Efficacy of Gamma Knife Radiosurgery for Recurrent High-Grade Gliomas with Limited Tumor Volume

Brain malignancies are still associated with poor prognosis despite multimodal radiosurgical therapeutic approach using Gamma Knife (GK), CyberKnife (CK), and linear accelerator-based technologies [1]. These advances have significantly improved the treatment outcome. However, the surgical and radiosurgical concept is still “image-guided”, and the success is closely related to precise tumor volume definition. The gross tumor volume (GTV) is defined as the visible contrast- enhancing lesion on magnetic resonance (MR) images with high three-dimensional spatial accuracy. Target delineation requires always both T2-weighted and volumetric T1-weighted sequences. T2-weighted fluid attenuated inversion recovery (FLAIR) sequences analyze the lesions surrounding brain tissues [2,3]. Objective assessment of apparently healthy tissue surrounding brain tumors seems to be a considerable factor interfering not only with the radiosurgical procedure, but also with the recurrence rate and overall survival. Several studies identified infiltrative spectroscopic pattern of the perilesional edema in more than 96% of high-grade gliomas cases and in 11,5% of patients with brain metastasis [4]. Moreover, some autopsy series of brain metastases confirmed infiltrative growth in radiologically healthy surrounding tissues in more than 60% of cases. This unseen malignant component is responsible of 80 % of “early recurrence” which should be considered as natural evolution of the main tumor [5]. In the management of high grade gliomas, the radiosurgeons are faced either to carcinologic incomplete procedures or to overestimated target irradiation with unbalanced benefit/risk action mostly related to radiation-induced brain necrosis [6]. The delineation of clinical target volume (CTV) which is defined as the volume of tissue that contains the GTV and any microscopic tumor or paths of spread, became a standard for any radio-surgical planning. Since a decade, the magnetic resonance spectroscopy (MRS) was standardized in the target volume assessment. The aim is to establish a metabolic lesional cartography. It had been reported that choline/ N- acetylaspartate (NAA) multivoxel MR spectroscopy index higher that 2,5 is in favor of malignancy in glioma with sensitivity of 90 % and specificity of 85 % [7]. However, NAA/Creatine (Cr) and Choline/Cr ratios are more relevant in the analysis of perilesional edema in brain metastasis cases. The introduction of MRS metabolic cartography concept, the use of relevant metabolite and adapted metabolites ratio estimation contributed to precision in radiosurgery. However, MRS is not used for target delineation for Gamma Knife radiosurgical treatment because of its incompatibility with the Leksell Gamma Knife planning software. Recently, we described the development of the first software allowing the integration of metabolic cartography based on multivoxel spectroscopic MRI in the radiosurgical planning for Leksell Gamma Knife Radiosurgery. The few existing meta-analysis could not lead to gold standard volume delineation techniques despite objective advance in imaging assessment [8,9]. Prospective studies using multimodal imaging data will help to overcome this insufficiency for target delineation in radiosurgery

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The effectiveness of gamma knife radiosurgery for the management of residual high-grade gliomas: A single institutional study

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2021.12.015 ◽

2022 ◽

Vol 95 ◽

pp. 159-163

Author(s):

Fatih Yakar ◽

Emrah Egemen ◽

Ümit A Dere ◽

Halil Sağınç ◽

Ulaş Gökdeniz ◽

...

Keyword(s):

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

High Grade ◽

High Grade Gliomas

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AT-45 * GAMMA KNIFE RADIOSURGERY FOR RECURRENT HIGH GRADE GLIOMAS

Neuro-Oncology ◽

10.1093/neuonc/nou237.44 ◽

2014 ◽

Vol 16 (suppl 5) ◽

pp. v18-v18

Author(s):

S. Peker ◽

I. A. Kabalay ◽

E. Tezcanli ◽

M. Yilmaz ◽

M. Sengoz

Keyword(s):

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

High Grade ◽

High Grade Gliomas

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768 Gamma Knife Radiosurgery Boost in High-grade Gliomas

Neurosurgery ◽

10.1227/00006123-200108000-00132 ◽

2001 ◽

Vol 49 (2) ◽

pp. 527

Author(s):

Rufus J. Mark ◽

Ronald Young ◽

Deane Jacques ◽

Brian Copcutt ◽

Sandra Vermeulen ◽

...

Keyword(s):

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

High Grade ◽

High Grade Gliomas

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P14.98 Improving the targeting of Gamma-Knife radiosurgery for recurrent high-grade gliomas (WHO grades III and IV) with 11C-Methionine PET/CT

Neuro-Oncology ◽

10.1093/neuonc/noz126.333 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii91-iii91

Author(s):

E Chaskis ◽

G Van Simaeys ◽

C Martens ◽

O De Witte ◽

S Goldman ◽

...

Keyword(s):

Gamma Knife ◽

Multidisciplinary Approach ◽

Gamma Knife Radiosurgery ◽

High Grade ◽

Who Grade ◽

Metabolic Monitoring ◽

Pet Ct ◽

High Grade Gliomas ◽

A Prospective Study ◽

Median Interval

Abstract BACKGROUND The survival of the patients with high-grade gliomas may be improved through a multidisciplinary approach including stereotactic re-irradiation such as Gamma-Knife at recurrence in a selected population. We report our experience in targeting the hypermetabolic areas of high-grade gliomas using 11C-Methionine PET/CT in selected patients. MATERIAL AND METHODS We retrospectively evaluated the local response in patients treated by Gamma-Knife for recurrent high-grade gliomas in our Institution between 2000 and 2018, targeting the hypermetabolic area with Methionine PET/CT. RESULTS We included 25 patients bearing high-grade gliomas (14 female, 11 male) with a median age of 45 years (5–64). There were 11 WHO grade III gliomas (6 astrocytomas, 5 oligodendrogliomas) and 14 glioblastomas. A total number of 33 Gamma-Knife procedures were performed. In all patients, the targeting was based on the hypermetabolic area as defined by Methionine PET/CT. Four patients were treated concomitantly on 2 or more targets. One patient was treated twice on different targets. We observed a positive response in 29 Gamma-Knife procedures, after a median interval of 2 months (1–33) and no response after 4 procedures (4 glioblastomas). In most cases, progression after Gamma-Knife was observed 4 months after irradiation. CONCLUSION Targeting the hypermetabolic areas with Methionine PET/CT was associated with favorable response in most patients treated by Gamma-Knife radiosurgery for local high-grade gliomas recurrence. Our results must be confirmed by a prospective study with regular and homogeneous morphological and metabolic monitoring.

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Gamma knife radiosurgery for craniopharyngiomas

Journal of Neurosurgery ◽

10.3171/jns.2000.93.supplement_3.0047 ◽

2000 ◽

Vol 93 (supplement_3) ◽

pp. 47-56 ◽

Cited By ~ 107

Author(s):

Wen-Yuh Chung ◽

David Hung-Chi Pan ◽

Cheng-Ying Shiau ◽

Wan-Yuo Guo ◽

Ling-Wei Wang

Keyword(s):

Clinical Outcome ◽

Gamma Knife ◽

Tumor Volume ◽

Gamma Knife Radiosurgery ◽

Tumor Control ◽

Content Type ◽

Stereotactic Aspiration ◽

Cystic Component ◽

The Mean ◽

Fine Print

Object. The goal of this study was to elucidate the role of gamma knife radiosurgery (GKS) and adjuvant stereotactic procedures by assessing the outcome of 31 consecutive patients harboring craniopharyngiomas treated between March 1993 and December 1999. Methods. There were 31 consecutive patients with craniopharyngiomas: 18 were men and 13 were women. The mean age was 32 years (range 3–69 years). The mean tumor volume was 9 cm3 (range 0.3–28 cm3). The prescription dose to the tumor margin varied from 9.5 to 16 Gy. The visual pathways received 8 Gy or less. Three patients underwent stereotactic aspiration to decompress the cystic component before GKS. The tumor response was classified by percentage reduction of tumor volume as calculated based on magnetic resonance imaging studies. Clinical outcome was evaluated according to improvement and dependence on replacement therapy. An initial postoperative volume increase with enlargement of a cystic component was found in three patients. They were treated by adjuvant stereotactic aspiration and/or Ommaya reservoir implantation. Tumor control was achieved in 87% of patients and 84% had fair to excellent clinical outcome in an average follow-up period of 36 months. Treatment failure due to uncontrolled tumor progression was seen in four patients at 26, 33, 49, and 55 months, respectively, after GKS. Only one patient was found to have a mildly restricted visual field; no additional endocrinological impairment or neurological deterioration could be attributed to the treatment. There was no treatment-related mortality. Conclusions. Multimodality management of patients with craniopharyngiomas seemed to provide a better quality of patient survival and greater long-term tumor control. It is suggested that GKS accompanied by adjuvant stereotactic procedures should be used as an alternative in treating recurrent or residual craniopharyngiomas if further microsurgical excision cannot promise a cure.

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Impact of mass effect, tumor location, age, and surgery on the cognitive outcome of patients with high-grade gliomas: a longitudinal study

Neuro-Oncology Practice ◽

10.1093/nop/npw030 ◽

2017 ◽

Vol 4 (4) ◽

pp. 229-240 ◽

Cited By ~ 5

Author(s):

Monica Dallabona ◽

Silvio Sarubbo ◽

Stefano Merler ◽

Francesco Corsini ◽

Giuseppe Pulcrano ◽

...

Keyword(s):

Tumor Volume ◽

High Grade Glioma ◽

Joint Effect ◽

Cognitive Outcome ◽

Tumor Localization ◽

High Grade ◽

Patient Age ◽

Patient Âgé ◽

High Grade Gliomas

Abstract Background High-grade gliomas are the most frequently occurring brain tumors and carry unfavorable prognosis. Literature is controversial regarding the effects of surgery on cognitive functions. Methods We analyzed a homogenous population of 30 patients with high-grade glioma who underwent complete resection. Patients underwent extensive neuropsychological analysis before surgery, 7 days after surgery, and approximately 40 days after surgery, before adjuvant treatments. Thirty-four neuropsychological tests were administered in the language, memory, attention, executive functions, and praxis domains. Results The preoperative percentage of patients with impairment in the considered tests ranged from 0% to 53.3% (mean 20.9%). Despite a general worsening at early follow-up, a significant recovery was observed at late follow-up. Preoperative performances in language and verbal memory tasks depended on the joint effect of tumor volume, volume of surrounding edema, and tumor localization, with major deficits in patients with left lateralized tumor, especially insular and temporal. Preoperative performances in attention and constructive abilities tasks depended on the joint effect of tumor volume, volume of surrounding edema, and patient age, with major deficits in patients ≥ 65 years old. Recovery at late follow-up depended on the volume of resected tumor, edema resorption, and patient age. Conclusions Longitudinal neuropsychological performance of patients affected by high-grade glioma depends, among other factors, on the complex interplay of tumor volume, volume of surrounding edema, tumor localization, and patient age. Reported results support the definition of criteria for surgical indication based on the above factors. They may be used to propose more customized surgical, oncological, and rehabilitative strategies.

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