Detection of residual metastatic tumor in the brain following Gamma Knife radiosurgery using a single or a series of magnetic resonance imaging scans: An autopsy study

Sakuramachi,Madoka; Igaki,Hiroshi; Ikemura,Masako; Yamashita,Hideomi; Okuma,Kae; Sekiya,Noriyasu; Hayakawa,Yayoi; Sakumi,Akira; Takahashi,Wataru; Hasegawa,Hirotaka; Fukayama,Masashi; Nakagawa,Keiichi

doi:10.3892/ol.2017.6359

Detection of residual metastatic tumor in the brain following Gamma Knife radiosurgery using a single or a series of magnetic resonance imaging scans: An autopsy study

Authors:
- Madoka Sakuramachi
- Hiroshi Igaki
- Masako Ikemura
- Hideomi Yamashita
- Kae Okuma
- Noriyasu Sekiya
- Yayoi Hayakawa
- Akira Sakumi
- Wataru Takahashi
- Hirotaka Hasegawa
- Masashi Fukayama
- Keiichi Nakagawa
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Affiliations: Department of Radiology, The University of Tokyo Hospital, Tokyo 113‑8655, Japan, Department of Radiation Oncology, National Cancer Center Hospital, Tokyo 104‑0045, Japan, Department of Pathology, The University of Tokyo Hospital, Tokyo 113‑8655, Japan, Department of Radiology, New Tokyo Hospital, Matsudo, Chiba 271‑2232, Japan, Department of Radiation Therapy, NTT Medical Center Tokyo, Tokyo 141‑0022, Japan, Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113‑8655, Japan
Published online on: June 9, 2017 https://doi.org/10.3892/ol.2017.6359
Pages: 2033-2040
Copyright: © Sakuramachi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The aim of the present study was to investigate the usefulness of magnetic resonance image (MRI) for the detection of residual tumors following Gamma Knife radiosurgery (GKR) for brain metastases based on autopsy cases. The study investigated two hypotheses: i) Whether a single MRI may detect the existence of a tumor; and ii) whether a series of MRIs may detect the existence of a tumor. The study is a retrospective case series in a single institution. A total of 11 brain metastases in 6 patients were treated with GKR between 2002 and 2011. Histopathological specimens from autopsy were compared with reconstructed follow‑up MRIs. The maximum diameters of the lesions on MRI series were measured, and the size changes classified. The primary sites in the patients were the kidneys (n=2), lung (n=1), breast (n=1) and colon (n=1), as well as 1 adenocarcinoma of unknown origin. The median prescribed dose for radiosurgery was 20 Gy (range, 18‑20 Gy), and median time interval between GKR and autopsy was 10 months (range, 1.6‑20 months). The pathological outcomes included 7 remissions and 4 failures. Enhanced areas on gadolinium‑enhanced MRI contained various components: Viable tumor cells, tumor necrosis, hemorrhage, inflammation and vessels. Regarding the first hypothesis, it was impossible to distinguish pathological failure from remission with a single MRI scan due to the presence of various components. Conversely, in treatment response (remission or failure), on time‑volume curves of MRI scans were in agreement with pathological findings, with the exception of progressive disease in the acute phase (0‑3 months). Thus, regarding the second hypothesis, time‑volume curves were useful for predicting treatment responses. In conclusion, it was difficult to predict treatment response using a single MRI, and a series of MRI scans were required to detect the existence of a tumor.

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