The Retrospective Evaluation of The Local Tumor Control and Adverse Effects of Treatment in Patients Treated Using Cyberknife Stereotactic Radiotherapy in Vestibular Schwannomas

Object Radiosurgery has become a popular treatment for small vestibular schwannomas (VSs). The aim of this study was to review an extensive, single-institution experience with linear accelerator (LINAC) radiosurgery for VSs. Methods Between July 1988 and August 2005, 390 patients with VSs were treated with LINAC–based radiosurgery at the authors’ institution. Patient and treatment variables were prospectively maintained in a computer database. Outcomes were tracked through periodic clinical examinations and annual scanning studies. Multivariate and actuarial statistics were used to analyze rates of local tumor control and complications, including facial and trigeminal neuropathies, after treatment. One- and 2-year actuarial control rates were both 98%, and the 5-year actuarial control rate was 90%. Only four patients (1%) required surgery for tumor growth. Seventeen patients (4.4%) reported facial weakness and 14 patients (3.6%) reported facial numbness after radiosurgery. The risk of these complications rose with increasing tumor volume or increasing radiosurgical dose to the tumor periphery. Since 1994, when doses were deliberately lowered to 1250 cGy, only two patients (0.7%) have experienced facial weakness and two (0.7%) have experienced facial numbness. Conclusions Radiosurgery provides a safe and effective therapeutic alternative to surgery for small VSs.

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Local Tumor Control and Clinical Symptoms After Gamma Knife Radiosurgery for Residual and Recurrent Vestibular Schwannomas

World Neurosurgery ◽

10.1016/j.wneu.2018.11.022 ◽

2019 ◽

Vol 122 ◽

pp. e1240-e1246 ◽

Cited By ~ 3

Author(s):

Eric Suero Molina ◽

Albertus T.C.J. van Eck ◽

Cristina Sauerland ◽

Stephanie Schipmann ◽

Gerhard Horstmann ◽

...

Keyword(s):

Gamma Knife ◽

Clinical Symptoms ◽

Gamma Knife Radiosurgery ◽

Local Tumor Control ◽

Vestibular Schwannomas ◽

Tumor Control ◽

Local Tumor

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Comparison of local tumor control in patients with HCC treated with stereotactic body radiation or TACE: a propensity score analysis

Zeitschrift für Gastroenterologie ◽

10.1055/s-0037-1612711 ◽

2018 ◽

Vol 56 (01) ◽

pp. E2-E89

Author(s):

D Bettinger ◽

E Gkika ◽

M Schultheiss ◽

N Glaser ◽

S Lange ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Analysis ◽

Local Tumor Control ◽

Tumor Control ◽

Local Tumor ◽

Stereotactic Body Radiation ◽

Score Analysis

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Gamma Knife surgery combined with resection for treatment of a single brain metastasis: preliminary results

Journal of Neurosurgery ◽

10.3171/2010.8.gks101067 ◽

2010 ◽

Vol 113 (Special_Supplement) ◽

pp. 90-96 ◽

Cited By ~ 16

Author(s):

M. Yashar S. Kalani ◽

Aristotelis S. Filippidis ◽

Maziyar A. Kalani ◽

Nader Sanai ◽

David Brachman ◽

...

Keyword(s):

Survival Data ◽

Initial Treatment ◽

Median Survival Time ◽

Local Tumor Control ◽

Survival Duration ◽

Tumor Control ◽

Local Tumor ◽

Systemic Control ◽

Cranial Metastasis

Object Resection and whole-brain radiation therapy (WBRT) have classically been the standard treatment for a single metastasis to the brain. The objective of this study was to evaluate the use of Gamma Knife surgery (GKS) as an alternative to WBRT in patients who had undergone resection and to evaluate patient survival and local tumor control. Methods The authors retrospectively reviewed the charts of 150 patients treated with a combination of stereotactic radiosurgery and resection of a cranial metastasis at their institution between April 1997 and September 2009. Patients who had multiple lesions or underwent both WBRT and GKS were excluded, as were patients for whom survival data beyond the initial treatment were not available. Clinical and imaging follow-up was assessed using notes from clinic visits and MR imaging studies when available. Follow-up data beyond the initial treatment and survival data were available for 68 patients. Results The study included 37 women (54.4%) and 31 men (45.6%) (mean age 60 years, range 28–89 years). In 45 patients (66.2%) there was systemic control of the primary tumor when the cranial metastasis was identified. The median duration between resection and radiosurgery was 15.5 days. The median volume of the treated cavity was 10.35 cm3 (range 0.9–45.4 cm3), and the median dose to the cavity margin was 15 Gy (range 14–30 Gy), delivered to the 50% isodose line (range 50%–76% isodose line). The patients' median preradiosurgery Karnofsky Performance Scale (KPS) score was 90 (range 40–100). During the follow-up period we identified 27 patients (39.7%) with recurrent tumor located either local or distant to the site of treatment. The median time from primary treatment of metastasis to recurrence was 10.6 months. The patients' median length of survival (interval between first treatment of cerebral metastasis and last follow-up) was 13.2 months. For the patient who died during follow-up, the median time from diagnosis of cerebral metastasis to death was 11.5 months. The median duration of survival from diagnosis of the primary cancer to last follow-up was 30.2 months. Patients with a pretreatment KPS score ≥ 90 had a median survival time of 23.2 months, and patients with a pretreatment KPS score < 90 had a median survival time of 10 months (p < 0.008). Systemic control of disease at the time of metastasis was not predictive of increased survival duration, although it did tend to improve survival. Conclusions Although the debate about the ideal form of radiation treatment after resection continues, these findings indicate that GKS combined with surgery offers comparable survival duration and local tumor control to WBRT for patients with a diagnosis of a single metastasis.

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Petroclival meningiomas: long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution

Journal of Neurosurgery ◽

10.3171/2019.2.jns182604 ◽

2020 ◽

Vol 132 (6) ◽

pp. 1675-1682 ◽

Cited By ~ 5

Author(s):

Jin Wook Kim ◽

Hee-Won Jung ◽

Yong Hwy Kim ◽

Chul-Kee Park ◽

Hyun-Tai Chung ◽

...

Keyword(s):

Adjuvant Treatment ◽

Management Strategies ◽

Local Tumor Control ◽

Tumor Control ◽

Years Of Experience ◽

Local Tumor ◽

Long Term Outcomes ◽

Single Institution ◽

Petroclival Meningiomas

OBJECTIVEA thorough investigation of the long-term outcomes and chronological changes of multimodal treatments for petroclival meningiomas is required to establish optimal management strategies. The authors retrospectively reviewed the long-term clinical outcomes of patients with petroclival meningioma according to various treatments, including various surgical approaches, and they suggest treatment strategies based on 30 years of experience at a single institution.METHODSNinety-two patients with petroclival meningiomas were treated surgically at the authors’ institution from 1986 to 2015. Patient demographics, overall survival, local tumor control rates, and functional outcomes according to multimodal treatments, as well as chronological change in management strategies, were evaluated. The mean clinical and radiological follow-up periods were 121 months (range 1–368 months) and 105 months (range 1–348 months), respectively.RESULTSA posterior transpetrosal approach was most frequently selected and was followed in 44 patients (48%); a simple retrosigmoid approach, undertaken in 30 patients, was the second most common. The initial extent of resection and following adjuvant treatment modality were classified into 3 subgroups: gross-total resection (GTR) only in 13 patients; non-GTR treatment followed by adjuvant radiosurgery or radiation therapy (non-GTR+RS/RT) in 56 patients; and non-GTR without adjuvant treatment (non-GTR only) in 23 patients. The overall progression-free survival rate was 85.8% at 5 years and 81.2% at 10 years. Progression or recurrence rates according to each subgroup were 7.7%, 12.5%, and 30.4%, respectively.CONCLUSIONSThe authors’ preferred multimodal treatment strategy, that of planned incomplete resection and subsequent adjuvant radiosurgery, is a feasible option for the management of patients with large petroclival meningiomas, considering both local tumor control and postoperative quality of life.

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Stereotactic radiosurgery versus stereotactic radiotherapy for patients with vestibular schwannoma: a Leksell Gamma Knife Society 2000 debate

Journal of Neurosurgery ◽

10.3171/jns.2000.93.supplement_3.0090 ◽

2000 ◽

Vol 93 (supplement_3) ◽

pp. 90-92 ◽

Cited By ~ 48

Author(s):

Mark E. Linskey

Keyword(s):

Gamma Knife ◽

Stereotactic Radiotherapy ◽

Three Dimensional ◽

Late Recurrence ◽

Vestibular Schwannomas ◽

Tumor Control ◽

Complication Rates ◽

Content Type ◽

Single Fraction ◽

Fine Print

✓ By definition, the term “radiosurgery” refers to the delivery of a therapeutic radiation dose in a single fraction, not simply the use of stereotaxy. Multiple-fraction delivery is better termed “stereotactic radiotherapy.” There are compelling radiobiological principles supporting the biological superiority of single-fraction radiation for achieving an optimal therapeutic response for the slowly proliferating, late-responding, tissue of a schwannoma. It is axiomatic that complication avoidance requires precise three-dimensional conformality between treatment and tumor volumes. This degree of conformality can only be achieved through complex multiisocenter planning. Alternative radiosurgery devices are generally limited to delivering one to four isocenters in a single treatment session. Although they can reproduce dose plans similar in conformality to early gamma knife dose plans by using a similar number of isocenters, they cannot reproduce the conformality of modern gamma knife plans based on magnetic resonance image—targeted localization and five to 30 isocenters. A disturbing trend is developing in which institutions without nongamma knife radiosurgery (GKS) centers are championing and/or shifting to hypofractionated stereotactic radiotherapy for vestibular schwannomas. This trend appears to be driven by a desire to reduce complication rates to compete with modern GKS results by using complex multiisocenter planning. Aggressive advertising and marketing from some of these centers even paradoxically suggests biological superiority of hypofractionation approaches over single-dose radiosurgery for vestibular schwannomas. At the same time these centers continue to use the term radiosurgery to describe their hypofractionated radiotherapy approach in an apparent effort to benefit from a GKS “halo effect.” It must be reemphasized that as neurosurgeons our primary duty is to achieve permanent tumor control for our patients and not to eliminate complications at the expense of potential late recurrence. The answer to minimizing complications while maintaining maximum tumor control is improved conformality of radiosurgery dose planning and not resorting to homeopathic radiosurgery doses or hypofractionation radiotherapy schemes.

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