Hypothalamic dysfunction following whole-brain irradiation

✓ The authors describe 15 cases with evidence of hypothalamic dysfunction 2 to 9 years following megavoltage whole-brain x-irradiation for primary glial neoplasm. The patients received 4000 to 5000 rads in 180- to 200-rad fractions. Dysfunction occurred in the absence of computerized tomography-delineated radiation necrosis or hypothalamic invasion by tumor, and antedated the onset of dementia. Fourteen patients displayed symptoms reflecting disturbances of personality, libido, thirst, appetite, or sleep. Hyperprolactinemia (with prolactin levels up to 70 ng/ml) was present in all of the nine patients so tested. Of seven patients tested with thyrotropin-releasing hormone, one demonstrated an abnormal pituitary gland response consistent with a hypothalamic disorder. Seven patients developed cognitive abnormalities. Computerized tomography scans performed a median of 4 years after tumor diagnosis revealed no hypothalamic tumor or diminished density of the hypothalamus. Cortical atrophy was present in 50% of cases and third ventricular dilatation in 58%. Hypothalamic dysfunction, heralded by endocrine, behavioral, and cognitive impairment, represents a common, subtle form of radiation damage.

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Reduction in radiation-induced brain injury by use of pentobarbital or lidocaine protection

Journal of Neurosurgery ◽

10.3171/jns.1990.72.5.0737 ◽

1990 ◽

Vol 72 (5) ◽

pp. 737-744 ◽

Cited By ~ 36

Author(s):

Edward H. Oldfield ◽

Robert Friedman ◽

Timothy Kinsella ◽

Ross Moquin ◽

Jeffrey J. Olson ◽

...

Keyword(s):

Survival Rates ◽

Cranial Irradiation ◽

High Dose ◽

Radiation Toxicity ◽

Whole Brain Irradiation ◽

Whole Brain ◽

Content Type ◽

Brain Irradiation ◽

Cns Neoplasms ◽

Fine Print

✓ To determine if barbiturates would protect brain at high doses of radiation, survival rates in rats that received whole-brain x-irradiation during pentobarbital- or lidocaine-induced anesthesia were compared with those of control animals that received no medication and of animals anesthetized with ketamine. The animals were shielded so that respiratory and digestive tissues would not be damaged by the radiation. Survival rates in rats that received whole-brain irradiation as a single 7500-rad dose under pentobarbital- or lidocaine-induced anesthesia was increased from between from 0% and 20% to between 45% and 69% over the 40 days of observation compared with the other two groups (p < 0.007). Ketamine anesthesia provided no protection. There were no notable differential effects upon non-neural tissues, suggesting that pentobarbital afforded protection through modulation of ambient neural activity during radiation exposure. Neural suppression during high-dose cranial irradiation protects brain from acute and early delayed radiation injury. Further development and application of this knowledge may reduce the incidence of radiation toxicity of the central nervous system (CNS) and may permit the safe use of otherwise “unsafe” doses of radiation in patients with CNS neoplasms.

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Stereotactic radiosurgery for cerebral metastatic melanoma

Journal of Neurosurgery ◽

10.3171/jns.1993.79.5.0661 ◽

1993 ◽

Vol 79 (5) ◽

pp. 661-666 ◽

Cited By ~ 118

Author(s):

Salvador Somaza ◽

Douglas Kondziolka ◽

L. Dade Lunsford ◽

John M. Kirkwood ◽

John C. Flickinger

Keyword(s):

Stereotactic Radiosurgery ◽

Systemic Disease ◽

Tumor Resection ◽

Local Tumor Control ◽

Tumor Control ◽

Local Tumor ◽

Whole Brain Irradiation ◽

Whole Brain ◽

Content Type ◽

Fine Print

✓ To determine local tumor control rates and survival of patients with melanoma metastases to the brain, the authors reviewed the results of 23 consecutive patients with a total of 32 tumors (19 patients had a solitary tumor and four had multiple tumors) who underwent adjuvant stereotactic radiosurgery. Tumor locations included the cerebral hemisphere (24 cases), brain stem (four cases), basal ganglia (two cases), and cerebellum (two cases). Fifteen patients had associated cranial symptomatology and eight had incidental metastases. All patients had tumors of 3 cm or less in diameter (mean tumor volume 2.5 cu cm), and all received fractionated whole-brain radiation therapy (30 Gy) in addition to radiosurgery (mean tumor margin dose 16 Gy). Nineteen patients were managed with both modalities at the time of diagnosis; four underwent radiosurgery 3 to 12 months after fractionated whole-brain radiotherapy. The mean patient follow-up period was 12 months (range 3 to 38 months). After radiosurgery, eight patients improved, 13 remained stable, and two deteriorated. One patient subsequently required craniotomy because of intratumoral hemorrhage; this patient and three others are living 13 to 38 months after radiosurgery. Nineteen patients died, 18 from progression of their systemic disease and one from another hemorrhage into a new brain metastasis. The local tumor control rate was 97%. Only two patients subsequently developed new intracranial metastases. The median survival period after diagnosis was 9 months (range 3 to 38 months). The authors believe that stereotactic radiosurgery coupled with fractionated whole-brain irradiation is an effective management strategy for cerebral metastases from a melanoma. Multi-institutional trials are warranted to confirm that stereotactic radiosurgery results equal or surpass the outcome achieved with craniotomy and tumor resection.

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Linear accelerator-based stereotaxic radiosurgery for brain metastases:the influence of number of lesions on survival.

Journal of Clinical Oncology ◽

10.1200/jco.1996.14.4.1085 ◽

1996 ◽

Vol 14 (4) ◽

pp. 1085-1092 ◽

Cited By ~ 128

Author(s):

J Joseph ◽

J R Adler ◽

R S Cox ◽

S L Hancock

Keyword(s):

Brain Metastases ◽

Linear Accelerator ◽

Radiation Necrosis ◽

Karnofsky Performance Status ◽

Survival Duration ◽

Survival Times ◽

Whole Brain Irradiation ◽

Whole Brain ◽

Solitary Metastasis ◽

Brain Irradiation

PURPOSE To evaluate the influence of the number of brain metastases on survival after stereotaxic radiosurgery and factors that affect the risk of delayed radiation necrosis after treatment. MATERIALS AND METHODS Between March 1989 and December 1993, 120 consecutive patients underwent linear accelerator-based stereotaxic radiosurgery for brain metastases identified by computed tomography (CT) or magnetic resonance imaging (MRI) scans. The influence of various clinical factors on outcome was assessed using Kaplan-Meier plots of survival from the date of radiosurgery, and univariate and multivariate analyses. RESULTS The median survival time was 32 weeks. Progressive brain metastases, both local and regional, caused 25 of 104 deaths. Patients with two metastases (n = 30) or a solitary metastasis (n = 70) had equivalent actuarial survival times (P = .07; median, 37 weeks; maximum, 211+ weeks). Patients treated to three or more metastases (n = 20) had significantly shorter survival times (P < .002; median, 14 weeks; maximum, 63 weeks). Prognostic factors associated with prolonged survival included a pretreatment Karnofsky performance status > or = 70% and fewer than three metastases. Delayed radiation necrosis at the treated site developed in 20 patients and correlated with prior or concurrent delivery of whole-brain irradiation and the logarithm of the tumor volume. CONCLUSION Survival duration is equivalent for patients with one or two brain metastases and is similar to that reported for patients with a solitary metastasis managed by surgical resection and whole-brain irradiation. Survival after radiosurgery for three or more metastases was similar to that reported for whole-brain irradiation.

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Radiotherapy of glioblastoma multiforme

Journal of Neurosurgery ◽

10.3171/jns.1973.39.2.0197 ◽

1973 ◽

Vol 39 (2) ◽

pp. 197-202 ◽

Cited By ~ 44

Author(s):

Ruth G. Ramsey ◽

William N. Brand

Keyword(s):

Overall Survival ◽

Specific Treatment ◽

Tumor Location ◽

Whole Brain Irradiation ◽

Efficient Treatment ◽

Content Type ◽

Treatment Groups ◽

Brain Irradiation ◽

Brain Scan ◽

Fine Print

✓ A comparison is made between limited field and whole brain irradiation in the treatment of 60 patients with intracranial glioblastomas, 34 of whom were picked at random for either treatment and 26 who were selected for specific treatment. A significant increase in overall survival time and tumor-free period was found in the limited field treatment groups and this was especially significant in those patients selected for limited field treatment. The improved results are felt to be due to the higher dose permissible because of avoidance of more sensitive brain-stem structures. Tumor location in the frontal lobe also appears significant in the longer survival of those patients selected for limited field treatment. More exact localization of the lesion by brain scan, surgery, and angiography also contribute to more efficient treatment and consequently better survival.

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A variant of normal-pressure hydrocephalus simulating Pick's disease on computerized tomography

Journal of Neurosurgery ◽

10.3171/jns.1983.59.5.0902 ◽

1983 ◽

Vol 59 (5) ◽

pp. 902-904 ◽

Cited By ~ 8

Author(s):

Naman A. Salibi ◽

Gerald L. Lourie ◽

Herbert Lourie

Keyword(s):

Computerized Tomography ◽

Normal Pressure Hydrocephalus ◽

Clinical Picture ◽

Normal Pressure ◽

Cortical Atrophy ◽

Pick's Disease ◽

Pick’S Disease ◽

Content Type ◽

Ventriculoperitoneal Shunting ◽

Fine Print

✓ The authors present two cases of normal-pressure hydrocephalus that simulated Pick's disease radiographically and that were initially diagnosed as cortical atrophy. In both cases, Sylvian cisternoperitoneal shunts improved the clinical picture only temporarily, but ventriculoperitoneal shunting produced dramatic relief of all symptoms.

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Progressive perturbations in cerebral energy metabolism after experimental whole-brain radiation in the therapeutic range

Journal of Neurosurgery ◽

10.3171/jns.1994.81.5.0774 ◽

1994 ◽

Vol 81 (5) ◽

pp. 774-779 ◽

Cited By ~ 18

Author(s):

Domenico D'Avella ◽

Rocco Cicciarello ◽

Maria E. Gagliardi ◽

Francesca Albiero ◽

Mario Mesiti ◽

...

Keyword(s):

Metabolic Activity ◽

Average Rate ◽

Weighted Average ◽

Whole Brain ◽

Content Type ◽

Conventional Fractionation ◽

Whole Brain Radiation ◽

X Irradiation ◽

The Difference ◽

Fine Print

✓ Basic mechanisms underlying the tolerance and reaction of the central nervous system to ionizing radiation have not been fully elucidated in the literature. The authors employed the [14C]-2-deoxy-D-glucose autoradiography method to investigate the effect of whole-brain x-irradiation on local cerebral glucose utilization in the rat brain. The animals were exposed to conventional fractionation (200 ± 4 cGy/day, 5 days/week for a total dose of 4000 cGy), and the effects of this regimen were assessed at 2 weeks and 3 months postirradiation. In rats evaluated 2 weeks after treatment, statistically significant decreases in cerebral metabolic activity were found in 13 of the 27 regions studied, compared to control animals. In rats studied 3 months after treatment, additional metabolic suppression and statistically significant decreases in cerebral metabolic activity were found in 11 of the 27 regions, compared to rats studied 2 weeks after treatment. A weighted-average rate for the brain as a whole was approximately 15% and approximately 25% below that of control animals 2 weeks and 3 months after exposure, respectively. Although the difference in species is significant enough so that direct extrapolation to humans may not be appropriate, the data reported here may have potential clinical implications for the evaluation of the risk-benefit ratio for radiotherapy. This model can be used reproducibly for further investigations, including evaluation of therapies that may reduce irradiation-induced brain injury.

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Primary central nervous system lymphoma

Journal of Neurosurgery ◽

10.3171/jns.1985.62.4.0522 ◽

1985 ◽

Vol 62 (4) ◽

pp. 522-527 ◽

Cited By ~ 82

Author(s):

Yasuto Kawakami ◽

Kazuo Tabuchi ◽

Rinkichi Ohnishi ◽

Shoji Asari ◽

Akira Nishimoto

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Primary Cns Lymphoma ◽

Central Nervous System Lymphoma ◽

Subtotal Resection ◽

Cns Lymphoma ◽

Whole Brain Irradiation ◽

Whole Brain ◽

Content Type ◽

Brain Irradiation

✓ A retrospective analysis of 21 cases of primary central nervous system (CNS) lymphoma is reported. All patients presented with a solitary mass in the supratentorial region. None had previously received immunosuppressive therapy. Neuroradiological studies included technetium-99m-pertechnetate brain scanning in eight cases, cerebral arteriography in all 21 cases, and computerized tomography (CT) in 14 cases. The characteristic features were increased uptake in brain scans, mass effect in arteriograms, and marked contrast enhancement on CT scans. Abnormal tumor vessels were occasionally seen on arteriography, and subtraction films were usually required to appreciate tumor stain. All patients underwent craniotomy, and histological studies of the tumors showed a diffuse type of lymphoma in all cases. Immunoglobulin testing was performed in 19 cases and a monoclonal spike was verified in 10, suggesting a B cell origin. All patients were followed until their death except one who was still alive 12 months from onset of symptoms. Therapy included subtotal resection in all 21 cases, whole-brain irradiation in six cases, chemotherapy in two cases, and a combination of whole-brain irradiation and chemotherapy in nine cases. Three different forms of chemotherapy were used. The results suggest that chemotherapy is an important addition to subtotal resection and whole-brain irradiation in the treatment of primary CNS lymphoma.

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Gamma knife treatment for multiple metastatic brain tumors compared with whole-brain radiation therapy

Journal of Neurosurgery ◽

10.3171/jns.2000.93.supplement_3.0032 ◽

2000 ◽

Vol 93 (supplement_3) ◽

pp. 32-36 ◽

Cited By ~ 57

Author(s):

Toru Serizawa ◽

Toshihiko Iuchi ◽

Junichi Ono ◽

Naokatsu Saeki ◽

Katsunobu Osato ◽

...

Keyword(s):

Radiation Therapy ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Cerebral Metastases ◽

Whole Brain Radiation Therapy ◽

Whole Brain ◽

Content Type ◽

Whole Brain Radiation ◽

Brain Radiation ◽

Fine Print

Object. The purpose of this retrospective study was to compare the effectiveness of gamma knife radiosurgery (GKS) for multiple cerebral metastases with that of whole-brain radiation therapy (WBRT). Methods. Ninety-six consecutive patients with cerebral metastases from nonsmall cell lung cancer were treated between 1990 and 1999. The entry criteria were the presence of between one and 10 multiple brain lesions at initial diagnosis, no surgically inaccessible tumors with more than a 30-mm diameter, no carcinomatous meningitis, and more than 2 months of life expectancy. The patients were divided into two groups: the GKS group (62 patients) and the WBRT group (34 patients). In the GKS group, large lesions (> 30 mm) were removed surgically and all other small lesions (≤ 30 mm) were treated by GKS. New distant lesions were treated by repeated GKS without prophylactic WBRT. In the WBRT group, the patients were treated by the traditional combined therapy of WBRT and surgery. In both groups, chemotherapy was administered according to the primary physician's protocol. The two groups did not differ in terms of age, sex, initial Karnofsky Performance Scale (KPS) score, type, lesion number, and size of lesion, systemic control, and chemotherapy. Neurological survival and qualitative survival of the GKS group were longer than those of the WBRT group. In multivariate analysis, significant poor prognostic factors were systemically uncontrolled patients, WBRT group, and poor initial KPS score. Conclusions. Gamma knife radiosurgery without prophylactic WBRT could be a primary choice of treatment for patients with as many as 10 cerebral metastases from nonsmall cell cancer.

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