosis after lung resection for patients with adenosquamous carcinoma of the lung. Ann Thorac Surg. 75:1740–1744. 2003. View Article : Google Scholar : PubMed/NCBI
33	Gawrychowski J, Bruliński K, Malinowski E and Papla B: Prognosis and survival after radical resection of primary adenosquamous lung carcinoma. Eur J Cardiothorac Surg. 27:686–692. 2005. View Article : Google Scholar : PubMed/NCBI
34	Cooke DT, Nguyen DV, Yang Y, et al: Survival comparison of adenosquamous, squamous cell and adenocarcinoma of the lung after lobectomy. Ann Thorac Surg. 90:943–948. 2010. View Article : Google Scholar : PubMed/NCBI
35	Filosso PL, Ruffini E, Asioli S, et al: Adenosquamous lung carcinomas: a histologic subtype with poor prognosis. Lung Cancer. 74:25–29. 2011. View Article : Google Scholar : PubMed/NCBI