scholarly journals Proceedings of the 2018 next-generation Gamma Knife research meeting

2018 ◽  
Vol 129 (Suppl1) ◽  
pp. 5-9 ◽  
Author(s):  
Veronica L. Chiang ◽  
Samuel T. Chao ◽  
Constantin Tuleasca ◽  
Matthew C. Foote ◽  
Cheng-chia Lee ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Radiation Necrosis ◽  
Society Meeting ◽  
Additional Imaging ◽  
Research Meeting ◽  
Areas Of Interest ◽  
Workshop Discussion ◽  
Group 1

In order to determine what areas of research are a clinical priority, a small group of young Gamma Knife investigators was invited to attend a workshop discussion at the 19th International Leksell Gamma Knife Society Meeting. Two areas of interest and the need for future radiosurgical research involving multiple institutions were identified by the young investigators working group: 1) the development of additional imaging sequences to guide the understanding, treatment, and outcome tracking of diseases such as tremor, radiation necrosis, and AVM; and 2) trials to clarify the role of hypofractionation versus single-fraction radiosurgery in the treatment of large lesions such as brain metastases, postoperative cavities, and meningiomas.

scholarly journals MLTI-15. A CASE SERIES OF PRE-OPERATIVE GAMMA-KNIFE RADIOSURGERY FOR RESECTABLE BRAIN METASTASES

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i17-i17
Author(s):  
Tatsuya Takezaki ◽  
Haruaki Yamamoto ◽  
Naoki Shinojima ◽  
Jun-ichiro Kuroda ◽  
Shigeo Yamashiro ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Systemic Treatment ◽  
Radiation Necrosis ◽  
Gamma Knife Radiosurgery ◽  
Case Series ◽  
Phase 3 ◽  
Optimal Sequence ◽  
Median Margin

Abstract Recent advances in the systemic treatment of various cancers have resulted in longer survival and higher incidence of brain metastases. Phase 3 trials in north America and in Japan have demonstrated that stereotactic radiosurgery will be a standard adjuvant modality following surgery for resectable brain metastases. However, we don’t know the optimal sequence of this combination therapy. We hypothesized that pre-operative stereotactic radiosurgery for resectable brain metastases provides favorable rates of local control, overall survival, leptomeningeal dissemination and symptomatic radiation necrosis. We have experienced 4 cases of resected brain metastases within 1–7 days after Gamma-knife surgery (median margin dose:22Gy) and have been following their clinical course. We will show the repressive cases.

scholarly journals Novel biomarker identification using metabolomic profiling to differentiate radiation necrosis and recurrent tumor following Gamma Knife radiosurgery

2017 ◽  
Vol 127 (2) ◽  
pp. 388-396 ◽  
Author(s):  
Alex Y. Lu ◽  
Jack L. Turban ◽  
Eyiyemisi C. Damisah ◽  
Jie Li ◽  
Ahmed K. Alomari ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Radiation Necrosis ◽  
Imaging Techniques ◽  
Statistical Significance ◽  
Gamma Knife Radiosurgery ◽  
Metabolic Imaging ◽  
Management Decision ◽  
Recurrent Tumor ◽  
Metabolite Profiles

OBJECTIVEFollowing an initial response of brain metastases to Gamma Knife radiosurgery, regrowth of the enhancing lesion as detected on MRI may represent either radiation necrosis (a treatment-related inflammatory change) or recurrent tumor. Differentiation of radiation necrosis from tumor is vital for management decision making but remains difficult by imaging alone. In this study, gas chromatography with time-of-flight mass spectrometry (GC-TOF) was used to identify differential metabolite profiles of the 2 tissue types obtained by surgical biopsy to find potential targets for noninvasive imaging.METHODSSpecimens of pure radiation necrosis and pure tumor obtained from patient brain biopsies were flash-frozen and validated histologically. These formalin-free tissue samples were then analyzed using GC-TOF. The metabolite profiles of radiation necrosis and tumor samples were compared using multivariate and univariate statistical analysis. Statistical significance was defined as p ≤ 0.05.RESULTSFor the metabolic profiling, GC-TOF was performed on 7 samples of radiation necrosis and 7 samples of tumor. Of the 141 metabolites identified, 17 (12.1%) were found to be statistically significantly different between comparison groups. Of these metabolites, 6 were increased in tumor, and 11 were increased in radiation necrosis. An unsupervised hierarchical clustering analysis found that tumor had elevated levels of metabolites associated with energy metabolism, whereas radiation necrosis had elevated levels of metabolites that were fatty acids and antioxidants/cofactors.CONCLUSIONSTo the authors' knowledge, this is the first tissue-based metabolomics study of radiation necrosis and tumor. Radiation necrosis and recurrent tumor following Gamma Knife radiosurgery for brain metastases have unique metabolite profiles that may be targeted in the future to develop noninvasive metabolic imaging techniques.

scholarly journals Regional treatment of metastasis: role of radiosurgery in brain metastases—gamma knife radiosurgery

2004 ◽  
Vol 15 ◽  
pp. iv113-iv117 ◽  
Author(s):  
M. Gerosa ◽  
A. Nicolato ◽  
R. Foroni ◽  
L. Tomazzoli ◽  
A. Bricolo
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Regional Treatment

scholarly journals Gamma Knife versus Frameless Linear Accelerator Based Stereotactic Radiosurgery for Brain Metastases: Clinical Outcomes and Factors Associated with Local Failure and Radiation Necrosis

2021 ◽  
Author(s):  
Gregory S. Alexander ◽  
Jill S. Remick ◽  
Emily S. Kowalski ◽  
Kai Sun ◽  
Yannick Poirer ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Clinical Outcomes ◽  
Gamma Knife ◽  
Linear Accelerator ◽  
Radiation Necrosis ◽  
Univariate Analysis ◽  
Local Failure ◽  
Rank Test ◽  
Chi Square Analysis

Abstract BackgroundSingle-fraction stereotactic radiosurgery (SF-SRS) for the treatment of brain metastases can be delivered with either a Gamma-Knife platform (GK-SRS) or with a frameless linear accelerator (LA-SRS) which vary based on patterns of prescribing, patient setup and radiation delivery. Whether these differences affect clinical outcomes is unknown. MethodsPatients treated for metastatic brain cancer treated with SF-SRS from 2014-2020 were retrospectively reviewed and clinical outcomes were recorded on a per lesion basis. Covariates between groups were compared using a Chi-square analysis for dichotomous variables and t-test for continuous variables. Median follow up was calculated using the reverse Kaplan Meier (KM) method. Primary endpoints of local failure (LF) and symptomatic radiation necrosis (RN) were estimated using the KM method with salvage WBRT used as a censoring event. Outcome estimates were compared using the log-rank test. Multivariate analysis (MVA) and Cox proportional hazards modeling were used for statistical analyses. Propensity score (PS) adjustments were used to reduce the effects confounding variables.ResultsOverall, 119 patients with 287 lesions were included for analysis which included 57 patients (127 lesions) treated with LA-SRS compared to 62 patients (160 lesions) treated with GK-SRS. On both multivariate and univariate analysis, there was no statistically significant differences between GK-SRS and LA-SRS for LF, RN, or the combined endpoint of either LF or RN (multivariate p-value=0.17).ConclusionsIn our retrospective cohort, we found no statistically significant differences in the incidence of RN or LF in patients treated with GK-SRS when compared to LA-SRS.Trial Registration: Retrospectively registered

scholarly journals Low-Dosage Bevacizumab Treatment: Effect on Radiation Necrosis After Gamma Knife Radiosurgery for Brain Metastases

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuxiang Weng ◽  
Jie Shen ◽  
Luyuan Zhang ◽  
Zebin Fang ◽  
Feng Xiao ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Low Dose ◽  
Radiation Necrosis ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Gamma Knife Radiosurgery ◽  
High Price ◽  
Bevacizumab Treatment ◽  
Low Dosage

Cerebral radiation necrosis (RN), a complication of Gamma Knife radiosurgery, is difficult to treat, although bevacizumab seems to be effective. However, clinical data pertaining to bevacizumab treatment for RN are scarce, and its high price is problematic. This study explored the effectiveness of low-dose bevacizumab for RN caused by Gamma Knife. We retrospectively analyzed 22 patients who suffered cerebral RN post-Gamma Knife, and received bevacizumab treatment because of the poor efficacy of glucocorticoids. Low-dose bevacizumab (3 mg/kg) was administered for two cycles at 2-week intervals. T1- and T2-enhanced magnetic resonance imaging (MRI) images were examined for changes in RN status. We also monitored the dose of glucocorticoid, Karnofsky Performance Status (KPS) score, and adverse drug reactions. The mean volume of RN lesions decreased by 45% on T1-weighted images with contrast enhancement, and by 74% on T2-weighted images. All patients discontinued the use of glucocorticoids. According to the KPS scores, all patients showed an improvement in their symptoms and neurological function. No side effects were observed. Low-dosage bevacizumab at a dose of 3 mg/kg every 2 weeks is effective for treating cerebral RN after Gamma knife for brain metastases.

Outcome evaluation of patients treated with fractionated Gamma Knife radiosurgery for large (> 3 cm) brain metastases: a dose-escalation study

2020 ◽  
Vol 133 (3) ◽  
pp. 675-684 ◽  
Author(s):  
Kyung Hwan Kim ◽  
Doo-Sik Kong ◽  
Kyung Rae Cho ◽  
Min Ho Lee ◽  
Jung-Won Choi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Risk Factor ◽  
Brain Metastases ◽  
Treatment Failure ◽  
Gamma Knife ◽  
Dose Escalation ◽  
Radiation Necrosis ◽  
Local Treatment ◽  
Gamma Knife Radiosurgery ◽  
Dose Escalation Study

OBJECTIVEFractionated Gamma Knife radiosurgery (GKS) represents a feasible option for patients with large brain metastases (BM). However, the dose-fractionation scheme balanced between local control and radiation-induced toxicity remains unclear. Therefore, the authors conducted a dose-escalation study using fractionated GKS as the primary treatment for large (> 3 cm) BM.METHODSThe exclusion criteria were more than 3 lesions, evidence of leptomeningeal disease, metastatic melanoma, poor general condition, and previously treated lesions. Patients were randomized to receive 24, 27, or 30 Gy in 3 fractions (8, 9, or 10 Gy per fraction, respectively). The primary endpoint was the development of radiation necrosis assessed by a neuroradiologist blinded to the study. The secondary endpoints included the local progression-free survival (PFS) rate, change in tumor volume, development of distant intracranial progression, and overall survival.RESULTSBetween September 2016 and April 2018, 60 patients were eligible for the study, with 46 patients (15, 17, and 14 patients in the 8-, 9-, and 10-Gy groups, respectively) available for analysis. The median follow-up duration was 9.6 months (range 2.5–25.1 months). The 6-month estimated cumulative incidence of radiation necrosis was 0% in the 8-Gy group, 13% (95% confidence interval [CI] 0%–29%) in the 9-Gy group, and 37% (95% CI 1%–58%) in the 10-Gy group. Being in the 10-Gy group was a significant risk factor for the development of radiation necrosis (p = 0.047; hazard ratio [HR] 7.2, 95% CI 1.1–51.4). The 12-month local PFS rates were 65%, 80%, and 75% in the 8-, 9-, and 10-Gy groups, respectively. Being in the 8-Gy group was a risk factor for local treatment failure (p = 0.037; HR 2.5, 95% CI 1.1–29.6). The mean volume change from baseline was a 47.5% decrease in this cohort. Distant intracranial progression and overall survival did not differ among the 3 groups.CONCLUSIONSIn this dose-escalation study, 27 Gy in 3 fractions appeared to be a relevant regimen of fractionated GKS for large BM because 30 Gy in 3 fractions resulted in unacceptable toxicities and 24 Gy in 3 fractions was associated with local treatment failure.

scholarly journals Role of Gamma Knife® Radiosurgery for the Treatment of Brain Metastases from Gynecological Cancers

Cureus ◽  
2016 ◽  
Author(s):  
Andrew Keller ◽  
Rahim Ismail ◽  
Peter S Potrebko ◽  
Julie Pepe ◽  
Meiling Wu ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Gynecological Cancers

Palliative treatment of brain metastases with gamma knife

2001 ◽  
Vol 58 (7) ◽  
pp. 413-418 ◽  
Author(s):  
Jean Siegfried ◽  
G. Wellis ◽  
S. Scheib ◽  
D. Haller ◽  
A. M. Landolt ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Scale Score ◽  
Gamma Knife ◽  
Palliative Treatment ◽  
Rating Scale ◽  
Psychische Belastung ◽  
Performance Rating ◽  
Wird Eine

Das Gamma Knife ist ein stereotaktisch-radiochirurgisches Gerät, das erlaubt, radiologisch scharf begrenzte Hirntumore (oder arteriovenöse Missbildungen) mit einem Durchmesser von maximal 3,5 cm und einem Volumen von höchstens 25 cm3 zu behandeln. Diese Methode ist eine echte Alternative zur klassischen Behandlung von Hirnmetastasen mit operativer Entfernung und/oder Ganzhirnbestrahlung. Die Vorteile dieser Technik sind klar: die Methode ist nicht invasiv, die Behandlung benötigt nur eine Sitzung mit einer kurzen Hospitalisation von höchstens zwei bis drei Tagen, die physische und psychische Belastung ist gering, der Kopf wird weder rasiert noch verliert der Patient durch die Behandlung seine Haare; für eine befriedigende Überlebenszeit wird eine gute Lebensqualität erreicht und im Kostenvergleich mit alternativen Methoden (Operation und/oder anschließender Ganzhirnbestrahlung) wirtschaftlich günstiger. Von September 1994 bis Dezember 2000 wurden am Gamma Knife Zentrum in Zürich 140 an Hirnmetastasen leidende Patienten mit dieser Methode behandelt. Mit einer Überlebenszeit von durchschnittlich 263 Tagen und einem Maximum von drei Jahren entsprechen unsere Resultate denjenigen der Literatur mit weltweit über 30000 behandelten Patienten. Günstige Prognosen sind ein Karnofsky Performance Rating Scale Score zwischen 70 und 100, kleine Volumina der Metastasen, kontrollierter Primärtumor und fehlende oder stabile extrakranielle Metastasen.

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