scholarly journals Radiation treatment strategies for acromegaly

2010 ◽  
Vol 29 (4) ◽  
pp. E12 ◽  
Author(s):  
Nathan C. Rowland ◽  
Manish K. Aghi
Keyword(s):  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Radiation Treatment ◽  
Cranial Nerves ◽  
Gamma Knife Surgery ◽  
Treatment Modalities ◽  
High Morbidity ◽  
Multisystem Disorder ◽  
Fractionated Radiotherapy ◽  
Adjacent Structures

The high morbidity and mortality associated with acromegaly can be addressed with multiple treatment modalities, including surgery, medicines, and radiation therapy. Radiation was initially delivered through conventional fractionated radiotherapy, which targets a wide area over many treatment sessions and has been shown to induce remission in 50%–60% of patients with acromegaly. However, conventional fractionated radiotherapy takes several years to achieve remission in patients with acromegaly and carries a risk of hypopituitarism that may limit its use. Stereotactic radiosurgery, of which there are several forms, including Gamma Knife surgery, CyberKnife therapy, and proton beam therapy, offers slightly attenuated efficacy but achieves remission in less time and provides more precise targeting of the adenoma with better control of the dose of radiation received by adjacent structures such as the pituitary stalk, pituitary gland, optic chiasm, and cranial nerves in the cavernous sinus. Of the forms of stereotactic radiosurgery, Gamma Knife surgery is the most widely used and, because of its long-term follow-up in clinical studies, is the most likely to compete with medical therapy for first-line adjuvant use after resection. In this review, the authors outline the major modes of radiation therapies in clinical use today, and they critically assess the feasibility of these modalities for acromegaly treatment. Acromegaly is a multisystem disorder that demands highly specialized treatment protocols including neurosurgical and endocrinological intervention. As more efficient forms of pituitary radiation develop, acromegaly treatment options may continue to change with radiation therapies playing a more prominent role.

scholarly journals Long-term safety of gamma knife radiosurgery (SRS) for acromegaly

Pituitary ◽  
2021 ◽  
Author(s):  
Hugh P. Sims‐Williams ◽  
Kaveesha Rajapaksa ◽  
John Yianni ◽  
Lee Walton ◽  
Saurabh Sinha ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Stereotactic Radiosurgery ◽  
Radiation Treatment ◽  
High Morbidity ◽  
Complication Rates ◽  
Stroke Rate ◽  
Stroke Incidence ◽  
Fractionated Radiotherapy

Abstract Purpose Acromegaly has high morbidity and mortality when growth hormone secretion remains uncontrolled. Stereotactic radiosurgery (SRS) may be used when pituitary surgery is not suitable or unsuccessful, but there are few very long-term safety data available, especially for significant adverse events such as stroke. Methods 118 patients with acromegaly were treated with SRS between 1985 and 2015, at the National Centre for Stereotactic Radiosurgery, Sheffield, UK. Data were gathered from case notes, hospital databases, and patient questionnaires. Stroke incidence in comparison to the normal population was quantified using the standardised incidence ratio (SIR), and visual complications assessed. Results 88% (104/118) had complete morbidity follow up data for analysis. The mean follow-up was 134 months, and median SRS dose was 30 Gy. 81% of tumours had cavernous sinus invasion. There was no excess stroke rate relative to that seen in two age- and sex-matched large population studies (SIR = 1.36, 95% CI 0.27–3.96; SIR = 0.52, 95% CI 0.06–1.89). In 68/104 patients who had MRI-guided SRS with no further radiation treatment (SRS or fractionated radiotherapy) there was no loss of visual acuity and 3% developed ophthalmoplegia. There was a positive correlation between > 1 radiation treatment and both ophthalmoplegia and worsening visual acuity. Conclusion Stroke rate is not increased by SRS for acromegaly. Accurate MRI-based treatment planning and single SRS treatment allow the lowest complication rates. More than one radiation treatment (SRS or fractionated radiotherapy) was associated with increased visual complications.

scholarly journals Cyberknife® hypofractionated stereotactic radiosurgery (CK-hSRS) as salvage treatment for brain metastases

2021 ◽  
Author(s):  
Sergej Telentschak ◽  
Daniel Ruess ◽  
Stefan Grau ◽  
Roland Goldbrunner ◽  
Niklas von Spreckelsen ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Poor Prognosis ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Salvage Treatment ◽  
Treatment Modalities ◽  
Large Tumor ◽  
Fractionated Radiotherapy ◽  
Hypofractionated Stereotactic Radiosurgery

Abstract Purpose The introduction of hypofractionated stereotactic radiosurgery (hSRS) extended the treatment modalities beyond the well-established single-fraction stereotactic radiosurgery and fractionated radiotherapy. Here, we report the efficacy and side effects of hSRS using Cyberknife® (CK-hSRS) for the treatment of patients with critical brain metastases (BM) and a very poor prognosis. We discuss our experience in light of current literature. Methods All patients who underwent CK-hSRS over 3 years were retrospectively included. We applied a surface dose of 27 Gy in 3 fractions. Rates of local control (LC), systemic progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier method. Treatment-related complications were rated using the Common Terminology Criteria for Adverse Events (CTCAE). Results We analyzed 34 patients with 75 BM. 53% of the patients had a large tumor, tumor location was eloquent in 32%, and deep seated in 15%. 36% of tumors were recurrent after previous irradiation. The median Karnofsky Performance Status was 65%. The actuarial rates of LC at 3, 6, and 12 months were 98%, 98%, and 78.6%, respectively. Three, 6, and 12 months PFS was 38%, 32%, and 15%, and OS was 65%, 47%, and 28%, respectively. Median OS was significantly associated with higher KPS, which was the only significant factor for survival. Complications CTCAE grade 1–3 were observed in 12%. Conclusion Our radiation schedule showed a reasonable treatment effectiveness and tolerance. Representing an optimal salvage treatment for critical BM in patients with a very poor prognosis and clinical performance state, CK-hSRS may close the gap between surgery, stereotactic radiosurgery, conventional radiotherapy, and palliative care.

scholarly journals Image-Guided Multisession Radiosurgery of Skull Base Meningiomas

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3569
Author(s):  
Alfredo Conti ◽  
Antonio Pontoriero ◽  
Giuseppe Iatì ◽  
Salvatore M. Cardali ◽  
Anna Brogna ◽  
...  
Keyword(s):  
Skull Base ◽  
Stereotactic Radiosurgery ◽  
Cranial Nerves ◽  
Progression Free Survival ◽  
Motor Deficits ◽  
Intracranial Meningioma ◽  
Treatment Schedule ◽  
Fractionated Radiotherapy ◽  
Patient Reported ◽  
Skull Base Meningiomas

Background: The efficacy of single-session stereotactic radiosurgery (sSRS) for the treatment of intracranial meningioma is widely recognized. However, sSRS is not always feasible in cases of large tumors and those lying close to critically radiation-sensitive structures. When surgery is not recommended, multi-session stereotactic radiosurgery (mSRS) can be applied. Even so, the efficacy and best treatment schedule of mSRS are not yet established. The aim of this study is to validate the role of mSRS in the treatment of skull base meningiomas. Methods: A retrospective analysis of patients with skull base meningiomas treated with mSRS (two to five fractions) at the University of Messina, Italy, from 2008 to 2018, was conducted. Results: 156 patients met the inclusion criteria. The median follow-up period was 36.2 ± 29.3 months. Progression-free survival at 2-, 5-, and 10- years was 95%, 90%, and 80.8%, respectively. There were no new visual or motor deficits, nor cranial nerves impairments, excluding trigeminal neuralgia, which was reported by 5.7% of patients. One patient reported carotid occlusion and one developed brain edema. Conclusion: Multisession radiosurgery is an effective approach for skull base meningiomas. The long-term control is comparable to that obtained with conventionally-fractionated radiotherapy, while the toxicity rate is very limited.

Gamma Knife surgery for glossopharyngeal neuralgia

2009 ◽  
Vol 110 (3) ◽  
pp. 559-563 ◽  
Author(s):  
Shoji Yomo ◽  
Yasser Arkha ◽  
Anne Donnet ◽  
Jean Régis
Keyword(s):  
Pain Relief ◽  
Gamma Knife ◽  
Cranial Nerves ◽  
Initial Response ◽  
Neurological Complications ◽  
Gamma Knife Surgery ◽  
Glossopharyngeal Neuralgia ◽  
Invasive Treatment ◽  
Neurological Effects ◽  
Lower Cranial Nerves

Gamma Knife surgery (GKS) is widely recognized as an effective, minimally invasive treatment for intractable trigeminal neuralgia, but the role of GKS in glossopharyngeal neuralgia (GPN) remains unclear. This study involved 2 patients with medically intractable GPN who were treated using GKS. One patient required 2 treatments because of a recurrence of symptoms (at maximum doses of 60 and 70 Gy), and the other patient had a single intervention (at a maximum dose of 75 Gy). The GKS target was the distal part of the glossopharyngeal nerve. Patients were investigated prospectively, treated, and then assessed periodically with respect to pain relief and neurological function. Complete pain relief was achieved initially after all 3 interventions. The first patient was pain free without medication for 2 months after the first treatment (60 Gy) and for 4 months after the second treatment (70 Gy). The second patient (treated with 75 Gy) was still pain free without medication at the last follow-up (12 months). Neither patient had any neurological complications. The initial response of GPN to low-dose GKS was favorable, but symptoms may recur. No adverse neurological effects were observed in any of the lower cranial nerves. It will be necessary to investigate the optimal radiation dose and target of GKS for achieving long-term pain relief in GPN.

Gamma Knife surgery for invasive pituitary macroadenoma

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 26-30 ◽  
Author(s):  
Mooseong Kim ◽  
Sunghwa Paeng ◽  
Seyoung Pyo ◽  
Yeonggyun Jeong ◽  
Sunil Lee ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Pituitary Macroadenoma ◽  
Female Ratio ◽  
Fractionated Radiotherapy ◽  
The Mean

ObjectPituitary adenomas have been treated using a variety of modalities including resection, medication, fractionated radiotherapy, and stereotactic radiosurgery. The policy has been that all adenomas should first be treated with resection to reduce the volume of the tumor. The authors' study was conducted to determine the efficacy of using Gamma Knife surgery (GKS) for pituitary adenomas invading the cavernous sinus.MethodsOf 397 patients with pituitary tumors who underwent GKS between October 1994 and October 2005, 68 patients had pituitary macroadenomas invading the cavernous sinus. Sixty-seven cases were available for follow up. The mean age of the patients in these cases was 42.8 years (range 14–73 years). The male/female ratio was 0.8:1. The mean adenoma volume was 9.3 cm3. A total of 24 patients had undergone craniotomies and resection, and 11 patients had undergone transsphenoidal surgery prior to GKS. The mean follow-up period was 32.8 months. Tumor control was defined as a decrease or no change in tumor volume after GKS. Endocrinological improvement was defined as a decline in hormone levels to below 50% of the pre-GKS level.Tumor control was achieved in 95.5% of the cases. Endocrinological improvement was achieved in 68% of 25 patients. One patient suffered hypopituitarism after GKS.Conclusions Gamma Knife surgery is a safe and effective treatment for invasive pituitary macroadenoma with few complications.

Gamma knife surgery for hypothalamic hamartomas accompanied by medically intractable epilepsy and precocious puberty: experience in Mexico

2005 ◽  
Vol 102 ◽  
pp. 53-55 ◽  
Author(s):  
Marco A. Barajas ◽  
Maria G. Ramírez-Guzmán ◽  
Carlos Rodríguez-Vázquez ◽  
Vinicio Toledo-Buenrostro ◽  
Abel Cuevas-Solórzano ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Precocious Puberty ◽  
Intractable Epilepsy ◽  
Gamma Knife Surgery ◽  
Sleep Cycle ◽  
Hypothalamic Hamartoma ◽  
High Morbidity ◽  
Content Type ◽  
Hypothalamic Hamartomas ◽  
Fine Print

Object.Hypothalamic hamartoma is a nonneoplastic malformative mass of neurons and glia in the region of the hypothalamus. Because of its location, open surgery is associated with high morbidity and mortality rates. Gamma knife surgery (GKS) may be an efficient and safe treatment approach, which produces little morbidity. The authors describe the results of GKS in three patients with hypothalamic hamartomas.Methods.All patients were male, aged 3, 12, and 15 years. The lesions were classified according to the Valdueza scale: one was Type IIb and two were Type IIa. The patients presented with gelastic seizures (15–20 per day), generalized epilepsy, behavioral abnormalities, and alterations of the sleep cycle. Precocious puberty was present in one patient. The Type IIb tumor had a volume of 1.8 cm3, and the Type IIa tumors were 597 mm3and 530.1 mm3. The lesions received 12.5 Gy, 14 Gy, and 15 Gy, respectively, to the 50% isodose line. The patients were followed for 30 to 50 months. After 3 months, all patients showed improvement of their sleep, behavior, and epilepsy. At the present time, these patients are receiving low-dose antiepileptic agents and have achieved adequate social development and school integration.Conclusions.Gamma knife surgery appears to be a good, safe, and effective option for the treatment of selected hypothalamic hamartomas. No morbidity or mortality was associated with these three cases.

scholarly journals Gamma Knife stereotactic radiosurgery for intraocular retinoblastoma: a 5-year experience

2021 ◽  
pp. 46-56
Author(s):  
A.A. Yarovoy ◽  
◽  
A.V. Golanov ◽  
T.L. Ushakova ◽  
V.V. Kostyuchenko ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Malignant Tumors ◽  
External Beam Radiotherapy ◽  
Local Treatment ◽  
Vitreous Hemorrhage ◽  
Treatment Modalities ◽  
Complete Regression ◽  
Group B ◽  
Gamma Knife Stereotactic Radiosurgery

External beam radiotherapy (EBR) remained for a long time the only method of treatment in children with recurrent and resistant retinoblastoma (RB). This method often leads to serious complications, including the occurrence of secondary malignant tumors. Currently, EBR is used as second-line (salvage) therapy. There is no data in the literature of using Gamma Knife stereotactic radiosurgery (GKRS) in RB treatment. Purpose. To present 5-year experience of using GKRS in patients with RB. Material and methods. 16 children (17 eyes) were treated using GKRS in the period from 2015 to 2019. Mean patient age was 34.7 months (range, 12–114 months). The eyes were classified as group B (n=4), C (n=1), D (n=12). 3 children had the last eye. All patients received systemic and local chemotherapy, all types of local treatment modalities before using GKRS. Recurrent and resistant RB was the indication for GKRS. Marginal 50% mean dose was 22 Gу (range, 20–24 Gу), depending on tumour type and location. Radiation doses were evaluated accounting critical eye structures and the orbit bones. Results. Complete regression was achieved in 11 patients, partial in 2. Four patients underwent enucleation after GKRS. Indications for enucleation were retinoblastoma recurrence (n=2) and vitreous hemorrhage with total retinal detachment (n=2). 13 eyes were salvaged with no signs of keratopathy, uveitis or damage of orbital and surrounding tissues during mean follow-up 30.6 months (range, 7–60 months). Сomplications of different severity occurred in 13 patients, including vitreous hemorrhage in 6 patients, which was successfully treated both conservative (n=3) and using pars plana vitrectomy with simultaneous melphalan irrigation (n=3). Conclusion. The first experience of GKRS as an alternative to enucleation in patients with RB was proved to be reasonable and successful. Key words: retinoblastoma, gamma-knife, stereotactic radiosurgery.

scholarly journals Gamma Knife Stereotactic Radiosurgery (GKS) for the treatment of Vestibular Schwannomas (VS)

2015 ◽  
Vol 10 (2) ◽  
pp. 143-147
Author(s):  
R. PERIN ◽  
◽  
A. MOHAN ◽  
H. MOISA ◽  
A.V. CIUREA ◽  
...  
Keyword(s):  
Nervous System ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
University Hospital ◽  
Vestibular Schwannomas ◽  
Response To Treatment ◽  
Benign Tumors ◽  
Acoustic Neuromas ◽  
The Impact

Introduction. Vestibular schwannomas (VS) or acoustic neuromas (AN) (as they are known to neurosurgeons) are benign tumors which originate at the junction between central nervous system myelin and peripheral nervous system myelin – an area known as the Obersteiner-Redlich area. Acoustic neuromas represent a special pathologic entity for neurosurgeons due to their important symptoms which need to be adressed as soon as possible and due to the secondary disfunctions which may appear if the tumors are not treated appropriately. Materials and methods. The study below presents the experience of the authors regarding the use of stereotactic radiosurgery for the treatment of acoustic neuromas. The authors focus on a population of 231 patients diagnosed and treated for VS over a period of 10 years at the „Bagdasar-Arseni“ University Hospital in Bucharest. This study compares the impact of Gamma Knife Surgery when performed alone or in association with open microneurosurgery. The authors assessed patients with tumors ranging between 0.25 and 14 cm3 in volume. Gamma Knife Surgery is used successfully to treat VS, both independantly or in association with open microsurgery. Results. The major complications of the treatment are represented by lack of response to treatment (less than 1% of patients) and cerebral edema (16.4% of patients). Conclusions. Given its multiple advantages, stereotactic radiosurgery is right now the tip of the spear regarding the therapeutical means available for VS. When the tumors met in daily practice are larger than the therapeutical resources of the devices used for Gamma Knife Surgery an open microsurgical approach may be attempted followed by stereotactic iradiation of the remnant tumor. Given the large number of successes reported in the literature and the small number of complications but also the ever progressing technology used to improve Gamma Knife devices, the authors consider stereotactic radiosurgery to be a very good solution for the treatment of VS. Furthermore, the improvement potential this technique has grants it the potential to improve standard of treatment for acoustic neuromas and the quality of life in patients with this disease.

scholarly journals Results of Treatment with Modern Fractionated Radiotherapy, Contemporary Stereotactic Radiosurgery, and Transsphenoidal Surgery in Nonfunctioning Pituitary Macroadenoma

2019 ◽  
Vol 8 (4) ◽  
pp. 518 ◽  
Author(s):  
Ping-Kun Hsiao ◽  
Chia-Lun Chang ◽  
Kevin Sheng-Po Yuan ◽  
Alexander T.H. Wu ◽  
Szu-Yuan Wu
Keyword(s):  
Regression Analysis ◽  
Local Recurrence ◽  
Stereotactic Radiosurgery ◽  
Transsphenoidal Surgery ◽  
Statistical Significance ◽  
Treatment Modalities ◽  
Pituitary Macroadenoma ◽  
Cox Regression Analysis ◽  
Fractionated Radiotherapy ◽  
All Cause Mortality

Background: To compare the effects of contemporary stereotactic radiosurgery (SRS), modern fractionated radiotherapy (FRT), and transsphenoidal surgery on nonfunctioning pituitary macroadenoma. Methods: We enrolled patients with nonfunctioning pituitary macroadenoma. To compare treatment outcomes, the patients were categorized into three groups according to the treatment modality: group 1, patients receiving modern FRT; group 2, patients receiving contemporary SRS; and group 3, patients receiving transsphenoidal surgery. Results: In total, 548 patients with nonfunctioning pituitary macroadenoma were selected for our study. Univariate and multivariate Cox regression analysis results indicated that the treatment modalities were significant independent prognostic factors. In multivariable Cox proportional hazard regression analysis, the adjusted hazard ratios (aHR; 95% confidence interval (CI)) of local recurrence were 0.27 (0.10–0.91) and 1.95 (1.25–2.37) for the SRS and transsphenoidal surgery cohorts, respectively, in comparison with the FRT cohort. The aHR (95% CI) of all-cause mortality was 1.03 (0.68–1.56) for the transsphenoidal surgery cohort in comparison with the FRT cohort, without statistical significance. However, the aHR (95% CI) of all-cause mortality was 0.36 (0.15–0.85) for the SRS cohort in comparison with the FRT cohort. Conclusion: Contemporary SRS has optimal effects on local recurrence and survival compared with modern FRT and transsphenoidal surgery. Modern FRT is associated with more favorable local control and equal survival compared with transsphenoidal surgery.

In vitro biological dosimeter modeling of the glioblastoma response to radiation delivered by the Gamma Knife

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 222-227
Author(s):  
Ryan Smith ◽  
Kris A. Smith ◽  
Christopher A. Biggs ◽  
Adrienne C. Scheck
Keyword(s):  
Cell Line ◽  
Gamma Knife ◽  
Radiation Treatment ◽  
High Dose ◽  
Single Fraction ◽  
Fractionated Radiotherapy ◽  
Tissue Equivalent ◽  
Cell Subpopulations ◽  
Gamma Knife Perfexion

Object The goal of this study was to develop an assay that makes possible the assessment of the glioma cell response to single-fraction high-dose Gamma Knife surgery. In this assay, the isolation of radioresistant cell subpopulations facilitates mechanistic studies of radioresistance. Methods A tissue-equivalent paraffin phantom with an aperture capable of holding an Opticell cell culture cassette was developed for treatment with the Leksell Gamma Knife model C. A second apparatus, which the authors also created, uses the manufacturer-supplied polystyrene phantom, thereby allowing this assay to be performed in the Leksell Gamma Knife Perfexion. After treatment, the cells were morphologically assessed to determine their response to radiation treatment. Two specific parameters were used to determine radiosensitivity: 1) the diameter of the clearing zone, defined as the central region of cell death; and 2) the number of surviving colonies within this central high-dose clearing zone. Results Radioresistance was compared in 2 different cell lines from glioblastomas. The first cell line, ME, was established from a primary tumor before its treatment, and the second cell line, DIV, was established from a tumor that recurred after treatment with chemotherapy and fractionated radiotherapy. The ME cell line had the most robust response to radiosurgery, as characterized by a consistently larger clearing zone (28.33 ± 1.1 mm). In contrast, the clearing zone produced when the DIV cell line was used was 24.0 ± 1 mm, indicating an approximate response difference of 5 Gy. The mean number of surviving colonies within the clearing zone for the ME cell line was 1.33 ± 1 compared with that for the DIV cell line, which was 66.67 ± 2. Conclusions The authors developed a biological dosimeter to model the response of cells from glioblastomas to single-fraction high-dose radiation. This system also allows the identification and isolation of radioresistant cells.

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