scholarly journals Linear accelerator-based stereotactic radiosurgery in recurrent glioblastoma: A single center experience

2011 ◽  
Vol 68 (11) ◽  
pp. 961-966 ◽  
Author(s):  
Sait Sirin ◽  
Kaan Oysul ◽  
Serdar Surenkok ◽  
Omer Sager ◽  
Ferrat Dincoglan ◽  
...  
Keyword(s):  
Single Dose ◽  
Stereotactic Radiosurgery ◽  
Planning Target Volume ◽  
Linear Accelerator ◽  
Therapeutic Option ◽  
Target Volume ◽  
Recurrent Glioblastoma ◽  
High Dose ◽  
Combined Modality Treatment ◽  
Karnofsky Performance Score

Background/Aim. Management of patients with recurrent glioblastoma (GB) comprises a therapeutic challenge in neurooncology owing to the aggressive nature of the disease with poor local control despite a combined modality treatment. The majority of cases recur within the highdose radiotherapy field limiting the use of conventional techniques for re-irradiation due to potential toxicity. Stereotactic radiosurgery (SRS) offers a viable noninvasive therapeutic option in palliative treatment of recurrent GB as a sophisticated modality with improved setup accuracy allowing the administration of high-dose, precise radiotherapy. The aim of the study was to, we report our experience with single-dose linear accelerator (LINAC) based SRS in the management of patients with recurrent GB. Methods. Between 1998 and 2010 a total of 19 patients with recurrent GB were treated using single-dose LINAC-based SRS. The median age was 47 (23-65) years at primary diagnosis. Karnofsky Performance Score was ? 70 for all the patients. The median planning target volume (PTV) was 13 (7-19) cc. The median marginal dose was 16 (10-19) Gy prescribed to the 80%-95% isodose line encompassing the planning target volume. The median follow-up time was 13 (2-59) months. Results. The median survival was 21 months and 9.3 months from the initial GB diagnosis and from SRS, respectively. The median progression-free survival from SRS was 5.7 months. All the patients tolerated radiosurgical treatment well without any Common Toxicity Criteria (CTC) grade > 2 acute side effects. Conclusion. Single-dose LINAC-based SRS is a safe and well- tolerated palliative therapeutic option in the management of patients with recurrent GB.

scholarly journals Image-guided radiosurgery in the treatment of spinal metastases

2001 ◽  
Vol 11 (6) ◽  
pp. 1-7 ◽  
Author(s):  
Martin J. Murphy ◽  
Steven Chang ◽  
Iris Gibbs ◽  
Quynh-Tu Le ◽  
David Martin ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Therapeutic Option ◽  
Spinal Metastases ◽  
Target Volume ◽  
Outpatient Setting ◽  
Spinal Tumors ◽  
High Dose ◽  
Radiation Beam ◽  
Image Guided ◽  
Frameless Radiosurgery

Object The authors describe a new method for treating metastatic spinal tumors in which noninvasive, image-guided, frameless stereotactic radiosurgery is performed. Stereotactic radiosurgery delivers a high dose of radiation in a single or limited number of fractions to a lesion while maintaining delivery of a low dose to adjacent normal structures. Methods Image-guided radiosurgery was developed by coupling an orthogonal pair of real-time x-ray cameras to a dynamically manipulated robot-mounted linear accelerator that guides the radiation beam to treatment sites associated with radiographic landmarks. This procedure can be conducted in an outpatient setting without the use of frame-based skeletal fixation. The system relies on skeletal landmarks or implanted fiducial markers to locate treatment targets. Four patients with spinal metastases underwent radiosurgery with total prescription doses of 1000 to 1600 cGy in one or two fractions. Alignment of the treatment dose with the target volume was accurate to within 1.5 mm. During the course of each treatment fraction, patient movement was less than 0.5 mm on average. Dosimetry was highly conformal, with a demonstrated ability to deliver 1600 cGy to the perimeter of an irregular target volume while keeping exposure to the cord itself below 800 cGy. Conclusions These experiences indicate that frameless radiosurgery is a viable therapeutic option for metastatic spine disease.

scholarly journals Stereotactic Radiosurgery Associated Neurotoxicity

2003 ◽  
Vol 2 (2) ◽  
pp. 147-151 ◽  
Author(s):  
William H. St. Clair ◽  
Curtis A. Given
Keyword(s):  
Stereotactic Radiosurgery ◽  
Therapeutic Option ◽  
Treatment Plan ◽  
Three Dimensional ◽  
Reference Points ◽  
Therapeutic Modality ◽  
High Dose ◽  
Lesion Volume ◽  
Three Dimensional Mapping ◽  
Effective Therapeutic Option

Stereotactic radiosurgery (SRS) is an evolving therapeutic modality for well demarcated intracranial lesions. Since the inception of stereotactic radiosurgery the types of parenchymal CNS lesions addressed by this mode of treatment has increased. All modern stereotactic radiosurgical procedures employ several common features. Patients are fitted with a stereotactic head frame or fiducial markers followed by radiographic imaging which allows for external reference points and three-dimensional mapping of the intracranial lesion. Armed with this information a highly conformal treatment plan is developed to deliver a high dose of radiation to a sharply defined target, with rapid dose fall-off outside the lesion volume. While an extremely effective therapeutic option, SRS is not without risk of neurotoxicity, with radiation necrosis being the most commonly recognized complication. The neurotoxic effects of SRS are reviewed and discussed.

scholarly journals Indications and Efficacy of Gamma Knife Stereotactic Radiosurgery for Recurrent Glioblastoma: 2 Decades of Institutional Experience

Neurosurgery ◽  
2016 ◽  
Vol 80 (1) ◽  
pp. 129-139 ◽  
Author(s):  
Brandon S. Imber ◽  
Ishan Kanungo ◽  
Steve Braunstein ◽  
Igor J. Barani ◽  
Shannon E. Fogh ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Proportional Hazards ◽  
Symptomatic Treatment ◽  
Target Volume ◽  
Recurrent Glioblastoma ◽  
Target Range ◽  
Kaplan Meier ◽  
Treatment Volume ◽  
Gamma Knife Stereotactic Radiosurgery

Abstract BACKGROUND: The role of stereotactic radiosurgery (SRS) for recurrent glioblastoma and the radionecrosis risk in this setting remain unclear. OBJECTIVE: To perform a large retrospective study to help inform proper indications, efficacy, and anticipated complications of SRS for recurrent glioblastoma. METHODS: We retrospectively analyzed patients who underwent Gamma Knife SRS between 1991 and 2013. We used the partitioning deletion/substitution/addition algorithm to identify potential predictor covariate cut points and Kaplan-Meier and proportional hazards modeling to identify factors associated with post-SRS and postdiagnosis survival. RESULTS: One hundred seventy-four glioblastoma patients (median age, 54.1 years) underwent SRS a median of 8.7 months after initial diagnosis. Seventy-five percent had 1 treatment target (range, 1-6), and median target volume and prescriptions were 7.0 cm3 (range, 0.3-39.0 cm3) and 16.0 Gy (range, 10-22 Gy), respectively. Median overall survival was 10.6 months after SRS and 19.1 months after diagnosis. Kaplan-Meier and multivariable modeling revealed that younger age at SRS, higher prescription dose, and longer interval between original surgery and SRS are significantly associated with improved post-SRS survival. Forty-six patients (26%) underwent salvage craniotomy after SRS, with 63% showing radionecrosis or mixed tumor/necrosis vs 35% showing purely recurrent tumor. The necrosis/mixed group had lower mean isodose prescription compared with the tumor group (16.2 vs 17.8 Gy; P = .003) and larger mean treatment volume (10.0 vs 5.4 cm3; P = .009). CONCLUSION: Gamma Knife may benefit a subset of focally recurrent patients, particularly those who are younger with smaller recurrences. Higher prescriptions are associated with improved post-SRS survival and do not seem to have greater risk of symptomatic treatment effect.

scholarly journals Does size matter? Investigating the optimal planning target volume margin for postoperative stereotactic radiosurgery to resected brain metastases

2019 ◽  
Vol 130 (3) ◽  
pp. 797-803 ◽  
Author(s):  
Jaymin Jhaveri ◽  
Mudit Chowdhary ◽  
Xinyan Zhang ◽  
Robert H. Press ◽  
Jeffrey M. Switchenko ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Planning Target Volume ◽  
Group Performance ◽  
Multivariate Analyses ◽  
Target Volume ◽  
Single Fraction ◽  
Ptv Margin ◽  
Size Matter

OBJECTIVEThe optimal margin size in postoperative stereotactic radiosurgery (SRS) for brain metastases is unknown. Herein, the authors investigated the effect of SRS planning target volume (PTV) margin on local recurrence and symptomatic radiation necrosis postoperatively.METHODSRecords of patients who received postoperative LINAC-based SRS for brain metastases between 2006 and 2016 were reviewed and stratified based on PTV margin size (1.0 or > 1.0 mm). Patients were treated using frameless and framed SRS techniques, and both single-fraction and hypofractionated dosing were used based on lesion size. Kaplan-Meier and cumulative incidence models were used to estimate survival and intracranial outcomes, respectively. Multivariate analyses were also performed.RESULTSA total of 133 patients with 139 cavities were identified; 36 patients (27.1%) and 35 lesions (25.2%) were in the 1.0-mm group, and 97 patients (72.9%) and 104 lesions (74.8%) were in the > 1.0–mm group. Patient characteristics were balanced, except the 1.0-mm cohort had a better Eastern Cooperative Group Performance Status (grade 0: 36.1% vs 19.6%), higher mean number of brain metastases (1.75 vs 1.31), lower prescription isodose line (80% vs 95%), and lower median single fraction–equivalent dose (15.0 vs 17.5 Gy) (all p < 0.05). The median survival and follow-up for all patients were 15.6 months and 17.7 months, respectively. No significant difference in local recurrence was noted between the cohorts. An increased 1-year rate of symptomatic radionecrosis was seen in the larger margin group (20.9% vs 6.0%, p = 0.028). On multivariate analyses, margin size > 1.0 mm was associated with an increased risk for symptomatic radionecrosis (HR 3.07, 95% CI 1.13–8.34; p = 0.028), while multifraction SRS emerged as a protective factor for symptomatic radionecrosis (HR 0.13, 95% CI 0.02–0.76; p = 0.023).CONCLUSIONSExpanding the PTV margin beyond 1.0 mm is not associated with improved local recurrence but appears to increase the risk of symptomatic radionecrosis after postoperative SRS.

scholarly journals Stereotactic radiosurgery for hemangiomas and ependymomas of the spinal cord

2003 ◽  
Vol 15 (5) ◽  
pp. 1-5 ◽  
Author(s):  
Stephen I. Ryu ◽  
Daniel H. Kim ◽  
Steven D. Chang
Keyword(s):  
Spinal Cord ◽  
Stereotactic Radiosurgery ◽  
Therapeutic Option ◽  
Spinal Tumors ◽  
High Dose ◽  
Significant Treatment ◽  
Conventional Radiation ◽  
Conformal Treatment ◽  
Dose Radiation

Object The optimal treatment for intramedullary spinal tumors is controversial, because both resection and conventional radiation therapy are associated with potential morbidity. Stereotactic radiosurgery can theoretically deliver highly conformal, high-dose radiation to surgically untreatable lesions while simultaneously mitigating radiation exposure to large portions of the spinal cord. The purpose of this study was to evaluate the authors' initial experience with frameless stereotactic radiosurgery for intramedullary spinal tumors. Methods Between 1998 and 2003, 10 intramedullary spinal tumors were treated with stereotactic radiosurgery at the authors' institution. Seven hemangioblastomas and three ependymomas were treated in four men and three women. These patients either had recurrent tumors, had undergone several previous surgeries, had medical contraindications to surgery, or had declined open resection. Conformal treatment planning delivered a prescribed dose of 1800 to 2500 cGy (mean 2100 cGy) to the lesions in one to three stages. No significant treatment-related complications have been recorded. The mean radiographic and clinical follow-up duration was 12 months (range 1–24 months). One ependymoma and two hemangioblastomas were smaller on follow-up neuroimaging. The remaining tumors were stable at the time of follow-up imaging. Conclusions Stereotactic radiosurgery for intramedullary spinal tumors is feasible and safe in selected cases and may prove to be another therapeutic option for these challenging lesions.

Pharmacokinetics (PK) of 2 Dosing Regimens of Palifermin in Patients (Pts) with Hematologic Malignancies (HM) Undergoing High-Dose Chemoradiotherapy and Hematopoietic Stem Cell Transplantation (HSCT).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5294-5294 ◽  
Author(s):  
Parnian Zia-Amirhosseini ◽  
Margaret Salfi ◽  
Dieter Elhardt ◽  
Jeff Aycock ◽  
Tsui Chern Cheah ◽  
...  
Keyword(s):  
Single Dose ◽  
Phase 1 ◽  
Dose Range ◽  
Volume Of Distribution ◽  
High Dose ◽  
Karnofsky Performance Score ◽  
Open Label ◽  
Hematopoietic Stem ◽  
Dosing Regimens ◽  
Parameter Values

Abstract For pts with HM undergoing HSCT, oral mucositis (OM) is a frequent and debilitating complication that negatively impacts treatment outcomes, patient quality of life, and healthcare resources. Palifermin reduces the incidence and duration of severe OM in the HSCT setting. This phase 1 open-label study assessed the PK of 2 palifermin dosing regimens. Methods: Pts were 18 to 76 years old with HM and a Karnofsky performance score ≥70%. Palifermin was administered intravenously once daily as follows: 60 mcg/kg/day [d] for 3 consecutive days on d -11, -10, and -9 before conditioning (total body irradiation [TBI] + etoposide + cyclophosphamide) and following HSCT on d 0, 1 and 2 (part A) and a single dose of 180 mcg/kg (part B) before conditioning on d -11 and after HSCT on d 0. In part A (6 total doses), PK parameters were assessed after the 1st, 3rd, 4th, and 6th doses. In part B (2 total doses), assessments were made after each dose administration (d -11 and d 0). Results: In part A, 13 pts received palifermin; in part B, 12 pts received the single dose on d -11 and 11 pts received the single dose on d 0. For both dosing regimens, palifermin concentrations declined rapidly (≥98% decrease) in the first 30 minutes postdose, followed by a slight increase in mean concentrations between 1 and 4 hours and then a terminal decay phase. Respective mean (SD) PK parameter values for the 2 dosing regimens are shown in Table 1. In part A, mean AUC0-t values were comparable between doses 1 and 3 (within 15%) and 1 and 4 (within 1%). In part B, mean PK parameter values were similar (within 10% of each other) between doses 1 and 2. The mean AUC after the first 180 mcg/kg dose in part B was approximately 4-fold higher than that after the first 60 mcg/kg dose in part A. Mean half-life values ranged between 3.3 to 5.7 hours in part A and the value was 5.4 hours in part B. Conclusion: The PK data in pts receiving HSCT were consistent with approximately dose-linear PK in the dose range of 60 and 180 mcg/kg, with no observed accumulation, based on AUC, after 3 daily doses of 60 mcg/kg in this pt population in the HSCT setting. Table 1 Dose Number (Dosing Day) n AUC0-t (hr x ng/mL) mean (SD) Clearance (mL/hr/kg) mean (SD) Vss (mL/kg) mean (SD) a Accurate computations of clearance (CL) and volume of distribution at steady state (Vss) were not possible for some concentration-time profiles. Part A - 60 mcg/kg/day x 3 consecutive days 1st dose (day -11) 9–13 34.3 (15.9) 1730a (497) 5320a (2330) 3rd dose(day -9) 13 39.8 (36.4) - - 4th dose(day 0) 11–13 34.8 (22.5) 2030a (862) 3870a (2080) 6th dose(day 2) 13 21.2 (15.1) - - Part B - 180 mcg/kg/day x 1 day 1st dose(day -11) 12 140 (50.9) 1460 (600) 4290 (3270) 2nd dose(day 0) 11 143 (71.8) 1770 (1290) 4270 (4700)

scholarly journals The Outcomes of Radiosurgery for Arteriovenous Malformations—Experience of a Tertiary Cancer Center from India

2021 ◽  
Author(s):  
Sanjay M. Hunugundmath ◽  
Sumit Basu ◽  
Bhooshan Zade ◽  
Vikram Maiya ◽  
Rahul Sharma ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Planning Target Volume ◽  
Arteriovenous Malformations ◽  
Target Volume ◽  
Cancer Center ◽  
Median Dose ◽  
Noninvasive Treatment ◽  
Entire Cohort ◽  
Tertiary Cancer Center

Abstract Objectives This article assesses the treatment outcomes in the patients diagnosed with arteriovenous malformations (AVMs) treated with stereotactic radiosurgery. Materials and Methods We retrospectively analyzed 30 patients diagnosed with AVM treated between 2010 and 2018.The median age at presentation was 30 years (range: 14–60 years). The median planning target volume (PTV) was 6.8 mL (range: 0.9–54 mL). The median dose prescribed was 18 Gy (range: 16–24 Gy). Modified radiosurgery-based AVM grading score was calculated for all the patients. Results The median follow-up of the entire cohort was 60 months (range: 24–96 months). The obliteration rates for patients followed up for 3 and 5 years were 75 and 86.1%, respectively. Age (< 35 years; p = 0.007) and PTV (< 7 mL; p = 0.04), had better obliteration rates. Three patients had hemorrhage, from the AVM after irradiation. None of them were fatal. Conclusion Stereotactic radiosurgery is a preferred noninvasive treatment modality with acceptable morbidity.

scholarly journals Advances in Technology for Intracranial Stereotactic Radiosurgery

2009 ◽  
Vol 8 (4) ◽  
pp. 271-280 ◽  
Author(s):  
Arjun Sahgal ◽  
Lijun Ma ◽  
Eric Chang ◽  
Almon Shiu ◽  
David A. Larson ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Stereotactic Radiosurgery ◽  
Linear Accelerator ◽  
Radiation Treatment ◽  
Three Dimensions ◽  
High Dose ◽  
Mri Imaging ◽  
Dose Delivery ◽  
Non Invasive ◽  
Accurate Dose

Stereotactic radiosurgery (SRS) refers to a single radiation treatment delivering a high dose to an intra-cranial target localized in three-dimensions by CT and/or MRI imaging. Traditionally, immobilization of the patient's head has been achieved using a rigid stereotactic head frame as the key step in allowing for accurate dose delivery. SRS has been delivered by both Cobalt-60 (Gamma Knife®) and linear accelerator (linac) technologies for many decades. The focus of this review is to highlight recent advances and major innovations in SRS technologies relevant to clinical practice and developments allowing for non-invasive frame SRS.

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