First experience in using Novalis shaped beam radiosurgery in Korea

2004 ◽  
Vol 101 (Supplement3) ◽  
pp. 341-345 ◽  
Author(s):  
Choong Jin Whang ◽  
Gi Taek Yee ◽  
Chan Young Choi ◽  
Moon-Jun Sohn ◽  
Dong Joon Lee
Keyword(s):  
Stereotactic Radiosurgery ◽  
Malignant Tumors ◽  
Benign Tumors ◽  
Tumor Control ◽  
Pineal Tumor ◽  
Content Type ◽  
Shaped Beam ◽  
Acoustic Neuromas ◽  
Fractionated Stereotactic Radiosurgery ◽  
Fine Print

Object. The role of radiosurgery has become increasingly important in the treatment of intracranial lesions. In this study the authors evaluated the efficacy of the Novalis shaped beam radiosurgery system (dedicated linear accelerator) for various brain and spinal lesions. Methods. Between November 2000 and October 2003 the authors treated 356 cases of various intracranial and extracranial lesions with Novalis shaped beam radiosurgery. Of these 356 cases, 109 cases were followed for more than a 2-year period. Fifty patients underwent fractionated stereotactic radiosurgery. Twenty patients (40%) harbored benign tumors (two acoustic neuromas, seven meningiomas, five pituitary adenomas, four optic gliomas, and two craniopharyngiomas), 18 patients (36%) harbored malignant tumors (16 glioblastoma multiforme [GBM], and two metastases), and the others included five with brainstem gliomas, one chordoma, five gliomas, and one with an arteriovenous malformation (AVM). Eighteen of 20 patients with benign tumors had good tumor control. Of 59 patients treated with single-dose stereotactic radiosurgery, 24 had benign intracranial tumors (12 acoustic neuromas, 11 meningiomas, and one pituitary adenoma), 20 had malignant tumors (two GBMs and 18 metastases), and the others were eight AVMs, two glomus jugulare tumors, three lymphomas, one pineal tumor, and one spinal tumor. Conclusions. Stereotactic radiosurgery and fractionated stereotactic radiosurgery using the Novalis shaped beam radiosurgery system are effective and safe noninvasive treatment modalities for various intracranial and extracranial lesions.

First experience in using Novalis shaped beam radiosurgery in Korea

2004 ◽  
pp. 341-345
Author(s):  
Choong Jin Whang ◽  
Gi Taek Yee ◽  
Chan Young Choi ◽  
Moon-Jun Sohn ◽  
Dong Joon Lee
Keyword(s):  
Stereotactic Radiosurgery ◽  
Malignant Tumors ◽  
Benign Tumors ◽  
Tumor Control ◽  
Pineal Tumor ◽  
Content Type ◽  
Shaped Beam ◽  
Acoustic Neuromas ◽  
Fractionated Stereotactic Radiosurgery ◽  
Fine Print

Object. The role of radiosurgery has become increasingly important in the treatment of intracranial lesions. In this study the authors evaluated the efficacy of the Novalis shaped beam radiosurgery system (dedicated linear accelerator) for various brain and spinal lesions. Methods. Between November 2000 and October 2003 the authors treated 356 cases of various intracranial and extracranial lesions with Novalis shaped beam radiosurgery. Of these 356 cases, 109 cases were followed for more than a 2-year period. Fifty patients underwent fractionated stereotactic radiosurgery. Twenty patients (40%) harbored benign tumors (two acoustic neuromas, seven meningiomas, five pituitary adenomas, four optic gliomas, and two craniopharyngiomas), 18 patients (36%) harbored malignant tumors (16 glioblastoma multiforme [GBM], and two metastases), and the others included five with brainstem gliomas, one chordoma, five gliomas, and one with an arteriovenous malformation (AVM). Eighteen of 20 patients with benign tumors had good tumor control. Of 59 patients treated with single-dose stereotactic radiosurgery, 24 had benign intracranial tumors (12 acoustic neuromas, 11 meningiomas, and one pituitary adenoma), 20 had malignant tumors (two GBMs and 18 metastases), and the others were eight AVMs, two glomus jugulare tumors, three lymphomas, one pineal tumor, and one spinal tumor. Conclusions. Stereotactic radiosurgery and fractionated stereotactic radiosurgery using the Novalis shaped beam radiosurgery system are effective and safe noninvasive treatment modalities for various intracranial and extracranial lesions.

Stereotactic radiosurgery in the management of acoustic neuromas associated with neurofibromatosis Type 2

1999 ◽  
Vol 90 (5) ◽  
pp. 815-822 ◽  
Author(s):  
Brian R. Subach ◽  
Douglas Kondziolka ◽  
L. Dade Lunsford ◽  
David J. Bissonette ◽  
John C. Flickinger ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Neurofibromatosis Type ◽  
Tumor Control ◽  
Nerve Function ◽  
Content Type ◽  
Acoustic Neuromas ◽  
The Mean ◽  
Fine Print

Object. Stereotactically guided radiosurgery is one of the primary treatment modalities for patients with acoustic neuromas (vestibular schwannomas). The goal of radiosurgery is to arrest tumor growth while preserving neurological function. Patients with acoustic neuromas associated with neurofibromatosis Type 2 (NF2) represent a special challenge because of the risk of complete deafness. To define better the tumor control rate and long-term functional outcome, the authors reviewed their 10-year experience in treating these lesions.Methods. Forty patients underwent stereotactic radiosurgery at the University of Pittsburgh, 35 of them for solitary tumors. The other five underwent staged procedures for bilateral lesions (10 tumors, 45 total). Thirteen patients (with 29% of tumors) had undergone a median of two prior resections. The mean tumor volume at radiosurgery was 4.8 ml, and the mean tumor margin dose was 15 Gy (range 12–20 Gy).The overall tumor control rate was 98%. During the median follow-up period of 36 months, 16 tumors (36%) regressed, 28 (62%) remained unchanged, and one (2%) grew. In the 10 patients for whom more than 5 years of clinical and neuroimaging follow-up results were available (median 92 months), five tumors were smaller and five remained unchanged. Surgical resection was performed in three patients (7%) after radiosurgery; only one showed radiographic evidence of progression. Useful hearing (Gardner—Robertson Class I or II) was preserved in six (43%) of 14 patients, and this rate improved to 67% after modifications made in 1992. Normal facial nerve function (House—Brackmann Grade 1) was preserved in 25 (81%) of 31 patients. Normal trigeminal nerve function was preserved in 34 (94%) of 36 patients.Conclusions. Stereotactically guided radiosurgery is a safe and effective treatment for patients with acoustic tumors in the setting of NF2. The rate of hearing preservation may be better with radiosurgery than with other available techniques.

Stereotactic radiotherapy for the treatment of acoustic neuromas

2004 ◽  
Vol 101 (Supplement3) ◽  
pp. 362-372 ◽  
Author(s):  
Michael T. Selch ◽  
Alessandro Pedroso ◽  
Steve P. Lee ◽  
Timothy D. Solberg ◽  
Nzhde Agazaryan ◽  
...  
Keyword(s):  
Stereotactic Radiotherapy ◽  
Tumor Size ◽  
Cranial Nerve ◽  
Target Volume ◽  
Tumor Control ◽  
Content Type ◽  
Seventh Cranial Nerve ◽  
Acoustic Neuromas ◽  
Fine Print

Object. The authors sought to assess the safety and efficacy of stereotactic radiotherapy when using a linear accelerator equipped with a micromultileaf collimator for the treatment of patients with acoustic neuromas. Methods. Fifty patients harboring acoustic neuromas were treated with stereotactic radiotherapy between September 1997 and June 2003. Two patients were lost to follow-up review. Patient age ranged from 20 to 76 years (median 59 years), and none had neurofibromatosis. Forty-two patients had useful hearing prior to stereotactic radiotherapy. The fifth and seventh cranial nerve functions were normal in 44 and 46 patients, respectively. Tumor volume ranged from 0.3 to 19.25 ml (median 2.51 ml). The largest tumor dimension varied from 0.6 to 4 cm (median 2.2 cm). Treatment planning in all patients included computerized tomography and magnetic resonance image fusion and beam shaping by using a micromultileaf collimator. The planning target volume included the contrast-enhancing tumor mass and a margin of normal tissue varying from 1 to 3 mm (median 2 mm). All tumors were treated with 6-MV photons and received 54 Gy prescribed at the 90% isodose line encompassing the planning target volume. A sustained increase greater than 2 mm in any tumor dimension was defined as local relapse. The follow-up duration varied from 6 to 74 months (median 36 months). The local tumor control rate in the 48 patients available for follow up was 100%. Central tumor hypodensity occurred in 32 patients (67%) at a median of 6 months following stereotactic radiotherapy. In 12 patients (25%), tumor size increased 1 to 2 mm at a median of 6 months following stereotactic radiotherapy. Increased tumor size in six of these patients was transient. In 13 patients (27%), tumor size decreased 1 to 14 mm at a median of 6 months after treatment. Useful hearing was preserved in 39 patients (93%). New facial numbness occurred in one patient (2.2%) with normal fifth cranial nerve function prior to stereotactic radiotherapy. New facial palsy occurred in one patient (2.1%) with normal seventh cranial nerve function prior to treatment. No patient's pretreatment dysfunction of the fifth or seventh cranial nerve worsened after stereotactic radiotherapy. Tinnitus improved in six patients and worsened in two. Conclusions. Stereotactic radiotherapy using field shaping for the treatment of acoustic neuromas achieves high rates of tumor control and preservation of useful hearing. The technique produces low rates of damage to the fifth and seventh cranial nerves. Long-term follow-up studies are necessary to confirm these findings.

Stereotactic radiosurgery for cerebral metastatic melanoma

1993 ◽  
Vol 79 (5) ◽  
pp. 661-666 ◽  
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.

Spinal lesions treated with Novalis shaped beam intensity-modulated radiosurgery and stereotactic radiotherapy

2004 ◽  
Vol 101 (Supplement3) ◽  
pp. 435-440 ◽  
Author(s):  
Antonio A. F. De Salles ◽  
Alessandra G. Pedroso ◽  
Paul Medin ◽  
Nzhde Agazaryan ◽  
Timothy Solberg ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Stereotactic Radiotherapy ◽  
Systemic Disease ◽  
Content Type ◽  
Shaped Beam ◽  
Intensity Modulated ◽  
Asymptomatic Patients ◽  
The Mean ◽  
Fine Print

Object. Spinal radiosurgery was implemented to improve quality of life (QOL) in patients with malignancies. It may also be applicable to the treatment of benign lesions. Methods. Between July 2002 and January 2004, 14 patients harboring 22 lesions were treated; 13 received single-dose stereotactic radiosurgery. Six were women. The mean age was 60.2 years (range 48–82 years). There were 11 metastases, two neurofibromas, and one meningioma. Six lesions were cervical, 10 thoracic, and six lumbar. Ten patients suffered pain, three paresthesias, two weakness, and three were asymptomatic. Seven patients underwent spinal surgery, with four receiving instrumentation. Twelve patients underwent conventional irradiation before stereotactic radiosurgery/stereotactic radiotherapy. A mean dose of 12 ± 2.7 Gy (range 8–21 Gy) was prescribed to the 91% isodose line (range 85–97%). The mean tumor volume was 25 ± 27.1 ml (range 0.75–91.8 ml). Treatment was planned using intensity-modulated radiosurgery (IMRS) fields in 15 cases, dynamic arcs in five, and conformal beams in two. The mean follow-up period was 6.1 ± 3.9 months (range 1–16 months). Three patients became pain free and four experienced considerable relief. Weakness improved in the two patients with this preoperative symptom and the asymptomatic patients remained so. Four lesions decreased in size, five remained stable, seven progressed, and six were not followed up (two patients died before follow up). Four patients in all died, three of systemic disease and one of thoracic lesion progression. No complications due to shaped beam and IMRS/intensity-modulated radiotherapy (IMRT) techniques were observed. Conclusions. Shaped beam and IMRS/IMRT involving the Novalis system may delay neurological deterioration, improving QOL. The lack of complication suggests that higher doses can be delivered to improve the control rate in patients with metastases.

Surgical management of brain-stem tumors in children: results and statistical analysis of 75 cases

1993 ◽  
Vol 79 (6) ◽  
pp. 845-852 ◽  
Author(s):  
Alain Pierre-Kahn ◽  
Jean-François Hirsch ◽  
Mathieu Vinchon ◽  
Christine Payan ◽  
Christian Sainte-Rose ◽  
...  
Keyword(s):  
Brain Stem ◽  
Malignant Tumors ◽  
Benign Tumors ◽  
Patient Age ◽  
Content Type ◽  
Patient Âgé ◽  
Significant Difference ◽  
Brain Stem Tumors ◽  
Subtotal Removal ◽  
Fine Print

A study was made of 75 children treated between 1970 and 1990, with partial, subtotal, or total removal of three intrinsic and 72 exophytic or surface brain-stem tumors. In all cases, the goal of surgery was to remove as much tumor as possible. Extent of removal was defined according to data obtained from postoperative computerized tomography or magnetic resonance imaging, and was considered partial when only a small amount of tumor was removed, subtotal when a few cubic millimeters of tumor was left, and total when no residual tumor was seen on postoperative radiological investigations. An ultrasonic aspirator was used for the 43 most recent operations. Among tumor removals without the aspirator, 24 (75%) were partial, eight (25%) subtotal, and none total; with the use of the aspirator, the number of partial removals decreased to 44.5% while that of subtotal and total removals increased to 32% and 23.5%, respectively. There were 69 gliomas (92%) and 47 benign tumors (62.6%). Forty-nine patients were irradiated postoperatively, and 14 of the 23 patients whose benign tumors were removed totally or subtotally did not undergo irradiation. This study showed that: 1) the overall prognosis of patients with malignant tumors was poor and was not improved by surgery; 2) the survival rate of those with benign tumors was significantly (p < 0.01) lower after partial removal than after total or subtotal removal (52% and 94%, respectively, at 5 years); 3) comparison of means and proportions (Student's and chi-squared tests) between benign and malignant tumors showed a significant difference relating to patient age (p < 0.03), peritumoral hypodensity (p < 0.001), and preoperative duration of symptoms (p < 0.001); 4) stepwise logistic regression analysis confirmed that two of these three variables were related to malignancy: namely, patient age at surgery (p < 0.03) and presence of peritumoral hypodensity (p < 0.001); and 5) routine postoperative irradiation was contraindicated after total or subtotal removal of benign tumors.

Factors associated with survival in patients with meningioma

1998 ◽  
Vol 88 (5) ◽  
pp. 831-839 ◽  
Author(s):  
Bridget J. McCarthy ◽  
Faith G. Davis ◽  
Sally Freels ◽  
Tanya S. Surawicz ◽  
Denise M. Damek ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Prognostic Factors ◽  
Survival Rate ◽  
Proportional Hazards Model ◽  
Malignant Tumors ◽  
Age At Diagnosis ◽  
Benign Tumors ◽  
Content Type ◽  
Cancer Data ◽  
Fine Print

Object. To explore factors affecting the survival rate in patients with meningiomas, the authors used the National Cancer Data Base (NCDB), which includes tumors from approximately 1000 hospitals participating in the American College of Surgeons tumor registry program. Methods. Analysis included over 9000 cases diagnosed from 1985 to 1988 and 1990 to 1992. Survival estimates were computed and prognostic factors were identified using a proportional hazards model. The overall 5-year survival rate was 69% and it declined with patient age. This rate was 81% in patients aged 21 to 64 years and 56% for patients 65 years of age or older. When patients were grouped by the histological type of their tumors, those with benign tumors had an overall 5-year survival rate of 70%, whereas the overall 5-year survival rates in patients with atypical and malignant meningiomas were 75% and 55%, respectively. Prognostic factors for benign tumors included age at diagnosis, tumor size, whether treated surgically, hospital type, and radiation therapy; for malignant tumors, the prognostic factors included: age at diagnosis, whether treated surgically, and radiation therapy. These factors were statistically significant. The 5-year rate for recurrence of symptoms (regardless of the method of treatment) was 19.2% for those with benign tumors and 32.4% for those with malignant tumors. In patients whose benign tumor had been completely removed, the 5-year rate of tumor recurrence was 20.5%. Conclusions. Although not population-based, the NCDB has the potential for providing pertinent information regarding patient characteristics and methods of treatment for benign, as well as malignant, brain tumors.

Stereotactic radiosurgery for acoustic nerve tumors in patients with useful preoperative hearing: results at 2-year follow-up examination

1994 ◽  
Vol 80 (6) ◽  
pp. 1011-1017 ◽  
Author(s):  
Olusola K. Ogunrinde ◽  
L. Dade Lunsford ◽  
John C. Flickinger ◽  
Douglas Kondziolka
Keyword(s):  
Stereotactic Radiosurgery ◽  
Trigeminal Nerve ◽  
Cranial Nerve ◽  
Nerve Function ◽  
Content Type ◽  
Acoustic Neuromas ◽  
Cranial Nerve Function ◽  
Acoustic Nerve ◽  
Radiation Beams ◽  
Fine Print

✓ Twenty patients with acoustic nerve tumors (mean diameter ≤ 30 mm) and useful preoperative hearing were examined 2 years after stereotactic radiosurgery to determine the effectiveness of the surgery in the control of tumor growth and the preservation of cranial nerve function. Results showed tumor volume stabilization (12 cases) or reduction (seven cases) was achieved in a total of 19 patients (95%). Useful hearing (defined as Gardner and Robertson Class I or II) preservation was obtained in 100% of cases immediately postoperatively, 50% at 6 months, and 45% at both 1 and 2 years. Two years after stereotactic radiosurgery, facial nerve function was preserved in 90% of patients and 75% continued to have normal trigeminal nerve function. All patients returned to and maintained their preoperative functional status within 3 to 5 days after radiosurgery. These findings indicate that stereotactic radiosurgery with multiple isocenters and narrow radiation beams is a safe and effective management strategy for progressive acoustic nerve tumors. Auditory, facial, and trigeminal nerve function can be preserved in most patients. Prevention of further growth and preservation of cranial nerve function appear to be satisfactory goals in the current management of patients with acoustic neuromas.

Analysis of treatment outcome after stereotactic radiosurgery for cavernous sinus meningiomas

2001 ◽  
Vol 95 (3) ◽  
pp. 435-439 ◽  
Author(s):  
Masahiro Shin ◽  
Hiroki Kurita ◽  
Tomio Sasaki ◽  
Shunsuke Kawamoto ◽  
Masao Tago ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Univariate Analysis ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Long Term Outcome ◽  
Content Type ◽  
Fine Print

Object. The long-term outcome of stereotactic radiosurgery for cavernous sinus (CS) meningiomas is not fully understood. The authors retrospectively reviewed their experience with 40 CS meningiomas treated with gamma knife radiosurgery. Methods. Follow-up periods for the 40 patients ranged from 12 to 123 months (median 42 months), and the overall tumor control rates were 86.4% at 3 years and 82.3% at 10 years. Factors associated with tumor recurrence in univariate analysis were histological malignancy (p < 0.0001), partial treatment (p < 0.0001), suprasellar tumor extension (p = 0.0201), or extension in more than three directions outside the CS (p = 0.0345). When the tumor was completely covered with a dose to the margin that was higher than 14 Gy (Group A, 22 patients), no patient showed recurrence within the median follow-up period of 37 months. On the other hand, when a part of the tumor was treated with 10 to 12 Gy (Group B, 15 patients) or did not receive radiation therapy (Group C, three patients), the recurrence rates were 20% and 100%, respectively. Neurological deterioration was seen in nine patients, but all symptoms were transient or very mild. Conclusions. The data indicate that stereotactic radiosurgery can control tumor growth if the whole mass can be irradiated by dosages of more than 14 Gy. When optimal radiosurgical planning is not feasible because of a tumor's large size, irregular shape, or proximity to visual pathways, use of limited surgical resection before radiosurgery is the best option and should provide sufficient long-term tumor control with minimal complications.

Spinal lesions treated with Novalis shaped beam intensity-modulated radiosurgery and stereotactic radiotherapy

2004 ◽  
pp. 435-440 ◽  
Author(s):  
Antonio A. F. De Salles ◽  
Alessandra G. Pedroso ◽  
Paul Medin ◽  
Nzhde Agazaryan ◽  
Timothy Solberg ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Stereotactic Radiotherapy ◽  
Systemic Disease ◽  
Content Type ◽  
Shaped Beam ◽  
Intensity Modulated ◽  
Asymptomatic Patients ◽  
The Mean ◽  
Fine Print

Object. Spinal radiosurgery was implemented to improve quality of life (QOL) in patients with malignancies. It may also be applicable to the treatment of benign lesions. Methods. Between July 2002 and January 2004, 14 patients harboring 22 lesions were treated; 13 received single-dose stereotactic radiosurgery. Six were women. The mean age was 60.2 years (range 48–82 years). There were 11 metastases, two neurofibromas, and one meningioma. Six lesions were cervical, 10 thoracic, and six lumbar. Ten patients suffered pain, three paresthesias, two weakness, and three were asymptomatic. Seven patients underwent spinal surgery, with four receiving instrumentation. Twelve patients underwent conventional irradiation before stereotactic radiosurgery/stereotactic radiotherapy. A mean dose of 12 ± 2.7 Gy (range 8–21 Gy) was prescribed to the 91% isodose line (range 85–97%). The mean tumor volume was 25 ± 27.1 ml (range 0.75–91.8 ml). Treatment was planned using intensity-modulated radiosurgery (IMRS) fields in 15 cases, dynamic arcs in five, and conformal beams in two. The mean follow-up period was 6.1 ± 3.9 months (range 1–16 months). Three patients became pain free and four experienced considerable relief. Weakness improved in the two patients with this preoperative symptom and the asymptomatic patients remained so. Four lesions decreased in size, five remained stable, seven progressed, and six were not followed up (two patients died before follow up). Four patients in all died, three of systemic disease and one of thoracic lesion progression. No complications due to shaped beam and IMRS/intensity-modulated radiotherapy (IMRT) techniques were observed. Conclusions. Shaped beam and IMRS/IMRT involving the Novalis system may delay neurological deterioration, improving QOL. The lack of complication suggests that higher doses can be delivered to improve the control rate in patients with metastases.

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