Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2003 Jul;74(7):908–912. doi: 10.1136/jnnp.74.7.908

Spontaneous haemorrhage into metastatic brain tumours after stereotactic radiosurgery using a linear accelerator

H Suzuki 1, S Toyoda 1, M Muramatsu 1, T Shimizu 1, T Kojima 1, W Taki 1
PMCID: PMC1738526  PMID: 12810777

Abstract

Objective: To determine the incidence and clinical characteristics of spontaneous haemorrhage into metastatic brain tumours after radiosurgery.

Methods: Intratumour haemorrhage rate, clinical features, and treatment were evaluated in 54 patients with 131 brain metastases of varying origin who were treated using linear accelerator radiosurgery. The marginal dose was maintained constant at 20 or 25 Gy, irrespective of tumour size.

Results: Haemorrhage was identified in 7.4% of the metastases (five tumours in four patients) before radiosurgery and in 18.5% (10 tumours in 10 patients) after radiosurgery. In three cases, haemorrhage into the tumour after radiosurgery was symptomatic. Half the haemorrhages occurred within one month of radiosurgery. The changes in tumour size observed at the time of haemorrhage were an increase in one tumour, no change in five, and a decrease in four. Haemorrhage into a tumour after radiosurgery was more likely to occur in female patients, in tumours with a larger volume on pretreatment neuroimaging, and in tumours treated with a larger number of isocentres or a higher maximum dose. Haemorrhagic features in the patients or their tumours on presurgical assessment were not disposing factors to haemorrhage after radiosurgery.

Conclusions: When larger brain metastases are aggressively treated by radiosurgery, better local control may be attained but there may also be a higher risk of haemorrhage soon after the treatment.

Full Text

The Full Text of this article is available as a PDF (114.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Chin L. S., Ma L., DiBiase S. Radiation necrosis following gamma knife surgery: a case-controlled comparison of treatment parameters and long-term clinical follow up. J Neurosurg. 2001 Jun;94(6):899–904. doi: 10.3171/jns.2001.94.6.0899. [DOI] [PubMed] [Google Scholar]
  2. Flickinger J. C., Lunsford L. D., Somaza S., Kondziolka D. Radiosurgery: its role in brain metastasis management. Neurosurg Clin N Am. 1996 Jul;7(3):497–504. [PubMed] [Google Scholar]
  3. Friedman W. A., Foote K. D. Linear accelerator radiosurgery in the management of brain tumours. Ann Med. 2000 Feb;32(1):64–80. doi: 10.3109/07853890008995912. [DOI] [PubMed] [Google Scholar]
  4. Kase C. S. Intracerebral hemorrhage: non-hypertensive causes. Stroke. 1986 Jul-Aug;17(4):590–595. doi: 10.1161/01.str.17.4.590. [DOI] [PubMed] [Google Scholar]
  5. Kim D. G., Chung H. T., Gwak H. S., Paek S. H., Jung H. W., Han D. H. Gamma knife radiosurgery for brain metastases: prognostic factors for survival and local control. J Neurosurg. 2000 Dec;93 (Suppl 3):23–29. doi: 10.3171/jns.2000.93.supplement. [DOI] [PubMed] [Google Scholar]
  6. Kondziolka D., Bernstein M., Resch L., Tator C. H., Fleming J. F., Vanderlinden R. G., Schutz H. Significance of hemorrhage into brain tumors: clinicopathological study. J Neurosurg. 1987 Dec;67(6):852–857. doi: 10.3171/jns.1987.67.6.0852. [DOI] [PubMed] [Google Scholar]
  7. Mori Y., Kondziolka D., Flickinger J. C., Kirkwood J. M., Agarwala S., Lunsford L. D. Stereotactic radiosurgery for cerebral metastatic melanoma: factors affecting local disease control and survival. Int J Radiat Oncol Biol Phys. 1998 Oct 1;42(3):581–589. doi: 10.1016/s0360-3016(98)00272-7. [DOI] [PubMed] [Google Scholar]
  8. Motozaki T., Ban S., Yamamoto T., Hamasaki M. [Peritumoral hemorrhage after radiosurgery for metastatic brain tumor: a case report]. No Shinkei Geka. 1994 Aug;22(8):789–793. [PubMed] [Google Scholar]
  9. Nataf F. Place de la radiochirurgie dans le traitement des métastases cérébrales. Neurochirurgie. 1999 Dec;45(5):393–397. [PubMed] [Google Scholar]
  10. Nedzi L. A., Kooy H., Alexander E., 3rd, Gelman R. S., Loeffler J. S. Variables associated with the development of complications from radiosurgery of intracranial tumors. Int J Radiat Oncol Biol Phys. 1991 Aug;21(3):591–599. doi: 10.1016/0360-3016(91)90675-t. [DOI] [PubMed] [Google Scholar]
  11. Rubin P., Gash D. M., Hansen J. T., Nelson D. F., Williams J. P. Disruption of the blood-brain barrier as the primary effect of CNS irradiation. Radiother Oncol. 1994 Apr;31(1):51–60. doi: 10.1016/0167-8140(94)90413-8. [DOI] [PubMed] [Google Scholar]
  12. Somaza S., Kondziolka D., Lunsford L. D., Kirkwood J. M., Flickinger J. C. Stereotactic radiosurgery for cerebral metastatic melanoma. J Neurosurg. 1993 Nov;79(5):661–666. doi: 10.3171/jns.1993.79.5.0661. [DOI] [PubMed] [Google Scholar]
  13. Suzuki S., Omagari J., Nishio S., Nishiye E., Fukui M. Gamma knife radiosurgery for simultaneous multiple metastatic brain tumors. J Neurosurg. 2000 Dec;93 (Suppl 3):30–31. doi: 10.3171/jns.2000.93.supplement. [DOI] [PubMed] [Google Scholar]
  14. Wakai S., Yamakawa K., Manaka S., Takakura K. Spontaneous intracranial hemorrhage caused by brain tumor: its incidence and clinical significance. Neurosurgery. 1982 Apr;10(4):437–444. doi: 10.1227/00006123-198204000-00004. [DOI] [PubMed] [Google Scholar]
  15. Zimmerman R. A., Bilaniuk L. T. Computed tomography of acute intratumoral hemorrhage. Radiology. 1980 May;135(2):355–359. doi: 10.1148/radiology.135.2.7367626. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES