RTHP-13. SECONDARY MALIGNANCY RATES AND ADVERSE RADIATION EFFECTS AFTER STEREOTACTIC RADIOSURGERY FOR BENIGN ACOUSTIC NEUROMA: AN INSTITUTIONAL EXPERIENCE

Abstract INTRODUCTION Despite increasing use of stereotactic radiosurgery (SRS) for management of brain metastases (BM), published Australian data is scarce. We aim to report on the outcomes following SRS for limited BM in a single Australian institution. METHODS This is a retrospective cohort of patients with limited BM treated with SRS between August 2015 and March 2019. A dose of 24Gy/3# were prescribed to intact lesion, and 21Gy/3# to surgical cavity post-surgical resection. All patients were followed with 3-monthly surveillance MRI brain. Primary outcomes were: local failure (LF: increased in size of SRS-treated BM lesion/ recurrence in surgical cavity), distant failure (DF: intracranial progression outside of the SRS-treated lesion/ cavity), and overall survival (OS). LF, DF and OS were estimated using the Kaplan-Meier method. Multivariate Cox regressions were used to evaluate factors associated with outcomes of interest, with death as competing-risk events for LF and DF. RESULTS 76 courses of SRS were delivered in 65 patients (54 unresected BM lesions, and 22 surgical cavities). 43 (66%) patients were ECOG 0–1. 35 (54%) patients had solitary BM. 41 (63%) had symptomatic BM. Half of the patients had primary lung cancer. Median follow-up was 4.8 months (range:0.1–39 months). 10 LF were observed at a median of 3.5 month post-SRS, with 6- and 12-month LF cumulative incidence of 14% and 24% respectively. 30 DF were observed at a median of 3.3 months, with 6- and 12-month DF cumulative incidence of 38% and 63% respectively. The 12- and 24-month OS were 39% and 26% respectively. In multivariate analyses, better ECOG status, solitary BM lesion, resection of BM pre-SRS, and use of subsequent systemic therapy were independently associated with improved OS. CONCLUSION This is one of the few Australian series reporting on outcomes following SRS for limited BM, with comparable outcomes to published international series.

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RTHP-04. PEDIATRIC STEREOTACTIC RADIOSURGERY FOR BENIGN NEUROLOGIC DISEASE: A 25-YEAR INSTITUTIONAL EXPERIENCE

Neuro-Oncology ◽

10.1093/neuonc/noz175.877 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi210-vi210

Author(s):

Alexander Sherry ◽

Brian Bingham ◽

Ellen Kim ◽

Benjin Facer ◽

Valentine Chukwuma ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Venous Malformation ◽

Disease Free Survival ◽

Neurologic Disease ◽

Institutional Review ◽

Median Total Dose ◽

Institutional Experience ◽

One Year

Abstract Long-term outcomes and sequalae of pediatric stereotactic radiosurgery (SRS) for benign neurologic disease are poorly understood. We sought to explore the efficacy and late effects of SRS in pediatric patients treated our institution. After institutional review board approval, we performed a retrospective analysis of patients age 21 or younger treated between 1990 and 2016. Covariates were summarized with descriptive statistics. 56 consecutive patients were enrolled. Patients were primarily Caucasian (n=51, 93%) males (n=30, 54%). Diagnoses included arterio-venous malformation (n=41, 73%) and functional pituitary adenoma (n=9, 16%) as well as vestibular schwannoma, craniopharyngioma, meningioma, papilloma, and ganglioglioma. Average age was 14 years (95% CI 13–16 years). SRS was often the first intervention (n=22, 44%); treatments prior to SRS included embolization (n=18, 36%) and surgery (n=10, 20%). SRS was typically single fraction (n=45, 94%) with a median total dose of 16 Gy (IQR 15–18 Gy). Most patients had no acute side effects of SRS (n=40, 87%). Median follow-up time after SRS was 12 years (IQR 6–18 years, max 26 years). 91% of patients had no late sequelae of SRS. One patient was diagnosed with radionecrosis one year after repeat SRS for residual malformation. Two patients had malformation hemorrhage. One patient with brainstem malformation developed focal weakness after ischemia from treatment effect; another patient with malformation developed seizures related to SRS edema. Over 673 patient-years following SRS, no patient developed radiation-induced malignancy or malignant transformation. Median disease-free survival after SRS was 6 years (IQR 3–13) with 66% overall local control; 84% of local failures occurred within 5 years of SRS. At last follow-up, 95% of patients remained without evidence of disease with 100% overall survival. These data support the long-term safety and efficacy of pediatric SRS.

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Microsatellite Analysis of Recurrent Vestibular Schwannoma (Acoustic Neuroma) Following Stereotactic Radiosurgery

Otology & Neurotology ◽

10.1097/01.mao.0000199753.44191.73 ◽

2006 ◽

Vol 27 (2) ◽

pp. 213-219 ◽

Cited By ~ 8

Author(s):

Daniel J Lee ◽

Brett Maseyesva ◽

William Westra ◽

Donlin Long ◽

John K Niparko ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Vestibular Schwannoma ◽

Acoustic Neuroma ◽

Microsatellite Analysis

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Stereotactic radiosurgery for jugular foramen schwannomas: an international multicenter study

Journal of Neurosurgery ◽

10.3171/2017.5.jns162894 ◽

2018 ◽

Vol 129 (4) ◽

pp. 928-936 ◽

Cited By ~ 2

Author(s):

Hideyuki Kano ◽

Antonio Meola ◽

Huai-che Yang ◽

Wan-Yuo Guo ◽

Roberto Martínez-Alvarez ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Radiation Effects ◽

Tumor Volume ◽

Progression Free Survival ◽

Jugular Foramen ◽

Management Approach ◽

Tumor Control ◽

Cranial Neuropathies ◽

Microsurgical Resection ◽

International Multicenter Study

OBJECTIVEFor some jugular foramen schwannomas (JFSs), complete resection is possible but may be associated with significant morbidity. Stereotactic radiosurgery (SRS) is a minimally invasive alternative or adjunct to microsurgery for JFSs. The authors reviewed clinical and imaging outcomes of SRS for patients with these tumors.METHODSNine participating centers of the International Gamma Knife Research Foundation identified 92 patients who underwent SRS between 1990 and 2013. Forty-one patients had prior subtotal microsurgical resection. The median interval between previous surgery and SRS was 15 months (range 0.5–144 months). Eighty-four patients had preexisting cranial nerve (CN) symptoms and signs. The median tumor volume was 4.1 cm3 (range 0.8–22.6 cm3), and the median margin dose was 12.5 Gy (range 10–18 Gy). Patients with neurofibromatosis were excluded from this study.RESULTSThe median follow-up was 51 months (range 6–266 months). Tumors regressed in 47 patients, remained stable in 33, and progressed in 12. The progression-free survival (PFS) was 93% at 3 years, 87% at 5 years, and 82% at 10 years. In the entire series, only a dumbbell shape (extension extracranially via the jugular foramen) was significantly associated with worse PFS. In the group of patients without prior microsurgery (n = 51), factors associated with better PFS included tumor volume < 6 cm3 (p = 0.037) and non–dumbbell-shaped tumors (p = 0.015). Preexisting cranial neuropathies improved in 27 patients, remained stable in 51, and worsened in 14. The CN function improved after SRS in 12% of patients at 1 year, 24% at 2 years, 27% at 3 years, and 32% at 5 years. Symptomatic adverse radiation effects occurred in 7 patients at a median of 7 months after SRS (range 5–38 months). Six patients underwent repeat SRS at a median of 64 months (range 44–134 months). Four patients underwent resection at a median of 14 months after SRS (range 8–30 months).CONCLUSIONSStereotactic radiosurgery proved to be a safe and effective primary or adjuvant management approach for JFSs. Long-term tumor control rates and stability or improvement in CN function were confirmed.

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SU-E-T-678: Normal Tissue Dose-Volume Constrains for Inverse Planning of Acoustic Neuroma Stereotactic Radiosurgery (SRS)

Medical Physics ◽

10.1118/1.4815105 ◽

2013 ◽

Vol 40 (6Part21) ◽

pp. 362-362

Author(s):

H Liu ◽

D Andrews ◽

M Werner-Wasik ◽

Y Xiao ◽

Y Yu ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Acoustic Neuroma ◽

Normal Tissue ◽

Inverse Planning ◽

Tissue Dose ◽

Dose Volume

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Stereotactic radiosurgery for arteriovenous malformations of the basal ganglia and thalamus: an international multicenter study

Journal of Neurosurgery ◽

10.3171/2018.8.jns182106 ◽

2020 ◽

Vol 132 (1) ◽

pp. 122-131

Author(s):

Ching-Jen Chen ◽

Kathryn N. Kearns ◽

Dale Ding ◽

Hideyuki Kano ◽

David Mathieu ◽

...

Keyword(s):

Basal Ganglia ◽

Stereotactic Radiosurgery ◽

Arteriovenous Malformations ◽

Radiation Effects ◽

Favorable Outcome ◽

Study Cohort ◽

Multicenter Cohort Study ◽

Radiation Induced ◽

The Mean ◽

International Multicenter Study

OBJECTIVEArteriovenous malformations (AVMs) of the basal ganglia (BG) and thalamus are associated with elevated risks of both hemorrhage if left untreated and neurological morbidity after resection. Therefore, stereotactic radiosurgery (SRS) has become a mainstay in the management of these lesions, although its safety and efficacy remain incompletely understood. The aim of this retrospective multicenter cohort study was to evaluate the outcomes of SRS for BG and thalamic AVMs and determine predictors of successful endpoints and adverse radiation effects.METHODSThe authors retrospectively reviewed data on patients with BG or thalamic AVMs who had undergone SRS at eight institutions participating in the International Gamma Knife Research Foundation (IGKRF) from 1987 to 2014. Favorable outcome was defined as AVM obliteration, no post-SRS hemorrhage, and no permanently symptomatic radiation-induced changes (RICs). Multivariable models were developed to identify independent predictors of outcome.RESULTSThe study cohort comprised 363 patients with BG or thalamic AVMs. The mean AVM volume and SRS margin dose were 3.8 cm3 and 20.7 Gy, respectively. The mean follow-up duration was 86.5 months. Favorable outcome was achieved in 58.5% of patients, including obliteration in 64.8%, with rates of post-SRS hemorrhage and permanent RIC in 11.3% and 5.6% of patients, respectively. Independent predictors of favorable outcome were no prior AVM embolization (p = 0.011), a higher margin dose (p = 0.008), and fewer isocenters (p = 0.044).CONCLUSIONSSRS is the preferred intervention for the majority of BG and thalamic AVMs. Patients with morphologically compact AVMs that have not been previously embolized are more likely to have a favorable outcome, which may be related to the use of a higher margin dose.

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