• Jennifer C Ho, Dershan Luo, Nandita Guha-Thakurta, Sherise D Ferguson, Amol J Ghia, James N Yang, Paul D Brown, and Khinh Ranh Voong.
• Departments of *Radiation Oncology, ‡Radiation Physics, §Radiology, and ¶Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
• Neurosurgery. 2016 Jun 1; 78 (6): 877-82.

BackgroundRemoval of a pin during Gamma Knife stereotactic radiosurgery (GK-SRS) may be necessary to prevent collision and allow treatment.ObjectiveTo investigate outcomes after GK-SRS for treatment of brain metastases using a head frame immobilized to the skull with only 3 pins.MethodsBetween 2009 and 2014, we retrospectively reviewed the records of 1971 patients and identified 20 patients with multiple brain metastases treated with GK-SRS in which 1 anterior pin was removed immediately before treatment of a single posterior lesion. GK-SRS was also delivered to 116 other lesions in these 20 patients using the standard 4 pins during the same session, serving as an internal control for comparison. Endpoints included local control, dosimetric parameters, toxicity, and overall survival.ResultsThe median number of lesions treated per session was 6 (range, 2-14). The lesions treated using 3 pins were located in the occipital lobe (n = 14) or the cerebellum (n = 6). Median follow-up was 12.3 months. There was 1 local failure involving a control lesion. Lesions treated using 3 pins had a lower prescription isodose line. GK-SRS of a lesion using 3 pins did not cause any clinical toxicities or increase in radiographic edema or hemorrhage.ConclusionTreating posteriorly located brain metastases with GK-SRS using only 3 pins provided excellent local control and no difference in treatment toxicity, which may make it a safe and reasonable option for lesions that may otherwise be difficult to treat.

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