CLINICAL STUDY Outcomes of gamma knife radiosurgery, bi-modality & tri-modality treatment regimens for patients with one or multiple brain metastases: the Columbia University Medical Center experience Tony J. C. Wang • Shumaila Saad • Yasir H. Qureshi • Ashish Jani • Steven R. Isaacson • Michael B. Sisti • Jeffrey N. Bruce • Guy M. McKhann II • Jeraldine Lesser • Simon K. Cheng • K. S. Clifford Chao • Andrew B. Lassman Received: 27 September 2014 / Accepted: 1 February 2015 Ó Springer Science+Business Media New York 2015 Abstract Optimal treatment of brain metastases (BMs) is debatable. However, surgery or gamma knife radiosurgery (GKRS) improves survival when combined with whole brain radiotherapy (WBRT) versus WBRT alone. We ret- rospectively reviewed an institutional database of patients treated with GKRS for BMs from 1998 to 2013 to explore effects of single or multi-modality therapies on survival. There were 528 patients with median age 62 years. His- tologies included 257 lung, 102 breast, 62 melanoma, 40 renal cell, 29 gastrointestinal, and 38 other primary cancers. Treatments included: 206 GKRS alone, 111 GKRS plus WBRT, 109 GKRS plus neurosurgical resec- tion (NSG), and 102 all three modalities. Median overall survival (mOS) was 16.6 months. mOS among patients with one versus multiple metastasis was 17.2 versus 16.0 months respectively (p = 0.825). For patients with one BM, mOS following GKRS alone, GKRS plus WBRT, GKRS plus NSG, and all three modalities was 9.0, 19.1, 25.5, and 25.0 months, respectively, and for patients with multiple BMs, mOS was 8.6, 20.4, 20.7, 24.5 months for the respective groups. Among all patients, multivariate analysis confirmed that tri-modality group had the longest survival (HR 0.467; 95 % CI 0.350–0.623; p \ 0.001) compared to GKRS alone; however, this was not sig- nificantly different than bi-modality approaches. Uncon- trolled primary extra-CNS disease, age and KPS were also independent predictors of survival. Patients treated with GKRS plus NSG, GKRS plus WBRT, or all three mod- alities had improved OS versus GKRS alone. In our ana- lysis, resection and GKRS allowed avoidance of WBRT without shortening survival. Keywords Brain metastases Á Gamma knife radiosurgery Á Surgery Á Whole brain radiotherapy Á Multi-modality Introduction Brain metastases (BMs) are a common clinical problem, occurring in 20–40 % of patients with cancer [1–3]. They also portend a poor prognosis, with median overall survival (mOS), ranging from 3 to 15 months [4]. The management of BMs remains controversial. For decades, whole brain radiotherapy (WBRT) [5] was the Electronic supplementary material The online version of this article (doi:10.1007/s11060-015-1728-y) contains supplementary material, which is available to authorized users. T. J. C. Wang (&) Á S. Saad Á A. Jani Á S. R. Isaacson Á J. Lesser Á S. K. Cheng Á K. S. Clifford Chao Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B-11, New York, NY 10032, USA e-mail: tjw2117@cumc.columbia.edu T. J. C. Wang Á S. R. Isaacson Á M. B. Sisti Á J. N. Bruce Á G. M. McKhann II Á S. K. Cheng Á K. S. Clifford Chao Á A. B. Lassman Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA Y. H. Qureshi The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA M. B. Sisti Á J. N. Bruce Á G. M. McKhann II Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA A. B. Lassman Department of Neurology, Columbia University Medical Center, New York, NY, USA 123 J Neurooncol DOI 10.1007/s11060-015-1728-y