scholarly journals Single centre, retrospective review of gamma-knife stereotactic radiosurgery and other therapies on prevalence of seizures in patients with brain metastases

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv13-iv13
Author(s):  
James De Boisanger ◽  
Katherine Mackay ◽  
Cornel Tancu ◽  
Naomi Fersht ◽  
Neil Kitchen ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Retrospective Review ◽  
De Novo ◽  
Primary Tumour ◽  
Whole Brain Radiotherapy ◽  
Previous Surgery ◽  
Tumour Metastasis ◽  
Number Of Patients

Abstract Background An increasing number of patients with brain metastases (BM) are having stereotactic radiosurgery (SRS), but it is not known whether this causes epilepsy. Methods We carried out a retrospective review of patients surviving one-year post gamma-knife SRS at the National Hospital for Neurology and Neurosurgery (NHNN) between February 2012 and April 2017. Data on seizures during the pre- and post-SRS periods were collected along with information about the primary tumour, metastasis location and previous treatments, including whole brain radiotherapy (WBRT) and surgery. Results 61 patients were treated with SRS. 6 patients had incomplete records and were excluded. Of the remaining 55, 21 had a seizure at some point. 4 had seizures both pre- and post-SRS, 7 had seizures pre-SRS but not post and 10 patients had de-novo seizures post-SRS. 34 did not have a documented seizure at any point. Of the 14 patients who had seizures post-SRS, 4 also had both WBRT and surgery, 2 had WBRT and 4 had surgery. 100% (4/4) who had WBRT, surgery and SRS went on to have a seizure. Seizures occurred in 11/25 patients who had previous surgery and 7/11 who had previous WBRT. The primary tumour and metastasis location had no obvious impact on seizure incidence. Conclusions The incidence of new seizures post-SRS is low (18%). Previous surgery and/or WBRT may increase seizure incidence post-SRS. The data is currently being reviewed for effect of tumour/ treatment volume, dose delivered, presence of significant oedema and radionecrosis. A larger prospective study is also underway.

Gamma Knife surgery for multiple brain metastases from a malignant schwannoma of the penis

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 238-240 ◽  
Author(s):  
Albertus T. C. J. van Eck ◽  
Gerhard A. Horstmann
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Gamma Knife ◽  
De Novo ◽  
Tumor Resection ◽  
Gamma Knife Surgery ◽  
Malignant Schwannoma ◽  
Efficacy And Safety ◽  
Single Brain Metastasis ◽  
Therapy Option

✓The occurrence of brain metastases from a malignant schwannoma of the penis is extremely rare. In patients with a single brain metastasis, microsurgical extirpation is the treatment of choice and verifies the diagnosis. In cases of multiple or recurrent metastases, radiosurgery is an effective and safe therapy option. Gamma Knife surgery was performed in a patient who had previously undergone tumor resection and who presented with recurrence of the lesion and three de novo brain metastases. This first report on brain metastasis from a malignant penile schwannoma illustrates the efficacy and safety of radiosurgical treatment for these tumors.

RADT-05. PROSPECTIVE LONG-TERM EVALUATION OF MRI- AND CLINICAL CHANGES FOLLOWING STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASES – IS REPEAT SRS A CONSEQUENCE, OR ALSO A CAUSE OF LONG-TERM SURVIVAL?

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi41-vi42
Author(s):  
Bente Skeie ◽  
Per Øyvind Enger ◽  
Geir Olve Skeie ◽  
Jan Ingemann Heggdal
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Whole Brain Radiotherapy ◽  
Cancer Site ◽  
Response Patterns ◽  
Primary Cancer ◽  
Term Survival ◽  
Cover Ratio ◽  
Primary Cancer Site

Abstract The use of stereotactic radiosurgery (SRS) for brain metastases are increasing. Response assessment is challenging and the clinical significance of radiological response and retreatments are poorly defined. Ninety-seven patients with a total of 406 brain metastases were followed prospectively for 10 years or until death. Volume changes over time and clinical outcome in response to first time SRS and SRS retreatments were analyzed. Tumors grew significantly before (p = 0.004), but shrunk at 1 and 3 months (p = 0.001) following SRS. Four response-patterns of were observed; tumors either continuously reduced in size (A, 62%), pseudo-progressed (PP, B, 13%), temporarily reduced in size (C, 24%), or grew continuously (D, 2%); corresponding to 75% local control (LC) at initial SRS. Predictors for LC were primary cancer site (p = 0.001), tumor volume (p = 0.002) and target cover ratio (p = 0.005). Subsequent SRS for new lesions resulted in 94% LC (87% A) and repeat-SRS for local failures in 80% LC (57% B), predicted by higher prescribed dose, p = 0.001 and p = 0.042, respectively. Overall survival was only 4.5 months if A-response for all lesions, 13.3 months if at least one B-response, 17.1 months if retreated C- or D-response (p < 0.001), (7.5 and 4.7 months if untreated). Quality of life (p = 0.003), steroid use (p = 0.019) and prior whole brain radiotherapy (p = 0.026) were predictors for survival. There are 4 response patterns to SRS predicted by tumor size, primary cancer site, target cover ratio and prescribed dose. Long-term survivors experienced a higher incidence of PP and were more often retreated for new lesions and local failures. The immune response induced by PP seems beneficial but further studies are needed.

Stereotactic radiosurgery for brain metastases from pelvic gynecological malignancies: oncologic outcomes, validation of prognostic scores, and dosimetric evaluation

2021 ◽  
pp. ijgc-2021-002906
Author(s):  
Eva Meixner ◽  
Tanja Eichkorn ◽  
Sinem Erdem ◽  
Laila König ◽  
Kristin Lang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Recursive Partitioning ◽  
Whole Brain Radiotherapy ◽  
Prognostic Scores ◽  
Gynecologic Malignancies ◽  
Whole Brain ◽  
Brain Radiotherapy ◽  
Cerebral Control

IntroductionStereotactic radiosurgery is a well-established treatment option in the management of brain metastases. Multiple prognostic scores for prediction of survival following radiotherapy exist, but are not disease-specific or validated for radiosurgery in women with primary pelvic gynecologic malignancies metastatic to the brain. The aim of the present study is to evaluate the feasibility, safety, outcomes, and impact of established prognostic scores.MethodsWe retrospectively identified 52 patients treated with radiotherapy for brain metastases between 2008 and 2021. Stereotactic radiosurgery was utilized in 31 patients for an overall number of 75 lesions; the remaining 21 patients received whole-brain radiotherapy. Kaplan-Meier survival analysis and the log-rank test were used to calculate and compare survival curves and univariate and multivariate Cox regression to assess the influence of cofactors on recurrence, local control, and prognosis.ResultsWith a median follow-up of 10.7 months, overall survival rates post radiosurgery were 65.3%, 51.3%, and 27.7% for 1, 2, and 5 years, respectively, which were significantly higher than post whole-brain radiotherapy (p=0.049). Five local failures (6.7%) were detected, resulting in 1 and 2 year local cerebral control rates of 97.4% and 94.0%, respectively. Univariate factors for prediction of superior overall survival were high performance status (p=0.030) and application of three prognostic scores, especially the Recursive Partitioning Analysis score (p=0.028). Uni- and multivariate analysis revealed that extracranial progression prior to radiosurgery was significant for inferior overall survival (p<0.0001). Radionecrosis was diagnosed in five women (16%); long-term neurotoxicity was significantly worse after whole-brain radiotherapy compared with radiosurgery (p=0.023).ConclusionStereotactic radiosurgery for brain metastases from pelvic gynecologic malignancies appears to be safe and well tolerated, achieving promising local cerebral control. Prognostic scores were shown to be transferable and radiosurgery should be recommended as primary intracranial treatment, especially in women with no prior extracranial progression and Recursive Partitioning Analysis class I.

scholarly journals Postoperative Survival in Patients With Multiple Brain Metastases

Medicina ◽  
2012 ◽  
Vol 48 (6) ◽  
pp. 41 ◽  
Author(s):  
Kaspars Auslands ◽  
Daina Apškalne ◽  
Kārlis Bicāns ◽  
Rolfs Ozols ◽  
Henrijs Ozoli
Keyword(s):  
Brain Metastases ◽  
Radiation Therapy Oncology Group ◽  
Whole Brain Radiotherapy ◽  
Postoperative Survival ◽  
Clinical Factors ◽  
Factors Affecting ◽  
Multiple Brain Metastases ◽  
Brain Radiotherapy ◽  
Number Of Patients ◽  
Radiotherapy Alone

Background and Objective. Although surgery is traditionally performed for patients with a single brain metastasis, an increasing number of patients with multiple brain metastases may also be treated surgically. The objective of the study was to analyze postoperative survival results and the clinical factors affecting these results. Material and Methods. The records of the patients who underwent surgical resection of 2 or more lesions between January 2005 and January 2010 were retrospectively reviewed. Survival was calculated from the date of surgery to the last follow-up evaluation or death, and different clinical factors were analyzed in regard to patient survival. Results. In total, 36 patients underwent one or more craniotomies. The survival of the total group ranged from 16 days to 37.5 months (mean, 29 months). There were 4 deaths within 30 days. When divided into Radiation Therapy Oncology Group RPA classes, the survival time was 11.75, 8.58, and 5.31 months for classes 1, 2, and 3, respectively. Regarding an impact on the survival, a significant association with a favorable outcome was found for the following factors: the number of brain metastases (2–3 vs. 4–6, P=0.046), RPA classes (1 vs. 2 or 3, P=0.0192), and extent of metastasis resection (all vs. partial, P=0.018). Conclusions. Well-selected patients with multiple brain metastases appear to benefit from surgery compared with historical controls of patients treated with whole-brain radiotherapy alone.

scholarly journals MLTI-15. A CASE SERIES OF PRE-OPERATIVE GAMMA-KNIFE RADIOSURGERY FOR RESECTABLE BRAIN METASTASES

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i17-i17
Author(s):  
Tatsuya Takezaki ◽  
Haruaki Yamamoto ◽  
Naoki Shinojima ◽  
Jun-ichiro Kuroda ◽  
Shigeo Yamashiro ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Systemic Treatment ◽  
Radiation Necrosis ◽  
Gamma Knife Radiosurgery ◽  
Case Series ◽  
Phase 3 ◽  
Optimal Sequence ◽  
Median Margin

Abstract Recent advances in the systemic treatment of various cancers have resulted in longer survival and higher incidence of brain metastases. Phase 3 trials in north America and in Japan have demonstrated that stereotactic radiosurgery will be a standard adjuvant modality following surgery for resectable brain metastases. However, we don’t know the optimal sequence of this combination therapy. We hypothesized that pre-operative stereotactic radiosurgery for resectable brain metastases provides favorable rates of local control, overall survival, leptomeningeal dissemination and symptomatic radiation necrosis. We have experienced 4 cases of resected brain metastases within 1–7 days after Gamma-knife surgery (median margin dose:22Gy) and have been following their clinical course. We will show the repressive cases.

Use of 3.0-T MRI for Stereotactic Radiosurgery Planning for Treatment of Brain Metastases: A Single-Institution Retrospective Review

2010 ◽  
Vol 78 (4) ◽  
pp. 1142-1146 ◽  
Author(s):  
Paul A. Saconn ◽  
Edward G. Shaw ◽  
Michael D. Chan ◽  
Sarah E. Squire ◽  
Annette J. Johnson ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Retrospective Review ◽  
Single Institution ◽  
3.0 T ◽  
3.0 T Mri
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