scholarly journals RADI-05. FRACTIONATED TREATMENT OF BRAIN METASTASES WITH GAMMA KNIFE ICON

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i22-i22
Author(s):  
Jameson Mendel ◽  
Ankur Patel ◽  
Toral Patel ◽  
Robert Timmerman ◽  
Tu Dan ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Local Control ◽  
Stereotactic Radiotherapy ◽  
Tumor Volume ◽  
Univariate Analysis ◽  
Local Failure ◽  
Fractionated Stereotactic Radiotherapy

Abstract PURPOSE/OBJECTIVE(S): Stereotactic radiosurgery with Gamma Knife is a common treatment modality for patients with brain metastasis. The Gamma Knife ICON allows for immobilization with an aquaplast mask, permitting fractionated treatments. We describe one of the first experiences utilizing this technique with brain metastasis and evaluate outcomes. MATERIALS/METHODS: From June 2017 to November 2018, 29 patients with 43 separate intracranial lesions were treated with fractionated stereotactic radiotherapy using the gamma knife ICON at a single institution. Patients received between 20–30 Gy in 3–5 fractions with no margin over the course of 5 to 23 days. Local control was physician assessed. Local failure over time was modeled using cumulative incidence; lesions were censored at last radiographic follow up. RESULTS: Median tumor volume and prescription isodose was 7.7 cm3 (range 0.3–43.9) and 50% (range 40–65), respectively. Median radiographic follow-up was 7 months and median survival was 9 months. Radiation necrosis occurred in 3/3 patients treated with 27 Gy in 3 fractions, one requiring therapeutic resection. Incidence of local failure for all treated lesions was 9% at 1 year. Tumor volume >7 cm3 was associated with local failure on univariate analysis (p=0.025). 100% (2/2) lesions treated with 20 Gy in 5 fractions developed local recurrence. CONCLUSION: Fractionated stereotactic radiotherapy with the Gamma Knife ICON provides excellent local control for small and large brain metastases with minimal toxicity. Tumors >7 cm3 should receive at least 30 Gy in 5 fractions for optimal control. Treatment with 27 Gy in 3 fractions appears to have high rates of treatment related toxicity and should be avoided.

The Energy Index Does Not Affect Local Control of Brain Metastases Treated by Gamma Knife Stereotactic Radiosurgery

Neurosurgery ◽  
2015 ◽  
Vol 77 (1) ◽  
pp. 119-125 ◽  
Author(s):  
Ashish Jani ◽  
Tzlil Rozenblat ◽  
Andrew M. Yaeh ◽  
Tavish Nanda ◽  
Shumaila Saad ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Local Control ◽  
Tumor Volume ◽  
Complete Response ◽  
Local Failure ◽  
Energy Index ◽  
Prescription Dose

Abstract BACKGROUND: The energy index (EI) is a measure of dose homogeneity within a target volume calculated by the integral dose divided by the product of prescription dose and tumor volume. OBJECTIVE: To assess whether a higher EI is associated with greater local control for brain metastases (BMs) treated by Gamma Knife radiosurgery (GKRS). METHODS: We reviewed all patients treated with GKRS for BM at our institution between January 2009 and February 2014. Data on the prescription dose, prescription isodose line, minimum dose, mean dose, integral dose, tumor volume, and EI were collected. Tumor response was assessed by reviewing follow-up brain imaging studies and classified according to the Response Evaluation Criteria in Solid Tumors. Local control per lesion and dosimetric prognostic factors for local control were assessed by univariate and multivariate Cox proportional hazards regression analyses. RESULTS: Of 213 patients treated, 126 had follow-up imaging available with a median follow-up of 6 months. Three hundred seventy-three individual tumors were analyzed. Of these, 133 showed a complete response, 157 showed a partial response, 46 remained stable, and 37 developed local failure. Tumors with EI ≥1.6 mJ.mL−1.Gy−1 showed a higher rate of complete response. Local control rates at 6, 11, and 17 months were 95.4%, 86.5%, and 81.5%, respectively. On univariate analysis, the following factors were associated with higher rates of local failure: prescription doses of 16 and 18 Gy compared with a prescription dose of 20 Gy. The following factors were associated with a greater rate of local control: maximum dose and mean dose. On multivariate analysis, the only statistically significant factor associated with a greater rate of local failure was prescription dose of 16 Gy compared with 20 Gy. CONCLUSION: GKRS for BM results in a high rate of local control with an 11-month rate of 86.5%. A higher EI was not significantly associated with a higher rate of local control on multivariate analysis. Prescription dose was found to be the only significant predictor of local control on multivariate analysis.

The Role of Tumor Size in the Radiosurgical Management of Patients with Ambiguous Brain Metastases

Neurosurgery ◽  
2003 ◽  
Vol 53 (2) ◽  
pp. 272-281 ◽  
Author(s):  
Eric L. Chang ◽  
Samuel J. Hassenbusch ◽  
Almon S. Shiu ◽  
Frederick F. Lang ◽  
Pamela K. Allen ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Local Control ◽  
Medical Records ◽  
Tumor Volume ◽  
Unknown Primary ◽  
Inclusion Criteria ◽  
Peripheral Dose

Abstract OBJECTIVE To identify a size cutoff below which it is safe to observe obscure brain lesions suspected of being metastases so that treatment of nonmetastases can be avoided. METHODS Medical records from patients who underwent linear accelerator-based radiosurgery from August 1991 to October 2001 were reviewed. Inclusion criteria were defined as brain metastasis tumor volume less than 5 cm3 (diameter, ∼2.1 cm) treated with a dose of 20 Gy or more. One hundred thirty-five patients had 153 evaluable brain metastases with follow-up imaging that met inclusion criteria. Median age was 54 years (range, 18–79 yr). Lesion primaries were non-small-cell lung (n = 39), melanoma (n = 44), renal (n = 37), breast (n = 18), colon (n = 3), sarcoma (n = 5), other (n = 5), and unknown primary (n = 2). Median tumor volume was 0.67 cm3 (range, 0.06–4.58 cm3). The minimum peripheral dose was 20 Gy (n = 132) or 21 to 24 Gy (n = 21). At the time of analysis, the median follow-up for all patients was 10 months (range, 0.2–99 mo). RESULTS The 1- and 2-year actuarial local control rates for all of the lesions were 69 and 46%, respectively. For lesions of 1 cm (0.5 cm3) or less, the corresponding local control rates were 86 and 78%, respectively, which was significantly higher than the corresponding rates of 56 and 24%, respectively, for lesions larger than 1 cm (0.5 cm3) (P = 0.0016). CONCLUSION A convincing brain metastasis measuring less than 1 cm should be pursued aggressively. If the suspected brain metastasis is ambiguous, observation is proposed up to a diameter of 1 cm. This is the first study in the literature to identify a 1-cm cutoff for radiosurgical control of small brain metastases, and validation by additional studies is required.

scholarly journals Short diameter may be a useful simple indicator of the tumor response in skull base meningiomas after conventionally fractionated stereotactic radiotherapy

2021 ◽  
Author(s):  
Keiichi Takehana ◽  
Daisuke Nakamura ◽  
Alshaymaa Abdelghaffar ◽  
Megumi Uto ◽  
Tomohiro Katagiri ◽  
...  
Keyword(s):  
Skull Base ◽  
Stereotactic Radiotherapy ◽  
Tumor Volume ◽  
Tumor Response ◽  
Fractionated Stereotactic Radiotherapy ◽  
Skull Base Meningioma ◽  
Skull Base Meningiomas ◽  
Simple Indicator ◽  
Conventionally Fractionated

Abstract Objectives The purpose of this study was to assess the radiological change patterns in skull base meningiomas after conventionally fractionated stereotactic radiotherapy (CFSRT) to determine a simple and valid method to assess the tumor response. Materials and methods Forty-one patients with a benign skull base meningioma treated by CFSRT from March 2007 to August 2015 were retrospectively evaluated. We measured tumor volume (TV), long-axis diameter (LD), and short-axis diameter (SD) on both pre-treatment images and follow-up images of 1, 3, and 5 years after CFSRT, respectively. The paired t test was used to detect differences in the LD and SD change rates. Spearman’s correlation coefficients were calculated to evaluate relationships between the TV and the diameters changes. Results The number of available follow-up MRIs that was performed at 1, 3, and 5 years after the CFSRT was 41 (100%), 34 (83%), and 23 (56%), respectively. The change rates of SD were significantly higher than those of LD at every time point and more strongly correlated with the change rates of tumor volume at 3 and 5 years after CFSRT. Conclusions SD may be useful as a simple indicator of the tumor response for skull base meningioma after CFSRT. Key Points • The change rate in short-axis diameter is a useful and simple indicator of the response of skull base meningioma to conventionally fractionated stereotactic radiotherapy. • Conventionally fractionated stereotactic radiotherapy for skull base meningioma achieved excellent 5-year local control.

scholarly journals P03.02 Risk of leptomeningeal dissemination in patients treated with postoperative stereotactic radiotherapy of brain metastases

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii24-iii25
Author(s):  
A Mousli ◽  
B Bihin ◽  
T Gustin ◽  
G Koerts ◽  
M Mouchamps ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiotherapy ◽  
Univariate Analysis ◽  
Survival Rates ◽  
Safety Margin ◽  
Incidence Rates ◽  
Leptomeningeal Dissemination ◽  
En Bloc ◽  
Tumor Dissemination

Abstract Background There is a body of evidence that the risk of leptomeningeal dissemination (LMD) is increased in the postoperative stereotactic radiotherapy (SRT) of brain metastases (BM) compared to adjuvant whole brain radiotherapy (WBRT). The proposed mechanism is an iatrogenic tumor dissemination into the cerebrospinal fluid at time of surgery. Including a wider volume of meningeal wall and the entire surgical track in the definition of the postoperative SRT clinical target volume (CTV) to decrease LMD is still controversial. The aim of this study was to retrospectively analyze the outcome of adjuvant SRT targeted at resection cavities of BM without previous WBRT. MATERIAL / METHODS We reviewed 70 patients treated with postoperative SRT for BM. Stereotactic planning computed tomography and planning MRI were imported into iPlan RT image software for image registration and TV delineation. The CTV consisted of any residual enhancement and all resected cavity including a safety margin of 1 to 2 mm. Only in cases of superficial initial tumor with meningeal contact was the CTV enlarged to the adjacent meningeal wall, but never included edema or the entire surgical track. Patients underwent regular follow-up MRI. The cumulative incidence rates of LMD was retrospectively calculated as well as patterns of failure. RESULTS The most common histological type was non small cell lung cancer in 61.4%. There were 38.6% infratentorial locations and 37.2 % superficial lesions. En bloc resection was achieved in 60% and compete resection in 75.7%. After a median imaging follow up time of 16.7 months, 54.3% of patients experienced distant brain failure. LMD occurred in 9 of 70 patients (12.9 %) at a median time of 10.7 months. Survival without LMD was 88% at 1 year (IC 95% 79%-97%) and 82% at 2years (IC 95% 72%-94%). In three quarter of cases, LMD interested superficial lesions. In univariate analysis, survival rates without LMD at 1 year for superficial and deep lesions were 88 % and 94 %, respectively (p=0.49). We report only one recurrence in the surgical track (1.42%). CONCLUSION The risk of LMD was comparable to the literature (11–17%). Superficial lesions were slightly more likely to relapse in the meninges, but it was non-significant. The risk of recurrence in the surgical track is negligible. Our results do not support the current guidelines recommending the systematic inclusion of the surgical track and the related meninges in the CTV.

scholarly journals Gamma Knife versus Frameless Linear Accelerator Based Stereotactic Radiosurgery for Brain Metastases: Clinical Outcomes and Factors Associated with Local Failure and Radiation Necrosis

2021 ◽  
Author(s):  
Gregory S. Alexander ◽  
Jill S. Remick ◽  
Emily S. Kowalski ◽  
Kai Sun ◽  
Yannick Poirer ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Clinical Outcomes ◽  
Gamma Knife ◽  
Linear Accelerator ◽  
Radiation Necrosis ◽  
Univariate Analysis ◽  
Local Failure ◽  
Rank Test ◽  
Chi Square Analysis

Abstract BackgroundSingle-fraction stereotactic radiosurgery (SF-SRS) for the treatment of brain metastases can be delivered with either a Gamma-Knife platform (GK-SRS) or with a frameless linear accelerator (LA-SRS) which vary based on patterns of prescribing, patient setup and radiation delivery. Whether these differences affect clinical outcomes is unknown. MethodsPatients treated for metastatic brain cancer treated with SF-SRS from 2014-2020 were retrospectively reviewed and clinical outcomes were recorded on a per lesion basis. Covariates between groups were compared using a Chi-square analysis for dichotomous variables and t-test for continuous variables. Median follow up was calculated using the reverse Kaplan Meier (KM) method. Primary endpoints of local failure (LF) and symptomatic radiation necrosis (RN) were estimated using the KM method with salvage WBRT used as a censoring event. Outcome estimates were compared using the log-rank test. Multivariate analysis (MVA) and Cox proportional hazards modeling were used for statistical analyses. Propensity score (PS) adjustments were used to reduce the effects confounding variables.ResultsOverall, 119 patients with 287 lesions were included for analysis which included 57 patients (127 lesions) treated with LA-SRS compared to 62 patients (160 lesions) treated with GK-SRS. On both multivariate and univariate analysis, there was no statistically significant differences between GK-SRS and LA-SRS for LF, RN, or the combined endpoint of either LF or RN (multivariate p-value=0.17).ConclusionsIn our retrospective cohort, we found no statistically significant differences in the incidence of RN or LF in patients treated with GK-SRS when compared to LA-SRS.Trial Registration: Retrospectively registered

scholarly journals Gamma Knife radiosurgery for brain metastasis: review of 103 patients

2009 ◽  
Vol 28 (04) ◽  
pp. 133-138
Author(s):  
Marcos Antônio Dellaretti Filho ◽  
George de Albuquerque Cavalcanti Mendes ◽  
Nicolas Reyns ◽  
Gustavo Touzet ◽  
François Dubois ◽  
...  
Keyword(s):  
Overall Survival ◽  
Brain Metastasis ◽  
Gamma Knife ◽  
Local Control ◽  
Tumor Volume ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Gamma Knife Radiosurgery ◽  
Intracranial Metastasis ◽  
Free Survival

Abstract Objective: To assess clinical and imaging outcomes in patients treated with Gamma Knife stereotactic radiosurgery (SRS) for brain metastasis. Methods: One hundred and three patients with 158 intracranial metastasis consecutively underwent Gamma Knife SRS between January, 2004 and December, 2006. The results were based on last imaging and the date of the last visit. Average age of the patients was 56 years (range 32-84 years). Karnofsky performance status average was 87.6. Fifty-eight (56.3%) patients had single brain metastasis. The average tumor volume was 2.5cc (range 0.02-16.6 cc). The SRS marginal dose average was 23.4 Gy (range 15-25 Gy). Results: Treatment sequence was SRS alone (89 patients) or SRS plus whole-brain radiotherapy (WBRT) (14 patients). The 1-year local control was 80%, being better for tumors with volume <5cc than for ≥5 cc: 86% vs 53% (p<0.05). The 1-year distant brain metastasis-free survival incidence was 73%. The initial number of brain lesions (single vs multiple) was not a significant factor on distant brain metastasis: free survival at 1 year was 75% for single metastases and 70% for multiple lesions. Renal cancer was the only factor with a significant effect on distant brain metastasis. The median overall survival was 15 months. According to unifactorial and multifactorial analysis, three prognostic factors for overall survival were retrieved recursive partitioning analysis (RPA) class, Karnofsky index performance and tumor volume. Conclusion: In this series, SRS provided excellent local control with relatively low morbidity in patients with brain metastases.

scholarly journals The effect of targeted agents on outcomes in patients with brain metastases from renal cell carcinoma treated with Gamma Knife surgery

2012 ◽  
Vol 116 (5) ◽  
pp. 978-983 ◽  
Author(s):  
D. Clay Cochran ◽  
Michael D. Chan ◽  
Mebea Aklilu ◽  
James F. Lovato ◽  
Natalie K. Alphonse ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Brain Metastases ◽  
Cell Carcinoma ◽  
Gamma Knife ◽  
Local Control ◽  
Renal Cell ◽  
Local Failure ◽  
Targeted Agents ◽  
Distant Failure

Object Gamma Knife surgery (GKS) has been reported as an effective modality for treating brain metastases from renal cell carcinoma (RCC). The authors aimed to determine if targeted agents such as tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors, and bevacizumab affect the patterns of failure of RCC after GKS. Methods Between 1999 and 2010, 61 patients with brain metastases from RCC were treated with GKS. A median dose of 20 Gy (range 13–24 Gy) was prescribed to the margin of each metastasis. Kaplan-Meier analysis was used to determine local control, distant failure, and overall survival rates. Cox proportional hazard regression was performed to determine the association between disease-related factors and survival. Results Overall survival at 1, 2, and 3 years was 38%, 17%, and 9%, respectively. Freedom from local failure at 1, 2, and 3 years was 74%, 61%, and 40%, respectively. The distant failure rate at 1, 2, and 3 years was 51%, 79%, and 89%, respectively. Twenty-seven percent of patients died of neurological disease. The median survival for patients receiving targeted agents (n = 24) was 16.6 months compared with 7.2 months (n = 37) for those not receiving targeted therapy (p = 0.04). Freedom from local failure at 1 year was 93% versus 60% for patients receiving and those not receiving targeted agents, respectively (p = 0.01). Multivariate analysis showed that the use of targeted agents (hazard ratio 3.02, p = 0.003) was the only factor that predicted for improved survival. Two patients experienced post-GKS hemorrhage within the treated volume. Conclusions Targeted agents appear to improve local control and overall survival in patients treated with GKS for metastastic RCC.

COMPARISON OF EARLY COMPLICATIONS FOR PATIENTS WITH CONVEXITY AND PARASAGITTAL MENINGIOMAS TREATED WITH EITHER STEREOTACTIC RADIOSURGERY OR FRACTIONATED STEREOTACTIC RADIOTHERAPY

Neurosurgery ◽  
2008 ◽  
Vol 62 (suppl_5) ◽  
pp. A19-A28 ◽  
Author(s):  
Michael R. Girvigian ◽  
Joseph C.T. Chen ◽  
Javad Rahimian ◽  
Michael J. Miller ◽  
Michael Tome
Keyword(s):  
Stereotactic Radiosurgery ◽  
Stereotactic Radiotherapy ◽  
Univariate Analysis ◽  
Tumor Location ◽  
Fractionated Stereotactic Radiotherapy ◽  
Tumor Control ◽  
Lesion Volume ◽  
Group A ◽  
Group B

ABSTRACT OBJECTIVE Patients with convexity and parasagittal (CPS) meningiomas treated with stereotactic radiosurgery (SRS) have been shown to be at risk for posttreatment symptomatic peritumoral edema (SPTE). We sought to analyze the pattern of this complication and compare it with the SPTE experienced in our patients treated with fractionated stereotactic radiotherapy. METHODS From January 2003 to October 2005, 32 patients with CPS meningiomas were treated. Thirty patients with a total of 38 lesions had sufficient follow-up for analysis. Group A (n = 14) patients were treated with single fraction SRS, and Group B (n = 16) patients were treated with fractionated stereotactic radiotherapy. The lesion volume was different between the two groups with the Group B median volume (7.46 cm3) being larger than that for Group A (2.84 cm3) (P = 0.0008). Conversely age, follow-up, sex, prior surgical events, number of lesions, tumor location, and atypical histology did not differ between these groups. The median marginal dose for patients in Group A was 14 Gy (range, 12.5–18 Gy). For Group B, six patients received a median marginal dose of 50.4 Gy in 28 fractions, and 10 patients received a marginal dose of 25 Gy in five fractions. RESULTS Seven of the 30 patients treated in this series developed posttreatment SPTE. The incidence of SPTE in Group A (six of 14 patients) was significantly higher than that in Group B (one of 16 patients) (P = 0.031). The median time to onset of SPTE in the six patients in Group A was 4 months. In Group B, one patient had onset of SPTE in 3 months. On univariate analysis, larger tumor volume (P = 0.0014) and tumor margin dose &gt;14 Gy in patients undergoing SRS (P = 0.031) was associated with onset of SPTE. Age, previous surgery, and tumor location were not associated with onset of SPTE. CONCLUSION Despite larger lesion volumes, fractionated stereotactic radiotherapy is associated with less risk of posttreatment SPTE than SRS for patients with CPS meningiomas in our series. For patients treated with SRS, smaller volume and dose &lt;14 Gy seems to be safe. Longer follow-up will be required to compare late complications and tumor control rates in these patients.

Gamma Knife stereotactic radiosurgery in the treatment of brain metastases from breast cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10555-10555
Author(s):  
R. Gutt ◽  
S. Yovino ◽  
L. Chin ◽  
W. Regine ◽  
P. Amin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Karnofsky Performance Status ◽  
Systemic Disease ◽  
Univariate Analysis ◽  
Complication Rates ◽  
Gamma Knife Stereotactic Radiosurgery

10555 Background: Outcomes of gamma knife stereotactic radiosurgery (GK-SRS) for patients with brain metastases specifically from breast cancer have not been well-defined. This study was undertaken to report the long-term experience with GK-SRS in this subset of patients. Methods: From 1995 to 2005, 75 patients with 162 brain lesions were treated with GK-SRS at the University of Maryland Medical Center. Complete follow-up data were available in 65 patients. Additional whole brain radiation therapy (WBRT) was administered to 53 (81.5%) patients. The median WBRT dose was 36.75 Gy (30.0–45.0 Gy). The median number of lesions treated with GK-SRS was 2 (1–8 lesions). The median follow-up, age, and KPS were 7.2 months (0.4–75.7 months), 53.5 years (23–81 years), and 90 (40–100), respectively. The factors included in the univariate and multivariate analyses for overall survival (OS) and progression free survival (PFS) were age, Karnofsky Performance Status (KPS), tumor histology, estrogen receptor status, Her-2-neu status, number of intracranial lesions, and presence of systemic disease. Results: Median PFS and OS from GK-SRS were 5.3 months (0.4–33.2 months) and 8.1 months (0.4–75.7 months), respectively. The 6, 12, and 24 month actuarial PFS were 47.8%, 24.9%, and 9.6% respectively. The 6, 12, and 24 month actuarial OS were 60.7%, 39.1%, and 18.1% respectively. The tumor local control after WBRT and GK-SRS was 87.7%. Radiation necrosis was a complication in 10.8% of patients. Forty-seven (72.3%) patients had neurological symptoms prior to gamma knife treatment. Seven (14.9%) and 9 (19.1%) of these patients experienced symptom resolution and significant symptomatic improvement, respectively. Multivariate and univariate analysis did not reveal any of the prognostic factors in question to be significantly associated with OS nor PFS. Conclusions: This relatively large cohort of patients experienced poor survival outcomes despite aggressive therapy with WBRT and GK-SRS. However, GK-SRS can provide significant symptomatic relief, with acceptable complication rates. More research is required to improve the survival of breast cancer patients with intracranial metastases. No significant financial relationships to disclose.

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