Gamma Knife Radiosurgery for High-Grade Gliomas: Single-Center Experience of Six Years in China

2021 ◽  
Vol 99 (3) ◽  
pp. 181-186
Author(s):  
Ming Zhao ◽  
Xiangping Fu ◽  
Zhiwen Zhang ◽  
Liang Ma ◽  
Xiaopeng Wang ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Cox Regression ◽  
Survival Rates ◽  
Gamma Knife Radiosurgery ◽  
Progression Free Survival ◽  
High Grade Glioma ◽  
Karnofsky Performance Score ◽  
High Grade ◽  
Alternative Treatment Option ◽  
The Mean

<b><i>Objective:</i></b> The aim of this study was to evaluate the efficacy of Gamma Knife radiosurgery (GKRS) as a salvage therapy for high-grade glioma in our center. <b><i>Methods:</i></b> A total of 167 patients with malignant glioma were treated with GKRS in our Gamma Knife Center between January 2013 and December 2017; 140 patients (85 males and 55 females) were followed up and enrolled in our study. A single lesion was found in 110 cases, and multiple lesions were found in 30 cases; 108 cases received a single therapy, and in 32 cases, at least 2 GKRSs were performed. The median tumor volume was 13.5 cm<sup>3</sup>. The mean radiation dosage was 14.35 Gy (range, 6–18 Gy). MRI was performed regularly. The RANO criteria and Cox analysis were used to evaluate the therapeutic efficiency. <b><i>Results:</i></b> Follow-up MRI showed the local control rate was 61.4% at 3 months after GKRS, 25.0% at 6 months, and 7.1% at 12 months. The mean and median progression-free survival (PFS) periods were 8.6 (95% CI, 6.3–11.0) and 4 (95% CI, 3.5–4.5) (range, 1–60) months, respectively. The overall survival (OS) after GKRS was 3–62 months, with a mean of 16.7 (95% CI, 14.6–18.9) months, and the median survival was 13 (95% CI, 12.1–13.9) months. The 1-, 2-, and 5-year survival rates were 51.4, 10.0, and 2.9%, respectively. No severe complications occurred. Cox regression showed that glioma pathology was closely related to prognosis (<i>p</i> &#x3c; 0.05). The Karnofsky Performance Score had little influence on PFS (<i>p</i> &#x3e; 0.05) but influenced OS significantly (<i>p</i> &#x3c; 0.05). <b><i>Conclusion:</i></b> GKRS can be used to effectively treat malignant brain glioma and can therefore be used as an alternative treatment option.

scholarly journals C-methionine-PET-guided Gamma Knife radiosurgery boost as adjuvant treatment for newly diagnosed glioblastomas

2021 ◽  
Vol 12 ◽  
pp. 247
Author(s):  
Javier A. Jacobo ◽  
Masao Buentello ◽  
Ramiro Del Valle
Keyword(s):  
Gamma Knife ◽  
External Beam Radiotherapy ◽  
Gamma Knife Radiosurgery ◽  
Progression Free Survival ◽  
Magnetic Resonance Images ◽  
Karnofsky Performance Score ◽  
Newly Diagnosed ◽  
Glial Tumor ◽  
Beneficial Role ◽  
Stupp Protocol

Background: The most common glial tumor is the glioblastoma, and the prognosis remains dismal despite a multimodal therapeutic approach. The role of radiosurgery for the treatment of glioblastomas has been evaluated in several studies with some benefit at the recurrent stage. We evaluate the results of the protocol administered at the Gamma Knife unit administering radiosurgery as a boost to metabolic active parts of the tumor after the patient had completed traditional external beam radiotherapy (XBRT) as part of the Stupp protocol for high-grade gliomas. Methods: This is a retrospective analysis of seven patients with newly diagnosed glioblastomas who were treated with Gamma Knife radiosurgery as a boost after receiving XBRT as part of the Stupp protocol. The target of radiation was determined according to the findings of the C-methionine PET scan in relation to magnetic resonance images. The primary end point of this study was to determine the progression-free survival (PFS) from the time of diagnosis. Results: The median age of patients was 48.8 years and the mean Karnofsky performance score was 92.8%. The median PFS was 12.4 months. No radiation adverse effects were documented. Conclusion: Stereotactic radiosurgery is safe to use in the upfront treatment for these patients and appears to have a beneficial role in improving the PFS. This beneficial role seems to be conditioned not only by the time the treatment is administered but also where the radiation dose is targeted to.

scholarly journals P03.07 Radiosurgical managementof trigeminal schwannomas: A single center experience

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii26-iii26
Author(s):  
R M Emad Eldin ◽  
A M El-Shehaby ◽  
K Abdel Karim ◽  
W A Reda ◽  
A Nabeel ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Progression Free Survival ◽  
Target Volume ◽  
Primary Treatment ◽  
Tumor Control ◽  
Single Center Experience ◽  
Primary Treatment Modality ◽  
The Mean

Abstract BACKGROUND Trigeminal schwannomas are a rare form of intracranial schwannomas. They can occur anywhere along the track of the trigeminal nerve, including the middle, posterior fossa or both. It can even extend extracranially. The variability of its location and extent, in addition to its close proximity to critical neurovascular structures makes surgical intervention challenging. Taking from the success of treating vestibular schwannomas with stereotactic radiosurgery, it has been used as an alternative to surgery for the treatment of trigeminal schwannomas. Because these tumors are rare more clinical evidence is required to assess the response of these tumors to stereotactic radiosurgery.The aim of this study was to evaluate the efficacy and complications associated with treatment of the trigeminal schwannomas by gamma knife radiosurgery. MATERIAL AND METHODS The study included 51 patients with trigeminal schwannomas not associated with NF2, treated by Leksell gamma knife. There were 25 males and 26 females. The mean age at presentation was 43 years. The patients underwent a total of 58 gamma knife sessions (44 single and 7 volume-staged sessions). Eight patients had previous surgery. The tumor nature was solid in 46, cystic in 3 and mixed in 2 patients. The mean target volume was 8.5 cc (0.6–30.7 cc) with the mean overall tumor volume being 9.6 cc (0.6–31.1 cc). The mean prescription dose was 12 Gy. RESULTS The mean follow up was 57 months (12–152 months). The tumor shrank in 23 (45%) patients and remained stable in 25 (49%). Tumor progressions occurred in 3 (6%) patients. The tumor control rate was 92%. The progression-free survival at 5,7 and 10 years was 95%, 88% and 79%, respectively. Clinical improvement occurred in 27 (53%) patients and was significantly associated with tumor shrinkage (p 0.03). Twenty patients (39%) remained clinically unchanged. Adverse radiation events occurred in 7 patients and were significantly associated with target and overall tumor volume (p 0.028 and 0.004). CONCLUSION Gamma knife radiosurgery appears to be an effective and safe adjuvant and primary treatment modality for trigeminal schwannomas. Large tumors should be debulked first before radiosurgery, when feasible.

Increased Survival Using Delayed Gamma Knife Radiosurgery for Recurrent High-Grade Glioma: A Feasibility Study

2014 ◽  
Vol 82 (5) ◽  
pp. e623-e632 ◽  
Author(s):  
Ernest Dodoo ◽  
Beate Huffmann ◽  
Inti Peredo ◽  
Hanne Grinaker ◽  
Georges Sinclair ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Feasibility Study ◽  
Gamma Knife Radiosurgery ◽  
High Grade Glioma ◽  
High Grade

Radiotherapy plus the anti-EGFR mAb nimotuzumab or placebo for the treatment of high-grade glioma patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 2515-2515
Author(s):  
Maria Teresa Solomon ◽  
Julio Cesar Selva ◽  
Javier Figueredo ◽  
Jose Vaquer ◽  
Carolina Toledo ◽  
...  
Keyword(s):  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Drug Exposure ◽  
Progression Free Survival ◽  
High Grade Glioma ◽  
Clinical Activity ◽  
High Grade ◽  
Double Blind ◽  
The Mean

2515 Background: Despite remarkable advances in multimodal therapy, high grade glioma (HGG) patients still face a poor prognosis. EGFR is well validated as a primary contributor of HGG initiation and progression. Nimotuzumab is a humanized monoclonal antibody (mAbs) that recognizes the EGFR extracellular domain. While it has similar preclinical and clinical activity when compared to other anti-EGFR mAbs, it does not induce skin toxicity or hypomagnesemia. Methods: A randomized, double blind, multicentric clinical trial was conducted in 70 anaplastic astrocytoma (AA) and glioblastoma multiforme (GBM) patients that received radiotherapy (RT) plus nimotuzumab or placebo. Patients received 6 weekly doses of nimotuzumab or placebo together with radiotherapy. Treatment was maintained every 3 weeks, until completing 1 year of treatment. GBM patients did not receive temozolomide since the drug cannot be sold to Cuba. The objectives of this study were to assess the overall survival, progression free survival (PFS), response rate, immunogenicity and safety in both treatment groups. Results: Seventy patients were included in the study: 41 AA and 29 GBM. The median cumulative dose was 3600 mg of nimotuzumab and the median antibody number of doses was 16. The combination of nimotuzumab and radiotherapy was very safe. The most prevalent related adverse events included grade 1-2 nausea, fever, tremors and anorexia. There was no increasing toxicity with repeated drug exposure. No anti-idyotipic response was detected. The mean and median survival time for subjects treated with nimotuzumab and RT was 31.06 and 17.76 months while the mean and median survival time for controls was 21.07 and 12.63 months, respectively. For the evaluable patients of the AA stratum, the median survival time was 44.56 months (active drug) vs. 14.6 months (control). For the evaluable patients in the GBM cohort, the median survival time was 16.06 months (nimotuzumab arm) vs. 8.36 months (placebo arm). Median PFS was 18.23 vs. 6.25 months. Conclusions: In this randomized trial, nimotuzumab continues showing an excellent safety profile and positive efficacy results in patients with high grade glioma in combination with irradiation.

scholarly journals Salvage Radiosurgery for Selected Patients with Recurrent Malignant Gliomas

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Miguel Martínez-Carrillo ◽  
Isabel Tovar-Martín ◽  
Mercedes Zurita-Herrera ◽  
Rosario Del Moral-Ávila ◽  
Rosario Guerrero-Tejada ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Stereotactic Radiosurgery ◽  
Anaplastic Astrocytoma ◽  
Cox Regression ◽  
Malignant Gliomas ◽  
High Grade Glioma ◽  
Initial Diagnosis ◽  
Karnofsky Performance Score ◽  
High Grade ◽  
Effective Treatment Option

Purpose. To analyse the survival after salvage radiosurgery and to identify prognostic factors.Methods. We retrospectively reviewed 87 consecutive patients, with recurrent high-grade glioma, that underwent stereotactic radiosurgery between 1997 and 2010. We evaluated the survival after initial diagnosis and after reirradiation. The prognostic factors were analysed by bivariate and multivariate Cox regression model.Results. The median age was 48 years old. The primary histology included anaplastic astrocytoma (47%) and glioblastoma (53%). A margin dose of 18 Gy was administered in the majority of cases (74%). The median survival after initial diagnosis was 21 months (39 months for anaplastic astrocytoma and 18.5 months for glioblastoma) and after reirradiation it was 10 months (17 months for anaplastic astrocytoma and 7.5 months for glioblastoma). In the bivariate analyses, the prognostic factors significantly associated with survival after reirradiation were age, tumour and treatment volume at recurrence, recursive partitioning analyses classification, Karnofsky performance score, histology, and margin to the planning target volume. Only the last four showed significant association in the multivariate analyses.Conclusion. stereotactic radiosurgery is a safe and may be an effective treatment option for selected patients diagnosed with recurrent high-grade glioma. The identified prognostic factors could help individualise the treatment.

High-grade glioma of central nervous system: Single center treatment experience.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e14040-e14040
Author(s):  
Nur Olgun ◽  
Deniz Kızmazoğlu ◽  
Batuhan Özdoğar ◽  
Emre Çeçen ◽  
Ceren Kızmazoğlu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rates ◽  
Progression Free Survival ◽  
High Grade Glioma ◽  
High Grade ◽  
Event Free Survival ◽  
Free Survival ◽  
Median Progression Free Survival ◽  
One Year ◽  
Overall Survival Rates

e14040 Background: To evaluate characteristics and treatment responses of patients with high grade gliomas (HGG) in our center Methods: Medical files of patients with malignant CNS tumors between 1987-2020 were analyzed retrospectively. There were 44 patients with HGG. Results: Diagnosis of patients as follows: 21 pons glioma, 2 anaplastic astrocytoma, 11 anaplastic ependimoma, 7 glioblastoma multiforme, 1 glioblastoma, 2 gliomatosis cerebri. The median age at diagnosis was 6,5 yrs (7 – 17 yrs), M/F:25/19. Age distrubution: <5 yrs 12 patients, 5-10 yrs 18 patients, 10-18 yrs 14 patients. The most frequent complaints for pons gliomas: cranial nerve paralysis (52%), visial impairment (48%), headache (38%), power loss (43%) and speech disorder (30%). Surgery was performed to extrinsic component of mass in 3 patients of pons gliomas. For other HGG: 7 subtotal resection and 16 gross total resection had performed. Seven patients died before RT. And other 37 patients received radiotherapy. RT total doses varied between 50-60 Gy. Seven patients were not received chemotherapy, 3 of them died before chemo, and others received only RT. Chemotherapy protocoles were changed over the years: For pons gliomas, MOPP (Mechlorethamine, vincristine, prednisone, procarbazine) in 3 patients, NOPP (nitrosourea, vincristine, prednisone, procarbazine) in 2 patients, only ICE (Ifosfamide, carboplatin, cisplatin) in five patients, oral cyclophosphamide in one patient, temozolamide in one patient and temo + bevacizumab in one patient. Last 3 patients received nimotuzumab-vinorelbine after ICE and temo. For other HGGs, platin based regimens used fort he first line treatment. Temozolamide-bevacizumab, irinotecan-temsirolimus combinations were the other options as second and also third line treatments. Median progression free survival time was 6 mos (2 weeks -25 mos) for pons gliomas, for other gliomas median progression free survival time was 14 mos (0 -74 mos). For pons gliomas: Event free survival rate for 6 mos was 75%, for one year was 17%, One year, 18 mos, and two years overall survival rates were 84%, 52% and 10% respectively. For other HGGs: Event free survival rate for one year and two years were 57% and 17% respectively. One year and two years overall survival rates were 73% and 36% respectively. Conclusions: High grade glioma is a group of tumor in which still the helplessness experienced in treatment. Despite radiotherapy and chemotherapy, prognosis is very poor. The progression free and overall survival rates of patients were similar to literature. With new developments in molecular pathology, as the use of molecular target therapies, the progression free survival rates newly will improve.

Survival and outcomes in patients with ≥ 25 cumulative brain metastases treated with stereotactic radiosurgery

2021 ◽  
pp. 1-11
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Radiation Effects ◽  
Univariate Analysis ◽  
Survival Rates ◽  
Gamma Knife Radiosurgery ◽  
Cumulative Number ◽  
Study Results ◽  
The Mean

OBJECTIVE In the era in which more patients with greater numbers of brain metastases (BMs) are being treated with stereotactic radiosurgery (SRS) alone, it is critical to understand how patient, tumor, and treatment factors affect functional status and overall survival (OS). The authors examined the survival outcomes and dosimetry to critical structures in patients treated with Gamma Knife radiosurgery (GKRS) for ≥ 25 metastases in a single session or cumulatively over the course of their disease. METHODS A retrospective analysis was conducted at a single institution. The institution’s prospective Gamma Knife (GK) SRS registry was queried to identify patients treated with GKRS for ≥ 25 cumulative BMs between June 2013 and April 2020. Ninety-five patients were identified, and their data were used for analysis. Treatment plans for dosimetric analysis were available for 89 patients. Patient, tumor, and treatment characteristics were identified, and outcomes and OS were evaluated. RESULTS The authors identified 1132 patients with BMs in their institutional registry. Ninety-five patients were treated for ≥ 25 cumulative metastases, resulting in a total of 3596 tumors treated during 373 separate treatment sessions. The median number of SRS sessions per patient was 3 (range 1–12 SRS sessions), with nearly all patients (n = 93, 98%) having > 1 session. On univariate analysis, factors affecting OS in a statistically significant manner included histology, tumor volume, tumor number, diagnosis-specific graded prognostic assessment (DS-GPA), brain metastasis velocity (BMV), and need for subsequent whole-brain radiation therapy (WBRT). The median of the mean WB dose was 4.07 Gy (range 1.39–10.15 Gy). In the top quartile for both the highest cumulative number and highest cumulative volume of treated metastases, the median of the mean WB dose was 6.14 Gy (range 4.02–10.15 Gy). Seventy-nine patients (83%) had all treated tumors controlled at last follow-up, reflecting the high and durable control rate. Corticosteroids for tumor- or treatment-related effects were prescribed in just over one-quarter of the patients. Of the patients with radiographically proven adverse radiation effects (AREs; 15%), 4 were symptomatic. Four patients required subsequent craniotomy for hemorrhage, progression, or AREs. CONCLUSIONS In selected patients with a large number of cumulative BMs, multiple courses of SRS are feasible and safe. Together with new systemic therapies, the study results demonstrate that the achieved survival rates compare favorably to those of larger contemporary cohorts, while avoiding WBRT in the majority of patients. Therefore, along with the findings of other series, this study supports SRS as a standard practice in selected patients with larger numbers of BMs.

Clinical Outcomes of Gamma Knife Radiosurgery in the Salvage Treatment of Patients with Recurrent High-Grade Glioma

2013 ◽  
Vol 80 (6) ◽  
pp. 872-878 ◽  
Author(s):  
Ameer L. Elaimy ◽  
Alexander R. Mackay ◽  
Wayne T. Lamoreaux ◽  
John J. Demakas ◽  
Robert K. Fairbanks ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
High Grade Glioma ◽  
Salvage Treatment ◽  
High Grade

Gamma knife radiosurgery in the management of cavernous sinus meningiomas

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 68-73 ◽  
Author(s):  
Pierre-Hugues Roche ◽  
Jean Régis ◽  
Henry Dufour ◽  
Henri-Dominique Fournier ◽  
Christine Delsanti ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Tumor Growth ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Gamma Knife Radiosurgery ◽  
Surgical Removal ◽  
Content Type ◽  
Cavernous Sinus Meningioma ◽  
The Mean ◽  
Fine Print

Object. The authors sought to assess the functional tolerance and tumor control rate of cavernous sinus meningiomas treated by gamma knife radiosurgery (GKS). Methods. Between July 1992 and October 1998, 92 patients harboring benign cavernous sinus meningiomas underwent GKS. The present study is concerned with the first 80 consecutive patients (63 women and 17 men). Gamma knife radiosurgery was performed as an alternative to surgical removal in 50 cases and as an adjuvant to microsurgery in 30 cases. The mean patient age was 49 years (range 6–71 years). The mean tumor volume was 5.8 cm3 (range 0.9–18.6 cm3). On magnetic resonance (MR) imaging the tumor was confined in 66 cases and extensive in 14 cases. The mean prescription dose was 28 Gy (range 12–50 Gy), delivered with an average of eight isocenters (range two–18). The median peripheral isodose was 50% (range 30–70%). Patients were evaluated at 6 months, and at 1, 2, 3, 5, and 7 years after GKS. The median follow-up period was 30.5 months (range 12–79 months). Tumor stabilization after GKS was noted in 51 patients, tumor shrinkage in 25 patients, and enlargement in four patients requiring surgical removal in two cases. The 5-year actuarial progression-free survival was 92.8%. No new oculomotor deficit was observed. Among the 54 patients with oculomotor nerve deficits, 15 improved, eight recovered, and one worsened. Among the 13 patients with trigeminal neuralgia, one worsened (contemporary of tumor growing), five remained unchanged, four improved, and three recovered. In a patient with a remnant surrounding the optic nerve and preoperative low vision (3/10) the decision was to treat the lesion and deliberately sacrifice the residual visual acuity. Only one transient unexpected optic neuropathy has been observed. One case of delayed intracavernous carotid artery occlusion occurred 3 months after GKS, without permanent deficit. Another patient presented with partial complex seizures 18 months after GKS. All cases of tumor growth and neurological deficits observed after GKS occurred before the use of GammaPlan. Since the initiation of systematic use of stereotactic MR imaging and computer-assisted modern dose planning, no more side effects or cases of tumor growth have occurred. Conclusions. Gamma knife radiosurgery was found to be an effective low morbidity—related tool for the treatment of cavernous sinus meningioma. In a significant number of patients, oculomotor functional restoration was observed. The treatment appears to be an alternative to surgical removal of confined enclosed cavernous sinus meningioma and should be proposed as an adjuvant to surgery in case of extensive meningiomas.

Gamma knife radiosurgery for craniopharyngiomas

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 47-56 ◽  
Author(s):  
Wen-Yuh Chung ◽  
David Hung-Chi Pan ◽  
Cheng-Ying Shiau ◽  
Wan-Yuo Guo ◽  
Ling-Wei Wang
Keyword(s):  
Clinical Outcome ◽  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Content Type ◽  
Stereotactic Aspiration ◽  
Cystic Component ◽  
The Mean ◽  
Fine Print

Object. The goal of this study was to elucidate the role of gamma knife radiosurgery (GKS) and adjuvant stereotactic procedures by assessing the outcome of 31 consecutive patients harboring craniopharyngiomas treated between March 1993 and December 1999. Methods. There were 31 consecutive patients with craniopharyngiomas: 18 were men and 13 were women. The mean age was 32 years (range 3–69 years). The mean tumor volume was 9 cm3 (range 0.3–28 cm3). The prescription dose to the tumor margin varied from 9.5 to 16 Gy. The visual pathways received 8 Gy or less. Three patients underwent stereotactic aspiration to decompress the cystic component before GKS. The tumor response was classified by percentage reduction of tumor volume as calculated based on magnetic resonance imaging studies. Clinical outcome was evaluated according to improvement and dependence on replacement therapy. An initial postoperative volume increase with enlargement of a cystic component was found in three patients. They were treated by adjuvant stereotactic aspiration and/or Ommaya reservoir implantation. Tumor control was achieved in 87% of patients and 84% had fair to excellent clinical outcome in an average follow-up period of 36 months. Treatment failure due to uncontrolled tumor progression was seen in four patients at 26, 33, 49, and 55 months, respectively, after GKS. Only one patient was found to have a mildly restricted visual field; no additional endocrinological impairment or neurological deterioration could be attributed to the treatment. There was no treatment-related mortality. Conclusions. Multimodality management of patients with craniopharyngiomas seemed to provide a better quality of patient survival and greater long-term tumor control. It is suggested that GKS accompanied by adjuvant stereotactic procedures should be used as an alternative in treating recurrent or residual craniopharyngiomas if further microsurgical excision cannot promise a cure.

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