RT-28 * INSTITUTIONAL REVIEW OF GAMMA KNIFE RADIOSURGERY IN PRIMARY AND RECURRENT HIGH-GRADE GLIOMAS

Abstract BACKGROUND The survival of the patients with high-grade gliomas may be improved through a multidisciplinary approach including stereotactic re-irradiation such as Gamma-Knife at recurrence in a selected population. We report our experience in targeting the hypermetabolic areas of high-grade gliomas using 11C-Methionine PET/CT in selected patients. MATERIAL AND METHODS We retrospectively evaluated the local response in patients treated by Gamma-Knife for recurrent high-grade gliomas in our Institution between 2000 and 2018, targeting the hypermetabolic area with Methionine PET/CT. RESULTS We included 25 patients bearing high-grade gliomas (14 female, 11 male) with a median age of 45 years (5–64). There were 11 WHO grade III gliomas (6 astrocytomas, 5 oligodendrogliomas) and 14 glioblastomas. A total number of 33 Gamma-Knife procedures were performed. In all patients, the targeting was based on the hypermetabolic area as defined by Methionine PET/CT. Four patients were treated concomitantly on 2 or more targets. One patient was treated twice on different targets. We observed a positive response in 29 Gamma-Knife procedures, after a median interval of 2 months (1–33) and no response after 4 procedures (4 glioblastomas). In most cases, progression after Gamma-Knife was observed 4 months after irradiation. CONCLUSION Targeting the hypermetabolic areas with Methionine PET/CT was associated with favorable response in most patients treated by Gamma-Knife radiosurgery for local high-grade gliomas recurrence. Our results must be confirmed by a prospective study with regular and homogeneous morphological and metabolic monitoring.

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A quantitative analysis of adverse radiation effects following Gamma Knife radiosurgery for arteriovenous malformations

Journal of Neurosurgery ◽

10.3171/2014.10.jns142264 ◽

2015 ◽

Vol 123 (4) ◽

pp. 945-953 ◽

Cited By ~ 12

Author(s):

Or Cohen-Inbar ◽

Cheng-Chia Lee ◽

Zhiyuan Xu ◽

David Schlesinger ◽

Jason P. Sheehan

Keyword(s):

Gamma Knife ◽

Arteriovenous Malformations ◽

Radiation Effects ◽

Late Onset ◽

Gamma Knife Radiosurgery ◽

Volumetric Analysis ◽

Institutional Review ◽

Complete Obliteration ◽

Quantitative Changes

OBJECT The authors review outcomes following Gamma Knife radiosurgery (GKRS) of cerebral arteriovenous malformations (AVMs) and their correlation to postradiosurgery adverse radiation effects (AREs). METHODS From a prospective institutional review board–approved database, the authors identified patients with a minimum of 2 years of follow-up and thin-slice T2-weighted MRI sequences for volumetric analysis. A total of 105 AVM patients were included. The authors analyzed the incidence and quantitative changes in AREs as a function of time after GKRS. Statistical analysis was performed to identify factors related to ARE development and changes in the ARE index. RESULTS The median clinical follow-up was 53.8 months (range 24–212.4 months), and the median MRI follow-up was 36.8 months (range 24–212.4 months). 47.6% of patients had an AVM with a Spetzler-Martin grade ≥ III. The median administered margin and maximum doses were 22 and 40 Gy, respectively. The overall obliteration rate was 70.5%. Of patients who showed complete obliteration, 74.4% developed AREs within 4–6 months after GKRS. Late-onset AREs (i.e., > 12 months) correlated to a failure to obliterate the nidus. 58.1% of patients who developed appreciable AREs (defined as ARE index > 8) proceeded to have a complete nidus obliteration. Appreciable AREs were found to be influenced by AVM nidus volume > 3 ml, lobar location, number of draining veins and feeding arteries, prior embolization, and higher margin dose. On the other hand, a minimum ARE index > 8 predicted obliteration (p = 0.043). CONCLUSIONS ARE development after radiosurgery follows a temporal pattern peaking at 7–12 months after stereotactic radiosurgery. The ARE index serves as an important adjunct tool in patient follow-up and outcome prediction.

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Gamma Knife Stereotactic Radiosurgery for Grade 2 Meningiomas

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0036-1597834 ◽

2017 ◽

Vol 78 (04) ◽

pp. 288-294 ◽

Cited By ~ 7

Author(s):

Tamer Refaat ◽

Michelle Gentile ◽

Sean Sachdev ◽

Prarthana Dalal ◽

Anish Butala ◽

...

Keyword(s):

Local Recurrence ◽

Gamma Knife ◽

Malignant Tumors ◽

Survival Rates ◽

Gamma Knife Radiosurgery ◽

Tumor Control ◽

Institutional Review ◽

Effective Treatment Modality ◽

Gamma Knife Stereotactic Radiosurgery

Purpose This study aims to report long-term clinical outcomes after Gamma Knife radiosurgery (GKRS) for intracranial grade 2 meningiomas. Methods In this Institutional Review Board approved study, we reviewed records of all patients with grade 2 meningiomas treated with GKRS between 1998 and 2014. Results A total of 97 postoperative histopathologically confirmed grade 2 meningiomas in 75 patients were treated and are included in this study. After a mean follow-up of 41 months, 28 meningiomas had local recurrence (29.79%). Median time to local recurrence was 89 months (mean: 69, range: 47–168). The 3- and 5-year actuarial local control (LC) rates were 68.9 and 55.7%, respectively. The 3- and 5-year overall survival rates were 88.6 and 81.1%, respectively. There was a trend toward worse LC with tumors treated with radiation doses ≤ 13 versus > 13 Gy. There was no radiation necrosis or second malignant tumors noted in our series. Conclusion This report, one of the largest GKRS series for grade 2 meningiomas, demonstrates that GKRS is a safe and effective treatment modality for patients with grade 2 meningiomas with durable tumor control and minimal toxicity. Adjuvant GKRS could be considered as a reasonable treatment approach for patients with grade 2 meningiomas.

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