Development of Dose–Volume Relation Model for Gamma Knife Surgery of Non-Skull Base Intracranial Meningiomas

2009 ◽  
Vol 74 (4) ◽  
pp. 1027-1032 ◽  
Author(s):  
Hyun-Tai Chung ◽  
Dong Gyu Kim ◽  
Sun Ha Paek ◽  
Hee-Won Jung
Keyword(s):  
Skull Base ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Intracranial Meningiomas ◽  
Dose Volume ◽  
Relation Model ◽  
Volume Relation

Gamma Knife surgery for skull base chordomas and chondrosarcomas

2007 ◽  
Vol 107 (4) ◽  
pp. 752-757 ◽  
Author(s):  
Toshinori Hasegawa ◽  
Dai Ishii ◽  
Yoshihisa Kida ◽  
Masayuki Yoshimoto ◽  
Joji Koike ◽  
...  
Keyword(s):  
Skull Base ◽  
Gamma Knife ◽  
Tumor Volume ◽  
Tumor Resection ◽  
Gamma Knife Surgery ◽  
High Rate ◽  
Tumor Control ◽  
Low Grade ◽  
The Mean ◽  
Skull Base Chordomas

Object The purpose of this study was to evaluate radiosurgical outcomes in skull base chordomas and chondrosarcomas, and to determine which tumors are appropriate for stereotactic radiosurgery as adjuvant therapy following maximum tumor resection. Methods Thirty-seven patients (48 lesions) were treated using Gamma Knife surgery (GKS); 27 had chordomas, seven had chondrosarcomas, and three had radiologically diagnosed chordomas. The mean tumor volume was 20 ml, and the mean maximum and marginal doses were 28 and 14 Gy, respectively. The mean follow-up period was 97 months from diagnosis and 59 months from GKS. Results The actuarial 5- and 10-year survival rates after GKS were 80 and 53%, respectively. The actuarial 5- and 10-year local tumor control (LTC) rates after single or multiple GKS sessions were 76 and 67%, respectively. All patients with low-grade chondrosarcomas achieved good LTC. A tumor volume of less than 20 ml significantly affected the high rate of LTC (p = 0.0182). No patient had adverse radiation effects, other than one in whom facial numbness worsened despite successful tumor control. Conclusions As an adjuvant treatment after resection, GKS is a reasonable option for selected patients harboring skull base chordomas or chondrosarcomas with a residual tumor volume of less than 20 ml. Dose planning with a generous treatment volume to avoid marginal treatment failure should be made at a marginal dose of at least 15 Gy to achieve long-term tumor control.

Radiation necrosis following gamma knife surgery: a case-controlled comparison of treatment parameters and long-term clinical follow up

2001 ◽  
Vol 94 (6) ◽  
pp. 899-904 ◽  
Author(s):  
Lawrence S. Chin ◽  
Lijun Ma ◽  
Steven DiBiase
Keyword(s):  
Risk Factors ◽  
Gamma Knife ◽  
Radiation Necrosis ◽  
Treatment Plan ◽  
Gamma Knife Surgery ◽  
Histological Findings ◽  
Content Type ◽  
Integral Dose ◽  
Dose Volume ◽  
Fine Print

Object. Radiation necrosis is the only significant complication of gamma knife surgery (GKS). The authors studied treatment plan parameters in patients who had radiation necrosis to determine if risk factors for necrosis could be identified. Methods. Between September 1994 and December 1998, 286 patients were treated with GKS by the senior author. Of the 243 patients who were suitable for analysis, 17 developed radiation necrosis and were prospectively followed. Concurrently, 17 patients without necrosis were randomly selected as case controls on the basis of histological findings in their lesions. Integral dose—volume histograms (DVHs) were calculated and dose—volume treatment parameters were determined. A comparison was made with both the established Kjellberg and Flickinger isonecrosis risk lines. Clinical outcome was assessed according to time to resolution of symptoms and return to normal radiographic appearance. Conclusions. Treatment plan variables associated with the risk of necrosis were increased tumor volume (TV) integral dose, increased TV, and increased 10-Gy volume. Other risk factors included repeated radiosurgery to the same lesion and glioma histological findings. The Kjellberg 1% risk line predicted a 5% risk of radiation necrosis and the Flickinger 3% risk line predicted a 3% risk. The median time to development of necrosis was 4 months, and symptomatic and radiographic recovery times were 7.5 and 10.5 months, respectively. The median survival time in patients with necrosis was 30 months. The authors recommend prospective TV determination and DVH calculation for all radiosurgical treatments and the avoidance of repeated radiosurgical treatments to the same lesion when possible.

Gamma knife surgery for skull base meningiomas

1999 ◽  
Vol 52 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Yoshiyasu Iwai ◽  
Kazuhiro Yamanaka ◽  
Toshihiro Yasui ◽  
Masaki Komiyama ◽  
Misao Nishikawa ◽  
...  
Keyword(s):  
Skull Base ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Skull Base Meningiomas

Gamma Knife surgery for skull base meningiomas

2012 ◽  
Vol 116 (3) ◽  
pp. 588-597 ◽  
Author(s):  
Robert M. Starke ◽  
Brian J. Williams ◽  
Claire Hiles ◽  
James H. Nguyen ◽  
Mohamed Y. Elsharkawy ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Tumor Progression ◽  
Skull Base ◽  
Gamma Knife ◽  
Cerebellopontine Angle ◽  
Tumor Volume ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Skull Base Meningiomas

Object Skull base meningiomas are challenging tumors owing in part to their close proximity to important neurovascular structures. Complete microsurgical resection can be associated with significant morbidity, and recurrence rates are not inconsequential. In this study, the authors evaluate the outcomes of skull base meningiomas treated with Gamma Knife surgery (GKS) both as an adjunct to microsurgery and as a primary treatment modality. Methods The authors performed a retrospective review of a prospectively compiled database detailing the outcomes in 255 patients with skull base meningiomas treated at the University of Virginia from 1989 to 2006. All patients had a minimum follow-up of 24 months. The group comprised 54 male and 201 female patients, with a median age of 55 years (range 19–85 years). One hundred nine patients were treated with upfront radiosurgery, and 146 patients were treated with GKS following resection. Patients were assessed clinically and radiographically at routine intervals following GKS. Factors predictive of new neurological deficit following GKS were assessed via univariate and multivariate analysis, and Kaplan-Meier analysis and Cox multivariate regression analysis were used to assess factors predictive of tumor progression. Results Meningiomas were centered over the cerebellopontine angle in 43 patients (17%), the clivus in 40 (16%), the petroclival region in 28 (11%), the petrous region in 6 (2%), and the parasellar region in 138 (54%). The median duration of follow-up was 6.5 years (range 2–18 years). The mean preradiosurgery tumor volume was 5.0 cm3 (range 0.3–54.8 cm3). At most recent follow-up, 220 patients (86%) displayed either no change or a decrease in tumor volume, and 35 (14%) displayed an increase in volume. Actuarial progression-free survival at 3, 5, and 10 years was 99%, 96%, and 79%, respectively. In Cox multivariate analysis, pre-GKS covariates associated with tumor progression included age greater then 65 years (HR 3.41, 95% CI 1.63–7.13, p = 0.001) and decreasing dose to tumor margin (HR 0.90, 95% CI 0.80–1.00, p = 0.05). At most recent clinical follow-up, 230 patients (90%) demonstrated no change or improvement in their neurological condition and the condition of 25 patients had deteriorated (10%). In multivariate analysis, the factors predictive of new or worsening symptoms were increasing duration of follow-up (OR 1.01, 95% CI 1.00–1.02, p = 0.015), tumor progression (OR 2.91, 95% CI 1.60–5.31, p < 0.001), decreasing maximum dose (OR 0.90, 95% CI 0.84–0.97, p = 0.007), and petrous or clival location versus parasellar, petroclival, and cerebellopontine angle location (OR 3.47, 95% CI 1.23–9.74, p = 0.018). Conclusions Stereotactic radiosurgery offers a high rate of tumor control and neurological preservation in patients with skull base meningiomas. After radiosurgery, better outcomes were observed for those receiving an optimal radiosurgery dose and harboring tumors located in a cerebellopontine angle, parasellar, or petroclival location.

The role of Gamma Knife surgery in the treatment of skull base chordomas

2009 ◽  
Vol 94 (2) ◽  
pp. 243-248 ◽  
Author(s):  
Kasandra Dassoulas ◽  
David Schlesinger ◽  
Chun Po Yen ◽  
Jason Sheehan
Keyword(s):  
Skull Base ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Skull Base Chordomas

Postoperative Gamma Knife surgery for benign meningiomas of the cranial base

2007 ◽  
Vol 23 (4) ◽  
pp. E6 ◽  
Author(s):  
Laurence Davidson ◽  
Dawn Fishback ◽  
Jonathan J. Russin ◽  
Martin H. Weiss ◽  
Cheng Yu ◽  
...  
Keyword(s):  
Skull Base ◽  
Gamma Knife ◽  
Progression Free Survival ◽  
Cranial Base ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
Tumor Control ◽  
Complete Excision ◽  
Neurological Improvement ◽  
Skull Base Meningiomas

Object The standard treatment for meningiomas is complete resection, but the proximity of skull base meningiomas to important neurovascular structures makes complete excision of the lesion difficult or impossible. The authors analyzed the mid- and long-term results obtained in patients treated with postresection Gamma Knife surgery (GKS) for residual or recurrent benign meningiomas of the cranial base. Methods Thirty-six patients with residual or recurrent benign meningiomas of the skull base following one or more surgical procedures underwent GKS. There were 31 women and five men, ranging in age from 22 to 73 years. The median tumor volume was 4.1 ml (range 0.8–20 ml) and the median radiation dose to the tumor margin was 16 Gy (range 15–16 Gy). Results Patients were followed for a median of 81 months (range 30–141 months) after GKS. At the end of the follow-up period, overall neurological improvement was observed in 16 patients (44.4%), whereas the condition in 20 patients (55.6%) was unchanged. One patient suffered transient cerebral edema 6 months after GKS. Based on imaging documentation, a partial response was seen in five patients (13.9%), the disease remained stable in 30 patients (83.3%), and in one patient (2.8%) there was an increase in tumor size. The actuarial progression-free survival rate was 100% at 5 years and 94.7% at 10 years. Conclusions Gamma Knife surgery was shown to be an excellent adjunct to resection because of its durable rate of tumor control and low toxicity. It should be initially considered along with surgery for the treatment of complex skull base meningiomas.

scholarly journals Calvarial and skull base metastases: expanding the clinical utility of Gamma Knife surgery

2014 ◽  
Vol 121 (Suppl_2) ◽  
pp. 91-101 ◽  
Author(s):  
Rupesh Kotecha ◽  
Lilyana Angelov ◽  
Gene H. Barnett ◽  
Chandana A. Reddy ◽  
John H. Suh ◽  
...  
Keyword(s):  
At Risk ◽  
Radiation Therapy ◽  
Skull Base ◽  
Gamma Knife ◽  
Local Control ◽  
Gamma Knife Surgery ◽  
Conventional Radiation ◽  
Skull Base Lesions ◽  
Brain Parenchymal ◽  
Conventional Radiation Therapy

ObjectTraditionally, the treatment of choice for patients with metastases to the calvaria or skull base has been conventional radiation therapy. Because patients with systemic malignancies are also at risk for intracranial metastases, the utility of Gamma Knife surgery (GKS) for these patients has been explored to reduce excess radiation exposure to the perilesional brain parenchyma. The purpose of this study was to report the efficacy of GKS for the treatment of calvarial metastases and skull base lesions.MethodsThe authors performed a retrospective chart review of 21 patients with at least 1 calvarial or skull base metastatic lesion treated with GKS during 2001–2013. For 7 calvarial lesions, a novel technique, in which a bolus was placed over the treatment site, was used. For determination of local control or disease progression, radiation therapy data were examined and posttreatment MR images and oncology records were reviewed. Survival times from the date of procedure were estimated by using Kaplan-Meier analyses.ResultsThe median patient age at treatment was 57 years (range 29–84 years). A total of 19 (90%) patients received treatment for single lesions, 1 patient received treatment for 3 lesions, and 1 patient received treatment for 4 lesions. The most common primary tumor was breast cancer (24% of patients). Per lesion, the median clinical and radiographic follow-up times were 10.3 months (range 0–71.9 months) and 7.1 months (range 0–61.3 months), respectively. Of the 26 lesions analyzed, 14 (54%) were located in calvarial bones and 12 (46%) were located in the skull base. The median lesion volume was 5.3 cm3 (range 0.3–55.6 cm3), and the median prescription margin dose was 15 Gy (range 13–24 Gy). The median overall survival time for all patients was 35.9 months, and the 1-year local control rate was 88.9% (95% CI 74.4%–100%). Local control rates did not differ between lesions treated with the bolus technique and those treated with traditional methods or between calvarial lesions and skull base lesions (p > 0.05). Of the 3 patients for whom local treatment failed, 1 patient received no further treatment and 2 patients responded to salvage chemotherapy. Subsequent brain parenchymal metastases developed in 2 patients, who then underwent GKS.ConclusionsGKS is an effective treatment modality for patients with metastases to the calvarial bones or skull base. For patients with superficial calvarial lesions, a novel approach with bolus application resulted in excellent rates of local control. GKS provides an effective therapeutic alternative to conventional radiation therapy and should be considered for patients at risk for calvarial metastases and brain parenchymal metastases.

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