Introduction: Metastasis to clivus is rare and usually encontered late in the disease process in patients with known advanced disease. Surgical resection could be carried only selective patient due to mulitple medical cormodities and advanced stage of disease. Most patients treated by palliative radiotherapy. But there is no clear consensus concerning the tratment of clivus metastasis because of the rairty of such lesion .
This study analyzed outcomes of clival tumor treated with gamma knife radiosurgery as a primary treatment modality.
Methods: Retrospective review of clinical record for 7 consecutive patients was performed. 4 male and 3 female with a median age of 52.5 years. GKRS was done as a primary treatment modality. Patient were assessed clinically and radiographicaly following GKRS.
Results: The median duration for follow-up was 11 months (range 1-30months, exclude 2 patients). The mean tumor volume was 3900 cumm (range 1100-8100cumm). The median dose to the tumor margin was 23.85Gy (range 20-28). Overall tumor contol was achieve in 80% of patients at last follow-up. Development of focal neurologic deficit at the time of GKRS were 100%( 6th nerve palsy 60%, 5th nerve palsy 40%, 7th nerve palsy 20%) At most recent clinical follow-up 5 patients (100%) demonstrated no change or improvement in their neurologic condition. 3 patients died of systemic disease progression (60%). The overall median survival time was 34.8 months(range 1-118 months). Distribution of median survival time across Recursive Partitioning Ananlysis(RPA) classes showed that the mean survial time were 118months in class 1( 1patient), 17.6 months in class 2 (3 patients), and 1month in class 3 (1 patient). Better karnofsky performance scale score, fewer metastasis, and well controlled primary tumor were significant predictive factors for longer survival.
Conclusions: The present results indicate that Gamma knife radiosurgery offers a high rate of local tumor control and neurological preservation in patients with metastatic clival tumors. It help to stablize the cranial nerve palsy and alleviate other symptoms such as headache. providing better quality . In patients with fewer metastasis, controlled systemic disease, and a low RPA class, GKRS may be most valuable.
Patient Care: This study analyzed outcomes of clival tumor treated with gamma knife radiosurgery as a primary treatment modality.
Learning Objectives: Identify an effective treatment of clivus metastatic tumor with gamma knife radiosurgery