scholarly journals Stereotactic Radiosurgery pada Benign Skull Base Tumor

2016 ◽  
Vol 10 (1) ◽  
pp. 35
Author(s):  
HENRY KODRAT ◽  
RIMA NOVIRIANTHY
Keyword(s):  
Skull Base ◽  
Stereotactic Radiosurgery ◽  
Point Of View ◽  
Therapeutic Modality ◽  
Treatment Modalities ◽  
High Dose ◽  
Skull Base Tumor ◽  
Fractionated Radiotherapy ◽  
Conventional Dose ◽  
Stereotactic Navigation

ABSTRACTTotal removal is difficult to be performed in skull base tumors because its location is surrounded by important structures such as nerves and blood vessels. Therefore, radiotherapy is one of treatment modalities that has been proven efficacy. Simultaneous with the development of imaging technology and advancement of radiobiology, radiosurgery is an emerging therapeutic modality. Radiosurgery is radiotherapy method which delivers high doseirradiation in single fraction. Rational use of stereotactic radiosurgery on benign skull base tumor is from radiobiology point of view; there is no advantage can be achieved from conventional dose fractionated radiotherapy compared with high dose. However, if we want to delivered high dose radiation, we must apply rigid immobilization, target definition using stereotactic navigation and image guidance verification. Radiosurgery can only be delivered in small intracranial lesion.ABSTRAKReseksi total kadang sulit dilakukan pada tumor yang terletak pada dasar tengkorak. Hal ini disebabkan lokasinya dikelilingi oleh struktur saraf dan pembuluh darah penting. Oleh karena itu, radioterapi merupakan salah satu modalitas terapi yang sudah terbukti maanfaatnya. Sejalan dengan perkembangan teknologi pencitraan dan kemajuan pengetahuan radiobiologi, radiosurgery merupakan modalitas terapi yang melejit penggunannya. Radiosurgery adalah metode pemberian radioterapi dengan dosis tinggi dan diberikan dalam fraksi tunggal. Rasional penggunaan stereotactic radiosurgery pada tumor jinak dasar tengkorak adalah karena dari sudut pandang radiobiologi, tidak ada kelebihan dariradioterapi dengan dosis konvensional dibandingkan dengan dosis tinggi. Namun, untuk pemberian dosis tinggi diwajibkan imobilisasi yang rigid dan lokalisasi yang akurat dengan menggunakan navigasi stereotaktik dan verifikasi dengan panduan pencitraan radiologi. Radiosurgery hanya dapat diberikan pada kelainan intrakranial yang berukuran kecil.

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.

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 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.

scholarly journals Treatment of Sinonasal Teratocarcinosarcoma: A Systematic Review and Survival Analysis

2020 ◽  
Vol 35 (1) ◽  
pp. 132-141
Author(s):  
Nikita Chapurin ◽  
Douglas J. Totten ◽  
Justin C. Morse ◽  
Mohammad S. Khurram ◽  
Peter C. Louis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Skull Base ◽  
Treatment Outcomes ◽  
English Literature ◽  
Anterior Skull Base ◽  
Treatment Modalities ◽  
Published Data ◽  
Skull Base Tumor ◽  
Kaplan Meier ◽  
Sinonasal Teratocarcinosarcoma

Background Sinonasal teratocarcinosarcoma (SNTCS) is a rare malignancy of the anterior skull base with only 127 cases described in the English literature. Given the rarity of this tumor, new cases and analysis of published reports may assist in future management of SNTCS. Objectives 1) Describe findings from a systematic review of all available literature for malignant SNTCS including the clinical presentation, treatment modalities and outcomes. 2) Present two new cases of this rare anterior skull base tumor. 3) Compare treatment outcomes with respect to recurrence and mortality. Methods A systematic review of all English literature available in 2 comprehensive databases was conducted by two independent reviewers using PRISMA guidelines. 85 publications were identified. Each case was reviewed for demographics, treatment and survival, and aggregate treatment outcomes were compared using Kaplan-Meier analysis. Results A total of 64 articles meeting inclusion criteria were reported in the literature between 1977-2018. This represented a total of 127 patients, with a strong male predominance (83%) and mean age of 50 years (range 10–82). Mean follow-up was 21 months. Recurrence rate was 38%, with mean survival at 2 years of 55%. Almost all patients underwent surgery as a primary treatment modality (90%). The majority of cases were treated with multimodal therapy, with 55% receiving surgery and radiation and 20% receiving surgery with adjuvant chemoradiation. Kaplan-Meier analysis demonstrated a significant survival advantage for patients treated with combined therapy compared to surgery alone (p < 0.001) but did not show differences in recurrence (p = 0.085). Conclusion Two-year survival rates for SNTCS are 55%. Multimodality treatment outcomes appear to be superior to surgery alone based on the published data of this rare skull base tumor, although heterogeneity of treatment methods and reporting bias limits the generalizability of these findings.

scholarly journals Stereotactic radiotherapy is a useful treatment option for patients with medullary thyroid cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aleksandra Kukulska ◽  
Jolanta Krajewska ◽  
Zofia Kołosza ◽  
Aleksandra Grządziel ◽  
Mateusz Gajek ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Stereotactic Radiosurgery ◽  
Stereotactic Radiotherapy ◽  
Kinase Inhibitors ◽  
Metastatic Lesion ◽  
Thyroid Tumor ◽  
High Dose ◽  
Radiation Doses ◽  
Medullary Thyroid ◽  
Fractionated Radiotherapy

Abstract The role of radiotherapy in advanced medullary thyroid carcinoma (MTC) is confined to patients in whom surgical treatment or the administration of tyrosine kinase inhibitors are not possible or contraindicated. High fractionated radiation doses during radiosurgery or fractionated stereotactic radiotherapy are applied to reduce cancer-related symptoms and stabilize irradiated lesions. This study aimed to retrospectively evaluate the therapeutic effect of stereotactic radiotherapy in MTC patients. Material and methods The study group involved 11 MTC patients, treated due to 16 cancer lesions, mainly bone metastases (10 lesions), lymph node (2 lesions) metastases, or liver metastases (2 lesions), one primary thyroid tumor, and one MTC recurrence in the thyroid bed. The fractionated and total radiation doses ranged between 5 and 12 Gy and 8–44 Gy, respectively. Six lesions were treated with a single radiation fraction, three lesions with 2 fractions, another 6 lesions with 3 fractions, whereas the remaining one metastatic lesion with 9 fractions of stereotactic radiosurgery. Results The beneficial effect of stereotactic radiosurgery was obtained in all treated lesions. None of treated lesions progressed in the further disease course. Fourteen lesions were stable (87.5 %), including eight lesions showing progression before radiosurgery (good response). Disease control was obtained in all soft-tissue metastases. Regarding bone metastases, partial regression was achieved in 20 % lesions, whereas in 30 % lesions progressive before radiotherapy, the treatment led to disease stabilization. Conclusions Our data pointed to the effectiveness of high-dose fractionated radiotherapy in MTC. However, an observation of a larger group of patients is required to confirm it.

Impact of cochlear modiolus dose on hearing preservation following stereotactic radiosurgery for non–vestibular schwannoma neoplasms of the lateral skull base: a cohort study

2020 ◽  
Vol 133 (3) ◽  
pp. 736-741
Author(s):  
Lucas P. Carlstrom ◽  
Jeffrey T. Jacob ◽  
Christopher S. Graffeo ◽  
Avital Perry ◽  
Michael S. Oldenburg ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Cohort Study ◽  
Skull Base ◽  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Hearing Preservation ◽  
Control Group ◽  
High Dose ◽  
Petroclival Meningiomas ◽  
Lateral Skull Base

OBJECTIVERadiation dose to the cochlea has been proposed as a key prognostic factor in hearing preservation following stereotactic radiosurgery (SRS) for vestibular schwannoma (VS). However, understanding of the predictive value of cochlear dose on hearing outcomes following SRS for patients with non-VS tumors of the lateral skull base (LSB) is incomplete. The authors investigated rates of hearing loss following high-dose SRS in patients with LSB non-VS lesions compared with patients with VS.METHODSPatients with LSB meningioma or jugular paraganglioma and serviceable pretreatment hearing who underwent SRS treatment during 2007–2016 and received a modiolus dose > 5 Gy were included in a retrospective cohort study, along with a similarly identified control group of consecutive patients with sporadic VS.RESULTSSixteen patients with non-VS tumors and a control group of 43 patients with VS met study criteria. Serviceable hearing, defined as American Academy of Otololaryngology–Head and Neck Surgery class A/B, was maintained in 13 non-VS versus 23 VS patients (81% vs 56%, p = 0.07). All 3 instances of hearing loss in non-VS patients were observed in cerebellopontine angle (CPA) meningiomas. Non-VS with preserved hearing had a median modiolus dose of 6.9 Gy (range 5.7–19.2 Gy), versus 7.4 Gy (range 5.4–7.6 Gy) in those patients with post-SRS hearing loss (p = 0.53). Sporadic VS patients received an overall median modiolus point-dose of 6.8 Gy (range 5.4–11.7 Gy).CONCLUSIONSThe modiolus dose threshold of 5 Gy does not predict hearing loss in patients with non-VS tumors undergoing SRS, suggesting that dosimetric parameters derived from VS may not be applicable to this population. Differential rates of hearing loss appear to vary by pathology, with paragangliomas and petroclival meningiomas demonstrating decreased risk of hearing loss compared to CPA meningiomas that may directly compress the cochlear nerve similarly to VS.

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 Quality Assurance in Modern Gynecological HDR-Brachytherapy (Interventional Radiotherapy): Clinical Considerations and Comments

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 912
Author(s):  
Tamer Soror ◽  
Frank-André Siebert ◽  
Valentina Lancellotta ◽  
Elisa Placidi ◽  
Bruno Fionda ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Survival Rates ◽  
High Dose Rate ◽  
Point Of View ◽  
Treatment Modalities ◽  
High Dose ◽  
Gynecological Cancers ◽  
Clinical Procedures ◽  
Dose Monitoring ◽  
Recent Developments

The use of brachytherapy (interventional radiotherapy) in the treatment of gynecological cancers is a crucial element in both definitive and adjuvant settings. The recent developments in high-dose rate remote afterloaders, modern applicators, treatment-planning software, image guidance, and dose monitoring systems have led to improvement in the local control rates and in some cases improved the survival rates. The development of these highly advanced and complicated treatment modalities has been accompanied by challenges, which have made the existence of quality assurance protocols a must to ensure the integrity of the treatment process. Quality assurance aims at standardizing the technical and clinical procedures involved in the treatment of patients, which could eventually decrease the source of uncertainties whether technical (source/equipment related) or clinical. This commentary review sheds light (from a clinical point of view) on some potential sources of uncertainties associated with the use of modern brachytherapy in the treatment of gynecological cancers.

scholarly journals Clinical phenotypes and prognostic features of ETMRs (Embryonal Tumor with Multi-layered Rosettes) a new CNS tumor entity: A Rare Brain Tumor Registry study

2020 ◽  
Author(s):  
Annie Huang
Keyword(s):  
Brain Tumor ◽  
High Dose Chemotherapy ◽  
Treatment Modalities ◽  
Patient Specific ◽  
High Dose ◽  
Total Resection ◽  
Prognostic Features ◽  
Clinical Phenotypes ◽  
Diagnostic Practices ◽  
Conventional Dose

Background ETMRs are a newly recognized rare paediatric brain tumor with alterations of the C19MC microRNA locus. Due to varied diagnostic practices and limited clinical data, disease features and determinants of outcome are poorly defined. We performed an integrated clinico-pathologic and molecular analyses of 159 primary ETMRs to define clinical phenotypes, identify predictors of survival and critical treatment modalities for this orphan disease. Methods Primary ETMR patients were identified from the Rare Brain Tumor Consortium (rarebraintumorconsortium.ca) global registry using histopathologic and molecular assays. Event-Free (EFS) and Overall Survival (OS) for 108 patients treated with curative multi-modal regimens were determined using Cox proportional hazard and log rank analyses. Findings ETMRs were predominantly non-metastatic (73%) tumors arising from multiple sites; 55% were cerebral tumors, 45% arose at sites characteristic of other brain tumors. Hallmark C19MC alterations were seen in 91%; 9% were ETMR-NOS. Survival and hazard analyses showed a 6 month median EFS and 2-4yr OS of 27-29% with metastatic disease (HR=0.44, 95% CI 0.26-0.74; p=0.002) and brainstem location (HR=0.40, 95% CI 0.021-0.75; p=0.005) correlating with adverse OS. Gross total resection (GTR: HR=0.38, 95% CI 0.21-0.68; p=0.001), high dose chemotherapy (HDC: HR=0.55, 95% CI 0.31-0.97; p=0.04) and radiation (RT: HR=0.32, 95% CI 0.16-0.60; p=<0.001) correlated with improved EFS and OS in multi-variable analyses. EFS and OS for patients treated with only conventional dose chemotherapy (CC) was 0% and respectively 37%+/-14% and 32%+/-13% for patients treated with HDC. Patients with GTR or sub-total resection (STR) treated with HDC and RT had superior EFS (GTR 73%+/-14%, p=0.018; STR 67%+/-19% p=0.009) and OS (GTR 66%+/-17%, p=0.05; STR 67%+/-16%, p=0.005). Amongst 21 long-term survivors (OS 24-202 months); 38%, 24% and 24% respectively received craniospinal, focal or no RT. Interpretation: Prompt molecular diagnosis and post-surgical treatment with multi-modal therapy tailored to patient-specific risk features improves ETMR survival.

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