Outcome of intracerebral cavernoma treated by Gamma Knife radiosurgery based on a double-blind assessment of treatment indication

Abstract Purpose The benefit and risk profile of Gamma Knife radiosurgery (GKRS) for intracerebral cavernoma remains undefined due to the low incidence of bleeding and spontaneous regression of cavernoma. We retrieved cases from a prospectively collected database to assess the outcome of intracerebral cavernoma treated with GKRS using a double blinded review process for treatment. Methods From 2003 to 2018, 94 cases of cavernoma were treated by GKRS with margin dose of 11–12 Gy. The treatment indications were doubly blinded assessed by two experienced neurosurgeon and afterward assessed for neurological outcome, radiologic response, and quality of life. Results Seven of 16(43.7%) achieved seizure freedom and 9 of 16 (56.3%) achieved decreased seizures. Rebleeding occurred in 2 cases (2.1%) at 13 and 52 months post GKRS. The nidus volume demonstrated the decrease in 20 (21.3%) cases, 69(73.4%) stable and 5 (7.3%) increase. Eight-seven of 94 (92.5%) cases achieve improvement in their quality of life. The effective seizure control was correlated with patients harboring a single lesion (p < 0.05) and deep seated location of the cavernoma (p < 0.01). New neurological deficits were correlated with decreased mental (p < 0.001) and physical (p < 0.05) components of quality of life testing, KPS (p < 0.001), deep seated location (p < 0.01), and increased nidus volume (p < 0.05). Quality of life deterioration either in physical component (p < 0.01), mental component (p < 0.01), and KPS (p < 0.05) was correlated with increased cavernoma volume. Conclusion Low margin dose GKRS for intracerebral cavernoma offers reasonable seizure control and improved quality of life with a low risk of treatment complications.

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Outcome of Intracerebral Cavernoma Treated by Gamma Knife Radiosurgery Based on a Double-blind Assessment of Treatment Indication

10.21203/rs.3.rs-550603/v2 ◽

2021 ◽

Author(s):

Chiung-Chyi Shen ◽

Ming-Hsi Sun ◽

Men-Yin Yang ◽

Weir Chiang You ◽

Meei-Ling Sheu ◽

...

Keyword(s):

Quality Of Life ◽

Gamma Knife ◽

Seizure Control ◽

Gamma Knife Radiosurgery ◽

Neurological Deficits ◽

Seizure Freedom ◽

Double Blind ◽

Highly Correlated

Abstract Background: The benefit and the risk profile of Gamma Knife radiosurgery for intracerebral cavernoma remains incompletely defined in part due to the natural history of low incidence of bleeding and spontaneous regression of this vascular malformation. In this study, we retrieved cases from a prospectively collected database to assess the outcome of intracerebral cavernoma treated with Gamma Knife using a double blinded review process for treatment.Methods: From 2003 to 2018, there were 94 cases of cavernoma treated by Gamma Knife radiosurgery doubly blinded assessed by two experienced neurological and approved for Gamma Knife treatment. All the patients received Gamma Knife radiosurgery with margin dose of 11-12 Gy and afterwards were assessed for neurological outcome, radiologic response, and quality of life.Results: The median age of the patients was 48(15-85) years with median follow up of 77(26-180) months post SRS. The mean treated volume was 1.93±3.45cc. In those who has pre-SRS epilepsy, 7 of 16(43.7%) achieved seizure freedom (Engel I/II) and 9 of 16 (56.3%) achieved decreased seizures (Engel III) after SRS. Rebleeding occurred in 2 cases (2.1%) at 13 and 52 months post SRS. The radiologic assessment demonstrated 20 (21.3%) cases of decreased cavernoma volume, 69(73.4%) were stable, and 5 (7.3%) increased size. Eight-seven of 94 (92.5%) cases at the last follow up achieve improvement in their quality of life, but 7 cases (7.4%) showed a deterioration. In statistical analysis, the effective seizure control class (Engel I/II) was highly correlated with patient harboring a single lesion (p<0.05) and deep seated location of the cavernoma (p<0.01). New neurological deficits were highly correlated with decreased mental (p<0.001) and physical (p<0.05) components of quality of life testing, KPS (p<0.001), deep seated location (p<0.01), and increased nidus volume (p<0.05). Quality of life deterioration either in physical component (p<0.01), mental component (p<0.01), and KPS (p<0.05) was highly correlated with increased cavernoma volume.Conclusion: Low margin dose Gamma Knife radiosurgery for intracerebral cavernoma offers reasonable seizure control and improved quality of life while conferring a low risk of treatment complications including adverse radiation effect.

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Outcome of intracerebral cavernoma treated by Gamma Knife radiosurgery based on a double-blind assessment of treatment indication

Radiation Oncology ◽

10.1186/s13014-021-01885-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Chiung-Chyi Shen ◽

Ming Hsi Sun ◽

Meng-Yin Yang ◽

Weir-Chiang You ◽

Meei-Ling Sheu ◽

...

Keyword(s):

Quality Of Life ◽

Gamma Knife ◽

Seizure Control ◽

Gamma Knife Radiosurgery ◽

Neurological Deficits ◽

Seizure Freedom ◽

Double Blind ◽

Highly Correlated

Abstract Background The benefit and the risk profile of Gamma Knife radiosurgery (GKRS) for intracerebral cavernoma remains incompletely defined in part due to the natural history of low incidence of bleeding and spontaneous regression of this vascular malformation. In this study, we retrieved cases from a prospectively collected database to assess the outcome of intracerebral cavernoma treated with GKRS using a double blinded review process for treatment. Methods From 2003 to 2018, there were 94 cases of cavernoma treated by GKRS in the doubly blinded assessments by two experienced neurological and approved for GKRS treatment. All the patients received GKRS with margin dose of 11–12 (Gray) Gy and afterwards were assessed for neurological outcome, radiologic response, and quality of life. Results The median age of the patients was 48 (15–85) years with median follow up of 77 (26–180) months post SRS. The mean target volume was 1.93 ± 3.45 cc. In those who has pre-SRS epilepsy, 7 of 16 (43.7%) achieved seizure freedom (Engel I/II) and 9 of 16 (56.3%) achieved decreased seizures (Engel III) after SRS. Rebleeding occurred in 2 cases (2.1%) at 13 and 52 months post SRS. The radiologic assessment demonstrated 20 (21.3%) cases of decreased cavernoma volume, 69 (73.4%) were stable, and 5 (7.3%) increased size. Eighty-seven of 94 (92.5%) cases at the last follow up achieve improvement in their quality of life, but 7 cases (7.4%) showed a deterioration. In statistical analysis, the effective seizure control class (Engel I/II) was highly correlated with patient harboring a single lesion (p < 0.05) and deep seated location of the cavernoma (p < 0.01). New neurological deficits were highly correlated with decreased mental (p < 0.001) and physical (p < 0.05) components of quality of life testing, KPS (p < 0.001), deep seated location (p < 0.01), and increased nidus volume (p < 0.05). Quality of life deterioration either in physical component (p < 0.01), mental component (p < 0.01), and KPS (p < 0.05) was highly correlated with increased cavernoma volume. Conclusion Low margin dose GKRS for intracerebral cavernoma offers reasonable seizure control and improved quality of life while conferring a low risk of treatment complications including adverse radiation effect.

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Surgery for low-grade glioma infiltrating the central cerebral region: location as a predictive factor for neurological deficit, epileptological outcome, and quality of life

Journal of Neurosurgery ◽

10.3171/2013.5.jns122235 ◽

2013 ◽

Vol 119 (2) ◽

pp. 318-323 ◽

Cited By ~ 37

Author(s):

Philippe Schucht ◽

Fadi Ghareeb ◽

Hugues Duffau

Keyword(s):

Quality Of Life ◽

Return To Work ◽

Seizure Control ◽

Extent Of Resection ◽

Low Grade Glioma ◽

Neurological Deficits ◽

Main Concern ◽

Low Grade ◽

Who Grade

Object A main concern with regard to surgery for low-grade glioma (LGG, WHO Grade II) is maintenance of the patient's functional integrity. This concern is particularly relevant for gliomas in the central region, where damage can have grave repercussions. The authors evaluated postsurgical outcomes with regard to neurological deficits, seizures, and quality of life. Methods Outcomes were compared for 33 patients with central LGG (central cohort) and a control cohort of 31 patients with frontal LGG (frontal cohort), all of whom had had medically intractable seizures before undergoing surgery with mapping while awake. All surgeries were performed in the period from February 2007 through April 2010 at the same institution. Results For the central cohort, the median extent of resection was 92% (range 80%–97%), and for the frontal cohort, the median extent of resection was 93% (range 83%–98%; p = 1.0). Although the rate of mild neurological deficits was similar for both groups, seizure freedom (Engel Class I) was achieved for only 4 (12.1%) of 33 patients in the central cohort compared with 26 (83.9%) of 31 patients in the frontal cohort (p < 0.0001). The rate of return to work was lower for patients in the central cohort (4 [12.1%] of 33) than for the patients in the frontal cohort (28 [90.3%] of 31; p < 0.0001). Conclusions Resection of central LGG is feasible and safe when appropriate intraoperative mapping is used. However, seizure control for these patients remains poor, a finding that contrasts markedly with seizure control for patients in the frontal cohort and with that reported in the literature. For patients with central LGG, poor seizure control ultimately determines quality of life because most will not be able to return to work.

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Repeat gamma knife radiosurgery for refractory or recurrent trigeminal neuralgia: treatment outcomes and quality-of-life assessment

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2003.10.041 ◽

2004 ◽

Vol 59 (1) ◽

pp. 112-116 ◽

Cited By ~ 47

Author(s):

Joseph M Herman ◽

Joshua H Petit ◽

Pradip Amin ◽

Young Kwok ◽

Pinaki R Dutta ◽

...

Keyword(s):

Quality Of Life ◽

Trigeminal Neuralgia ◽

Treatment Outcomes ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Life Assessment ◽

Quality Of Life Assessment

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Impact on the quality of life of patients with arteriovenous malformations during the latent interval between gamma knife radiosurgery and lesion obliteration

Journal of Neurosurgery ◽

10.3171/jns.2002.97.supplement_5.0471 ◽

2002 ◽

Vol 97 ◽

pp. 471-473 ◽

Cited By ~ 3

Author(s):

Erica Ho Pik Lai ◽

Samuel Leung Cheong Lun

Keyword(s):

Quality Of Life ◽

Gamma Knife ◽

Arteriovenous Malformations ◽

Gamma Knife Radiosurgery ◽

Medical Problems ◽

Waiting Period ◽

Content Type ◽

Latent Interval ◽

Fine Print

Object. The aim of this study was to measure the quality of life (QOL) in patients with cerebral arteriovenous malformations (AVMs) receiving gamma knife treatment before total AVM obliteration. Quality of life was assessed as it related to the knowledge of rebleeding risk during the waiting period, AVM symptoms, and previous bleeding. Methods. Thirty-nine patients age 18 years or older without other medical problems were asked to complete a questionnaire that included demographic variables, immediate effect of gamma knife radiosurgery, symptoms of AVM, previous hemorrhage, and the Duke—University of North Carolina Health Profile (63 items). Conclusions. The QOL of patients with cerebral AVM during the waiting period after undergoing gamma knife treatment was affected by irreversible physical disabilities rather than the knowledge of hemorrhage risk and bleeding experience.

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A phase II double-blind, randomized clinical trial assessing the tolerability of two different ratios of cannabis in patients with glioblastoma multiforme (GBM).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.2530 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 2530-2530

Author(s):

Judith Lacey ◽

Janet Margaret Schloss ◽

Justin Sinclair ◽

Amie Steel ◽

Mike Sughrue ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Trial ◽

Statistical Significance ◽

Tumour Response ◽

Recurrent Glioblastoma ◽

Mri Imaging ◽

Double Blind ◽

Disease Response ◽

Double Blinded

2530 Background: Cannabis has been used for cancer-related symptoms but few trials have assessed quality of life or tolerability, and trials assessing tumour response or survival remain scarce. Treatment for recurrent glioblastoma (rGBM) remains palliative with poor prognosis. The tolerability of THC-containing cannabis products, and their effect on symptoms and quality of life in people with rGBM patients is poorly defined but is essential before efficacy trials can be conducted. Methods: We conducted a randomised double-blinded trial assessing the tolerability of two preparations of cannabis in 88 people with rGBM. The two preparations used different cannabidiol (CBD) to tetrahydrocannibidiol (THC) ratios; 1:1 (5.8mg/ml:5.6mg/ml) and 1:4 (3.8mg/ml:15mg/ml). Daily evening doses were individually monitored and titrated. Outcomes included disease response by FACT-Br, MRI imaging 12 weekly, blood pathology, NCI-CTC and clinical monitoring. Symptom assessments were performed 4 weekly for 12 weeks. Results: 921 people volunteered for screening across Australia, with 642 excluded, 92 recruited with 88 enrolled. 61 participants completed 12-week follow-up (attrition 30%). Both cannabis oils were well tolerated. Total FACT-Br was similar for both preparations, however, statistical significance was found for the physical section (p = 0.025) and functional (p = 0.014) identifying the 1:1 ratio as the more appropriate combination. Comparing groups to baseline, participants reported improvement of sleep (p = 0.009), improved energy (p = 0.015), and contentment with QoL (p = 0.006). Total cohort compared to baseline, participants reported improvement of sleep (p = 0.0001), pain (p = 0.046), nausea (p = 0.017), anxiety (p = 0.005) and seizure activity (p = 0.022). There were no major adverse events attributable to the cannabis with main side effects noted as dizziness, drowsiness, tiredness, and dry mouth. No abnormal blood pathology nor variance in NCI-CTCAE scores were observed. Conclusions: A single nightly dose of THC-containing cannabis was well tolerated in patients in both groups with rGBM and significantly improved sleep and functional wellbeing and QOL in a sample of patients compared to baseline. From this trial, the 1:1 ratio has been identified as the better tolerated product with suprerior symptom and QoL outcomes compared to the 1:4 product. Clinical trial information: ACTRN12617001287325 .

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