Systematic Review and Meta-Analysis on the Use of Photon-based Stereotactic Radiosurgery Versus Fractionated Stereotactic Radiotherapy for the Treatment of Uveal Melanoma

Context: Radiotherapy for patients with acromegaly was considered when patients have residual disease or tumor recurrence after surgery, or when surgery can’t be carried out. There are two main modes of radiotherapy, including stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT). Objective: We conducted a systematic review and meta-analysis to present the effectiveness and safety of SRS and FSRT for GH secreting pituitary adenoma in clinical practice. Methods: We searched the published literature using following databases: Pub Med, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and EMBASE up to March 22, 2020, for studies in which SRS or FSRT were used in patients with GH secreting pituitary. Results: A total of 33 studies were eligible, involving 2016 participants. No significant differences were observed in tumor shrinkage rate, local tumor control rate and adverse effect rate between SRS and FSRT. Compared to FSRT, SRS showed significant increase in biochemical remission rate (43% vs. 28%; p=0.023) and significant lower follow-up GH level (SMD: −1.20 vs. −0.37, p=0.006). Conclusions: SRS and FSRT showed comparable effectiveness and safety in the management of GH secreting pituitary adenoma patients. SRS might be associated with better biochemical remission.

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Hypo-fractionated stereotactic radiotherapy of five fractions with linear accelerator for vestibular schwannomas: A systematic review and meta-analysis

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2018.01.005 ◽

2018 ◽

Vol 166 ◽

pp. 116-123 ◽

Cited By ~ 10

Author(s):

Thien Nguyen ◽

Courtney Duong ◽

John P. Sheppard ◽

Seung Jin Lee ◽

Amar U. Kishan ◽

...

Keyword(s):

Systematic Review ◽

Stereotactic Radiotherapy ◽

Linear Accelerator ◽

Meta Analysis ◽

Fractionated Stereotactic Radiotherapy ◽

Vestibular Schwannomas

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Uveal Melanoma

10.5772/intechopen.95321 ◽

2021 ◽

Author(s):

Kristina Horkovicova ◽

Alena Furdova

Keyword(s):

Stereotactic Radiosurgery ◽

Uveal Melanoma ◽

Stereotactic Radiotherapy ◽

Radiation Treatment ◽

Fractionated Stereotactic Radiotherapy

Currently, melanoma of uvea is the most well-known essential tumor, which is intaocular and malignant. Treatment using radiation has now supplanted enucleation as the therapy of decision. Radioactive eye plaques and treatment using proton are being the two most examined radiotherapeutic modalities. All the more as of late, stereotactic radiosurgery and fractionated stereotactic radiotherapy have risen as promising, non-intrusive medicines for uveal melanoma. Technique called stereotactic radiosurgery might be viewed as like „not surgery” on the grounds no extractions are included. All things being equal, it is a serious strategy for radiation treatment that conveys high dosages of radiation to exceptionally little territories and volumes.

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Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: a systematic review and meta-analysis

Neurosurgical FOCUS ◽

10.3171/2019.3.focus1970 ◽

2019 ◽

Vol 46 (6) ◽

pp. E2 ◽

Cited By ~ 11

Author(s):

Nida Fatima ◽

Antonio Meola ◽

Erqi L. Pollom ◽

Scott G. Soltys ◽

Steven D. Chang

Keyword(s):

Systematic Review ◽

Stereotactic Radiosurgery ◽

Stereotactic Radiotherapy ◽

Meta Analysis ◽

Progression Free Survival ◽

Cochrane Library ◽

Tumor Control ◽

Case Control Studies ◽

Intracranial Meningiomas

OBJECTIVEStereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) have been used as a primary treatment or adjuvant to resection in the management of intracranial meningiomas (ICMs). The aim of this analysis is to compare the safety and long-term efficacy of SRS and SRT in patients with primary or recurrent ICMs.METHODSA systematic review of the literature comparing SRT and SRS in the same study was conducted using PubMed, the Cochrane Library, Google Scholar, and EMBASE from January 1980 to December 2018. Randomized controlled trials, case-control studies, and cohort studies (prospective and retrospective) analyzing SRS versus SRT for the treatment of ICMs in adult patients (age > 16 years) were included. Pooled and subgroup analyses were based on the fixed-effect model.RESULTSA total of 1736 patients from 12 retrospective studies were included. The treatment modality used was: 1) SRS (n = 306), including Gamma Knife surgery (n = 36), linear accelerator (n = 261), and CyberKnife (n = 9); or 2) SRT (n = 1430), including hypofractionated SRT (hFSRT, n = 268) and full-fractionated SRT (FSRT, n = 1162). The median age of patients at the time of treatment was 59 years. The median follow-up duration after treatment was 35.5 months. The median tumor volumes at the time of treatment with SRS, hFSRT, and FSRT were 2.84 cm3, 5.45 cm3, and 12.75 cm3, respectively. The radiographic tumor control at last follow-up was significantly worse in patients who underwent SRS than SRT (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.27–0.82, p = 0.007) with 7% less volume of tumor shrinkage (OR 0.93, 95% CI 0.61–1.40, p = 0.72). Compared to SRS, the radiographic tumor control was better achieved by FSRT (OR 0.46, 95% CI 0.26–0.80, p = 0.006) than by hFSRT (OR 0.81, 95% CI 0.21–3.17, p = 0.76). Moreover, SRS leads to a significantly higher risk of clinical neurological worsening during follow-up (OR 2.07, 95% CI 1.06–4.06, p = 0.03) and of immediate symptomatic edema (OR 4.58, 95% CI 1.67–12.56, p = 0.003) with respect to SRT. SRT could produce a better progression-free survival at 4–10 years compared to SRS, but this was not statistically significant (p = 0.29).CONCLUSIONSSRS and SRT are both safe options in the management of ICMs. However, SRT carries a better radiographic tumor control rate and a lower incidence of posttreatment symptomatic worsening and symptomatic edema, with respect to SRS. However, further prospective studies are still needed to validate these results.

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Stereotactic Radiosurgery and Fractionated Stereotactic Radiotherapy in the Treatment of Uveal Melanoma

Technology in Cancer Research & Treatment ◽

10.1177/153303460600500409 ◽

2006 ◽

Vol 5 (4) ◽

pp. 411-419 ◽

Cited By ~ 13

Author(s):

Mark A. Henderson ◽

Haider Shirazi ◽

Simon S. Lo ◽

Marc S. Mendonca ◽

Achilles J. Fakiris ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Uveal Melanoma ◽

Stereotactic Radiotherapy ◽

Fractionated Stereotactic Radiotherapy

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Fractionated Stereotactic Radiotherapy For the Treatment of Large Arteriovenous Malformations with or without Previous Partial Embolization

Neurosurgery ◽

10.1227/01.neu.0000134285.41701.83 ◽

2004 ◽

Vol 55 (3) ◽

pp. 519-531 ◽

Cited By ~ 53

Author(s):

Erol Veznedaroglu ◽

David W. Andrews ◽

Ronald P. Benitez ◽

M. Beverly Downes ◽

Maria Werner-Wasik ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Stereotactic Radiotherapy ◽

Arteriovenous Malformations ◽

Three Dimensional ◽

Late Complications ◽

Fractionated Stereotactic Radiotherapy ◽

Medical Systems ◽

Significant Treatment ◽

Lost To Follow Up

Abstract OBJECTIVE: Despite the success of stereotactic radiosurgery, large inoperable arteriovenous malformations (AVMs) of 14 cm3 or more have remained largely refractory to stereotactic radiosurgery, with much lower obliteration rates. We review treatment of large AVMs either previously untreated or partially obliterated by embolization with fractionated stereotactic radiotherapy (FSR) regimens using a dedicated linear accelerator (LINAC). METHODS: Before treatment, all patients were discussed at a multidisciplinary radiosurgery board and found to be suitable for FSR. All patients were evaluated for pre-embolization. Those who had feeding pedicles amenable to glue embolization were treated. LINAC technique involved acquisition of a stereotactic angiogram in a relocatable frame that was also used for head localization during treatment. The FSR technique involved the use of six 7-Gy fractions delivered on alternate days over a 2-week period, and this was subsequently dropped to 5-Gy fractions after late complications in one of seven patients treated with 7-Gy fractions. Treatments were based exclusively on digitized biplanar stereotactic angiographic data. We used a Varian 600SR LINAC (Varian Medical Systems, Inc., Palo Alto, CA) and XKnife treatment planning software (Radionics, Inc., Burlington, MA). In most cases, one isocenter was used, and conformality was established by non-coplanar arc beam shaping and differential beam weighting. RESULTS: Thirty patients with large AVMs were treated between January 1995 and August 1998. Seven patients were treated with 42-Gy/7-Gy fractions, with one patient lost to follow-up and the remaining six with previous partial embolization. Twenty-three patients were treated with 30-Gy/5-Gy fractions, with two patients lost to follow-up and three who died as a result of unrelated causes. Of 18 evaluable patients, 8 had previous partial embolization. Mean AVM volumes at FSR treatment were 23.8 and 14.5 cm3, respectively, for the 42-Gy/7-Gy fraction and 30-Gy/5-Gy fraction groups. After embolization, 18 patients still had AVM niduses of 14 cm3 or more: 6 in the 7-Gy cohort and 12 in the 5-Gy cohort. For patients with at least 5-year follow-up, angiographically documented AVM obliteration rates were 83% for the 42-Gy/7-Gy fraction group, with a mean latency of 108 weeks (5 of 6 evaluable patients), and 22% for the 30-Gy/5-Gy fraction group, with an average latency of 191 weeks (4 of 18 evaluable patients) (P = 0.018). For AVMs that remained at 14 cm3 or more after embolization (5 of 6 patients), the obliteration rate remained 80% (4 of 5 patients) for the 7-Gy cohort and dropped to 9% for the 5-Gy cohort. A cumulative hazard plot revealed a 7.2-fold greater likelihood of obliteration with the 42-Gy/7-Gy fraction protocol (P = 0.0001), which increased to a 17-fold greater likelihood for postembolization AVMs of 14 cm3 or more (P = 0.003). CONCLUSION: FSR achieves obliteration for AVMs at a threshold dose, including large residual niduses after embolization. With significant treatment-related morbidities, further investigation warrants a need for better three-dimensional target definition with higher dose conformality.

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