scholarly journals MET-05 PRELIMINARY REPORT OF RADIOTHERAPY FOR BRAIN METASTASES FROM GASTRO-INTESTINAL CANCERS USING MASK SYSTEM OF LEKSELL GAMMA KNIFE ICON

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii35-ii36
Author(s):  
Takuya Kawabe ◽  
Manabu Sato
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Local Control ◽  
Malignant Tumors ◽  
Survival Rates ◽  
Benign Tumors ◽  
Survival Times ◽  
Single Session ◽  
Tumor Number ◽  
Eloquent Area

Abstract OBJECT Leksell Gamma Knife Icon enables us to apply new methods of immobilization using mask fixation and the option of fractionated treatment. This provides exceptional accuracy and precision of radiosurgery, making it a possibility for many more disease types and many more patients to be treated. METHODS We retrospectively analyzed 50 patients (71 times) with brain metastases from gastro-intestinal cancers who underwent Gamma Knife Icon using mask fixation between September 25th, 2017 and June 30th, 2019 at Rakusai Shimizu Hospital. Patients with small, few, newly diagnosed, and non-eloquent area tumors were treated in a single session. If the tumor volume was larger than 5.0 ml, recurrence, or the location was in an eloquent area, we applied a fractionated schedule. If the tumor number was large, we selected a multisession schedule. The most common origin was colon (19 patients), followed by rectum (11), stomach (7), esophagus (5) and others (8). RESULTS 13 cases were treated in a single session, 53 with fractionation, and five with multiple sessions. We selected fractionated schedules as follows; 7.0 Gy x 5Fr (5–10 ml), 4.2Gy x 10Fr (10-20ml), 3.7Gy x 10Fr (20-30ml), 3.2Gy x 10Fr (30ml-) for malignant tumors, and 2.7Gy x 10Fr for benign tumors. Median tumor number was two (1–40) and median tumor size was 8.1 (0.03–67.5) ml. Median survival times after Icon treatment was 13.5 months and local control rate after 6-month Icon treatment was 80%. CONCLUSIONS Although these results are limited to short periods, survival rates, local control rates and qualitative survival rated in patients unsuitable for stereotactic radiosurgery, such as those with large, recurrent, and eloquent site lesions, were within the acceptable ranges.

scholarly journals MET-10 Preliminary report of radiotherapy for brain metastases from breast and kidney using mask system of Leksell Gamma Knife Icon

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii20-ii20
Author(s):  
Takuya Kawabe ◽  
Manabu Sato
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Local Control ◽  
Survival Rates ◽  
Survival Times ◽  
Single Session ◽  
Accuracy And Precision ◽  
Tumor Number ◽  
Eloquent Area ◽  
Hospital Patients

Abstract Object: Leksell Gamma Knife Icon enables us to apply new methods of immobilization using mask fixation and the option of fractionated treatment. This provides exceptional accuracy and precision of radiosurgery, making it a possibility for many more disease types and many more patients to be treated. Methods: We retrospectively analyzed 97 patients (140 times) with brain metastases from breast (B group) and 26 patients (33 times) with brain metastases from kidney (K group) and who underwent Gamma Knife Icon using mask fixation between September 25th, 2017 and June 30th, 2020 at Rakusai Shimizu Hospital. Patients with small, few, newly diagnosed, and non-eloquent area tumors were treated in a single session. If the tumor volume was larger than 5.0 ml, recurrence, or the location was in an eloquent area, we applied a fractionated schedule. If the tumor number was large, we selected a multisession schedule. Median tumor number was three (1–64) in B group and two (1–31) in K group. Median tumor size was 2.7 (0. 01-58.8) ml in B group and 2.8 (0.02–123.5) ml in K group. We selected fractionated schedules as follows; 7.0 Gy x 5Fr (5–10 ml), 4.2Gy x 10Fr (10-20ml), 3.7Gy x 10Fr (20-30ml), 3.2Gy x 10Fr (30ml-). Results: 32 (B) and 14 (K) cases were treated in a single session, 80 (B) and 17 (K) with fractionation, and 28 (B) and 2 (K) with multiple sessions. Median survival times after Icon treatment was 28.2 (B) and 15.5 (K) months. Local control rates were 89 % (B) and 85% after 12-month Icon treatment. Qualitative survival rates were 91% (B) and 86% (K) after 12-month Icon treatment. There were no statistically differences between two groups. Conclusions: Although these results are limited to short periods, survival rates, local control rates and qualitative survival rates were within the acceptable ranges.

scholarly journals Three-stage Gamma Knife treatment for metastatic brain tumors larger than 10 cm3: a 2-institute study including re-analyses of earlier results using competing risk analysis

2018 ◽  
Vol 129 (Suppl1) ◽  
pp. 77-85 ◽  
Author(s):  
Masaaki Yamamoto ◽  
Yoshinori Higuchi ◽  
Toru Serizawa ◽  
Takuya Kawabe ◽  
Osamu Nagano ◽  
...  
Keyword(s):  
Risk Analysis ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Survival Rates ◽  
Competing Risk ◽  
Published Data ◽  
Competing Risk Analysis ◽  
Survival Times ◽  
Actuarial Survival ◽  
Peripheral Dose

OBJECTIVEThe results of 3-stage Gamma Knife treatment (3-st-GK-Tx) for relatively large brain metastases have previously been reported for a series of patients in Chiba, Japan (referred to in this study as the C-series). In the current study, the authors reappraised, using a competing risk analysis, the efficacy and safety of 3-st-GK-Tx by comparing their experience with that of the C-series.METHODSThis was a retrospective cohort study. Among 1767 patients undergoing GK radiosurgery for brain metastases at Mito Gamma House during the 2005–2015 period, 78 (34 female, 44 male; mean age 65 years, range 35–86 years) whose largest tumor was > 10 cm3, treated with 3-st-GK-Tx, were studied (referred to in this study as the M-series). The target volumes were covered with a 50% isodose gradient and irradiated with a peripheral dose of 10 Gy at each procedure. The interval between procedures was 2 weeks. Because competing risk analysis had not been employed in the published C-series, the authors reanalyzed the previously published data using this method.RESULTSThe overall median survival time after 3-st-GK-Tx was 8.3 months (95% CI 5.6–12.0 months) in the M-series and 8.6 months (95% CI 5.5–10.6 months) in the C-series (p = 0.41). Actuarial survival rates at the 6th and 12th post–3-st-GK-Tx months were, respectively, 55.1% and 35.2% in the M-series and 62.5% and 26.4% in the C-series (HR 1.175, 95% CI 0.790–1.728, p = 0.42). Cumulative incidences at the 12th post–3-st-GK-Tx, determined by competing risk analyses, of neurological deterioration (14.2% in C-series vs 12.8% in M-series), neurological death (7.2% vs 7.7%), local recurrence (4.8% vs 6.2%), repeat SRS (25.9% vs 18.0%), and SRS-related complications (2.3% vs 5.1%) did not differ significantly between the 2 series.CONCLUSIONSThere were no significant differences in post–3-st-GK-Tx results between the 2 series in terms of overall survival times, neurological death, maintained neurological status, local control, repeat SRS, and SRS-related complications. The previously published results (C-series) are considered to be validated by the M-series results.

scholarly journals Gamma Knife Stereotactic Radiosurgery for Grade 2 Meningiomas

2017 ◽  
Vol 78 (04) ◽  
pp. 288-294 ◽  
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.

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.

Gamma Knife Stereotactic Radiosurgery for Brain Metastases Using Only 3 Pins

Neurosurgery ◽  
2016 ◽  
Vol 78 (6) ◽  
pp. 877-882 ◽  
Author(s):  
Jennifer C. Ho ◽  
Dershan Luo ◽  
Nandita Guha-Thakurta ◽  
Sherise D. Ferguson ◽  
Amol J. Ghia ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Local Control ◽  
Internal Control ◽  
Occipital Lobe ◽  
Median Number ◽  
Posterior Lesion ◽  
Control Lesion ◽  
Gamma Knife Stereotactic Radiosurgery

Abstract BACKGROUND: Removal of a pin during Gamma Knife stereotactic radiosurgery (GK-SRS) may be necessary to prevent collision and allow treatment. OBJECTIVE: To investigate outcomes after GK-SRS for treatment of brain metastases using a head frame immobilized to the skull with only 3 pins. METHODS: Between 2009 and 2014, we retrospectively reviewed the records of 1971 patients and identified 20 patients with multiple brain metastases treated with GK-SRS in which 1 anterior pin was removed immediately before treatment of a single posterior lesion. GK-SRS was also delivered to 116 other lesions in these 20 patients using the standard 4 pins during the same session, serving as an internal control for comparison. Endpoints included local control, dosimetric parameters, toxicity, and overall survival. RESULTS: The median number of lesions treated per session was 6 (range, 2-14). The lesions treated using 3 pins were located in the occipital lobe (n = 14) or the cerebellum (n = 6). Median follow-up was 12.3 months. There was 1 local failure involving a control lesion. Lesions treated using 3 pins had a lower prescription isodose line. GK-SRS of a lesion using 3 pins did not cause any clinical toxicities or increase in radiographic edema or hemorrhage. CONCLUSION: Treating posteriorly located brain metastases with GK-SRS using only 3 pins provided excellent local control and no difference in treatment toxicity, which may make it a safe and reasonable option for lesions that may otherwise be difficult to treat.

Comparison of prognostic indices in patients who undergo melanoma brain metastasis radiosurgery

2018 ◽  
Vol 128 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Hideyuki Kano ◽  
Alejandro Morales-Restrepo ◽  
Aditya Iyer ◽  
Gregory M. Weiner ◽  
Seyed H. Mousavi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Recursive Partitioning ◽  
Prognostic Index ◽  
Median Number ◽  
Class Iii ◽  
Survival Times ◽  
Prognostic Assessment ◽  
Prognostic Indices

OBJECTIVEThe goal of this study was to use 4 prognostic indices to compare survival times of patients who underwent Gamma Knife stereotactic radiosurgery (SRS) to treat melanoma brain metastases.METHODSThe authors analyzed 422 consecutive patients (1440 brain metastases) who underwent Gamma Knife SRS. The median total brain tumor volume was 4.7 cm3 (range 0.3–69.3 cm3), and the median number of metastases was 2 (range 1–32). One hundred thirty-two patients underwent whole-brain radiation therapy. Survival times were compared using recursive partitioning analysis (RPA), the Score Index for Radiosurgery (SIR), the Basic Score for Brain Metastases (BSBM), and the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA).RESULTSThe overall survival times after SRS were compared. With the RPA index, survival times were 2.6 months (Class III, n = 27), 5.5 months (Class II, n = 348), and 13.0 months (Class I, n = 47). With the DS-GPA index, survival times were 2.8 months (Scores 0–1, n = 67), 4.2 months (Scores 1.5–2.0, n = 143), 6.6 months (Scores 2.5–3.0, n = 111), and 9.4 months (Scores 3.5–4.0, n = 101). With the SIR, survival times were 3.2 months (Scores 0–3, n = 56), 5.8 months (Scores 4–7, n = 319), and 12.7 months (Scores 8–10, n = 47). With the BSBM index, survival times were 2.6 months (BSBM0, n = 47), 5.4 months (BSBM1, n = 282), 11.0 months (BSBM2, n = 86), and 8.8 months (BSBM3, n = 7). The DS-GPA index was the most balanced by case numbers in each class and provided the overall best prognostic index for overall survival.CONCLUSIONSThe DS-GPA index proved most balanced and predictive of survival for patients with melanoma who underwent SRS as part of management for brain metastases. Patients whose DS-GPA score was ≥ 2.5 had predictably improved survival times after SRS.

Meningioma Radiosurgery: Tumor Control, Outcomes, and Complications among 190 Consecutive Patients

Neurosurgery ◽  
2001 ◽  
Vol 49 (5) ◽  
pp. 1029-1038 ◽  
Author(s):  
Scott L. Stafford ◽  
Bruce E. Pollock ◽  
Robert L. Foote ◽  
Michael J. Link ◽  
Deborah A. Gorman ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
External Beam Radiotherapy ◽  
Survival Rates ◽  
Internal Carotid Artery Stenosis ◽  
Benign Tumors ◽  
Tumor Control ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Tumor Margin ◽  
Cause Specific Survival

ABSTRACT OBJECTIVE To determine local control (LC) and complication rates for patients with intracranial meningiomas who underwent radiosurgery. METHODS One hundred ninety consecutive patients with 206 meningiomas underwent radiosurgery between 1990 and 1998. One hundred forty-seven tumors (77%) involved the cranial base. The median age at the time of radiosurgery was 58 years (range, 20–90 yr). There were 126 female patients (66%). One hundred twelve patients (59%) had undergone one or more previous operations (median, 1; range, 1–5). Twenty-two patients (12%) had either atypical (n = 13) or malignant (n = 9) tumors. The median prescription isodose volume was 8.2 cm3 (range, 0.5–50.5 cm3), and the median tumor margin dose was 16 Gy (range, 12–36 Gy). The median imaging and clinical follow-up periods were 40 and 47 months, respectively. RESULTS Overall survival rates for the entire cohort at 5 and 7 years were 82 and 82%, respectively; cause-specific survival rates at 5 and 7 years were 94 and 92%, respectively. The cause-specific survival rates at 5 years for patients with benign, atypical, and malignant tumors were 100, 76, and 0%, respectively (P < 0.0001). The 5-year LC rate was 89%, with 114 tumors (56%) decreasing in size. LC rates were correlated with tumor histological features (P < 0.0001); patients with benign tumors exhibited a 5-year LC rate of 93%, compared with 68 and 0% for patients with atypical or malignant meningiomas, respectively. No correlation was observed between radiation dose and LC rate. Twenty-four patients (13%) experienced treatment-related complications, including cranial nerve deficits (8%), symptomatic parenchymal changes (3%), internal carotid artery stenosis (1%), and symptomatic cyst formation (1%). Only six patients (3%) exhibited decreases in functional status that were directly related to radiosurgery. Tumor volume, tumor margin dose, or previous radiotherapy was not associated with the development of radiation-related complications. CONCLUSION Radiosurgery is an effective management strategy for many patients with meningiomas. Patients with atypical or malignant tumors exhibit high recurrence rates despite the use of radiosurgery, and these patients continue to exhibit worse cause-specific survival rates despite aggressive treatment, including surgery, external-beam radiotherapy, and radiosurgery. Further study is needed to determine the tumor control and complication rates 10 years or more after meningioma radiosurgery.

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.

scholarly journals A new grading system focusing on neurological outcomes for brain metastases treated with stereotactic radiosurgery: the modified Basic Score for Brain Metastases

2014 ◽  
Vol 121 (Suppl_2) ◽  
pp. 35-43 ◽  
Author(s):  
Toru Serizawa ◽  
Yoshinori Higuchi ◽  
Osamu Nagano ◽  
Shinji Matsuda ◽  
Junichi Ono ◽  
...  
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Survival Rates ◽  
Neurological Function ◽  
Prognostic Scores ◽  
Survival Times ◽  
Mri Findings ◽  
Neurological Outcomes ◽  
One Year

ObjectThe Basic Score for Brain Metastases (BSBM) proposed by Lorenzoni and colleagues is one of the best grading systems for predicting survival periods after stereotactic radiosurgery (SRS) for brain metastases. However, it includes no brain factors and cannot predict neurological outcomes, such as preservation of neurological function and prevention of neurological death. Herein, the authors propose a modified BSBM, adding 4 brain factors to the original BSBM, enabling prediction of neurological outcomes, as well as of overall survival, in patients undergoing SRS.MethodsTo serve as neurological prognostic scores (NPSs), the authors scored 4 significant brain factors for both preservation of neurological function (qualitative survival) and prevention of neurological death (neurological survival) as 0 or 1 as described in the following: > 10 brain tumors = 0 or ≤ 10 = 1, total tumor volume > 15 cm3 = 0 or ≤ 15 cm3 = 1, MRI findings of localized meningeal dissemination (yes = 0 or no = 1), and neurological symptoms (yes = 0 or no = 1). According to the sum of NPSs, patients were classified into 2 subgroups: Subgroup A with a total NPS of 3 or 4 and Subgroup B with an NPS of 0, 1, or 2. The authors defined the modified BSBM according to the NPS subgroup classification applied to the original BSBM groups. The validity of this modified BSBM in 2838 consecutive patients with brain metastases treated with SRS was verified.ResultsPatients included 1868 with cancer of the lung (including 1604 with non–small cell lung cancer), 355 of the gastrointestinal tract, 305 of the breast, 176 of the urogenital tract, and 134 with other cancers. Subgroup A had 2089 patients and Subgroup B 749. Median overall survival times were 2.6 months in BSBM 0 (382 patients), 5.7 in BSBM 1 (1143), 11.4 in BSBM 2 (1011) and 21.7 in BSBM 3 (302), and pairwise differences between the BSBM groups were statistically significant (all p < 0.0001). One-year qualitative survival rates were 64.6% (modified BSBM 0A, 204 patients), 45.0% (0B, 178), 82.5% (1A, 825), 63.3% (1B, 318), 86.4% (2A, 792), 73.7% (2B, 219), 91.4% (3A, 268), and 73.5% (3B, 34). One-year neurological survival rates were 82.6% (0A), 52.4% (0B), 90.5% (1A), 78.1% (1B), 91.1% (2A), 83.2% (2B), 93.9% (3A), and 76.3% (3B), where A and B identify the subgroup. Statistically significant differences in both qualitative and neurological survivals between Subgroups A and B were detected in all BSBM groups.ConclusionsThe authors' new index, the modified BSBM, was found to be excellent for predicting neurological outcomes, independently of life expectancy, in SRS-treated patients with brain metastases.

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