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Zhang H, Wu H, Lu J, Shao W, Yu L. Combined helical tomotherapy and Gamma Knife stereotactic radiosurgery for high-grade recurrent orbital meningioma: a case report. Front Oncol 2023; 13:1273465. [PMID: 37886178 PMCID: PMC10599143 DOI: 10.3389/fonc.2023.1273465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023] Open
Abstract
Orbital meningioma is a rare type of orbital tumor with high invasiveness and recurrence rates, making it extremely challenging to treat. Due to the special location of the disease, surgery often cannot completely remove the tumor, requiring postoperative radiation therapy. Here, we report a case of an elderly male patient with right-sided proptosis, visual impairment, and diplopia. Imaging diagnosis revealed a space-occupying lesion in the extraconal space of the right orbit. Pathological and immunohistochemical examination of the resected tumor confirmed it as a grade 3 anaplastic meningioma. Two months after surgery, the patient complained of right eye swelling and a magnetic resonance imaging (MRI) scan showed a recurrence of the tumor. The patient received helical tomotherapy (TOMO) in the postoperative tumor bed and high-risk areas within the orbit with a total dose of 48Gy. However, there was no significant improvement in the patient's right eye swelling, and the size of the recurrent lesion showed no significant change on imaging. Gamma knife multifractionated stereotactic radiosurgery (MF-SRS) was then given to the recurrent lesion with 50% prescription dose 13.5Gy/3f, once every other day. An imaging diagnosis performed 45 days later showed that the tumor had disappeared completely. The patient's vision remained unchanged, but diplopia was significantly relieved after MF-SRS. We propose a new hybrid treatment model for recurrent orbital meningioma, where conventional radiation therapy ensures local control of high-risk areas around the postoperative cavity, and MF-SRS maximizes the radiation dose to recurrent lesion areas while protecting surrounding tissues and organs.
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Affiliation(s)
- Haomiao Zhang
- Department of Radiation Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hanfeng Wu
- Department of Neurosurgery, Shanghai Gamma Hospital, Shanghai, China
| | - Jianjie Lu
- Department of Radiation Physics, Harbin Medical University Cancer Hospital, Harbin, China
| | - Wencheng Shao
- Department of Radiation Physics, Harbin Medical University Cancer Hospital, Harbin, China
| | - Lili Yu
- Department of Radiation Oncology, Harbin Medical University Cancer Hospital, Harbin, China
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2
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Fong CH, Heaton R, Liu ZA, Li K, van Prooijen M, Cho Y, Shultz DB, Tsang DS. Dosimetric evaluation of adult and paediatric brain tumours planned using mask-based cobalt-60 fractionated stereotactic radiotherapy compared to linear accelerator-based volumetric modulated arc therapy. J Med Radiat Sci 2023; 70:64-71. [PMID: 36181359 PMCID: PMC9977670 DOI: 10.1002/jmrs.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/10/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION We conducted a study to evaluate the dosimetric feasibility of mask-based cobalt-60 fractionated stereotactic radiotherapy (mcfSRT) with the Leksell Gamma Knife® Icon™ device. METHODS Eleven patients with intracranial tumours were selected for this dosimetry study. These patients, previously treated with volumetric arc therapy (VMAT), were re-planned using mcfSRT. Target volume coverage, conformity/gradient indices, doses to organs at risk and treatment times were compared between the mcfSRT and VMAT plans. Two-sided paired Wilcoxon signed-rank test was used to compare differences between the two plans. RESULTS The V95 for PTV was similar between fractionated mcfSRT and VMAT (P = 0.47). The conformity index and gradient indices were 0.9 and 3.3, respectively, for mcfSRT compared to 0.7 and 4.2, respectively, for VMAT (P < 0.001 and 0.004, respectively). The radiation exposure to normal brain was lower for mcfSRT across V10, V25 and V50 compared with VMAT (P = 0.007, <0.001 and <0.001, respectively). The median D0.1cc for optic nerve and chiasm as well as the median D50 to the hippocampi were lower for mcfSRT compared to VMAT. Median beam-on time for mcfSRT was 9.7 min per fraction, compared to 0.9 min for VMAT (P = 0.002). CONCLUSION mcfSRT plans achieve equivalent target volume coverage, improved conformity and gradient indices, and reduced radiation doses to organs at risk as compared with VMAT plans. These results suggest superior dosimetric parameters for mcfSRT plans and can form the basis for future prospective studies.
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Affiliation(s)
- Chin Heng Fong
- Radiation Medicine ProgramPrincess Margaret Cancer Centre, University Health NetworkTorontoOntarioCanada
| | - Robert Heaton
- Radiation Medicine ProgramPrincess Margaret Cancer Centre, University Health NetworkTorontoOntarioCanada
| | - Zhihui Amy Liu
- Department of BiostatisticsPrincess Margaret Cancer Centre, University Health NetworkTorontoOntarioCanada
| | - Kecheng Li
- Department of Statistics and Actuarial ScienceUniversity of WaterlooWaterlooOntarioCanada
| | - Monique van Prooijen
- Radiation Medicine ProgramPrincess Margaret Cancer Centre, University Health NetworkTorontoOntarioCanada
| | - Young‐Bin Cho
- Radiation Medicine ProgramPrincess Margaret Cancer Centre, University Health NetworkTorontoOntarioCanada
| | - David B. Shultz
- Radiation Medicine ProgramPrincess Margaret Cancer Centre, University Health NetworkTorontoOntarioCanada
| | - Derek S. Tsang
- Radiation Medicine ProgramPrincess Margaret Cancer Centre, University Health NetworkTorontoOntarioCanada
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Duggar WN, Morris B, He R, Yang C. Total workflow uncertainty of frameless radiosurgery with the Gamma Knife Icon cone-beam computed tomography. J Appl Clin Med Phys 2022; 23:e13564. [PMID: 35157361 PMCID: PMC9121051 DOI: 10.1002/acm2.13564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/29/2021] [Accepted: 02/01/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Frameless treatment with the Gamma Knife Icon is still relatively new as a treatment option. As a result, additional confidence/knowledge about the uncertainty that exists within each portion of the treatment workflow could be gained especially regarding steps that have not been previously studied in the literature. Methods The Icon base delivery device (Perfexion) uncertainty is quantified and validated. The novel portions of the Icon such as mask immobilization, cone‐beam computed tomography image guidance, and the intrafraction motion management methods are studied specifically and to a greater extent to determine a total workflow uncertainty of frameless treatment with the Icon. Results The uncertainty of each treatment workflow step has been identified with the total workflow uncertainty being identified in this work as 1.3 mm with a standard deviation of 0.51 mm. Conclusion The total uncertainty of frameless treatment with the Icon has been evaluated and this data may indicate the need for setup margin in this setting with data that could be used by other institutions to calculate needed setup margin per their preferred recipe after validation of this data in their context.
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Affiliation(s)
- William N Duggar
- Department of Radiation Oncology, University of MS Medical Center, Jackson, Mississippi, USA
| | - Bart Morris
- Department of Radiation Oncology, University of MS Medical Center, Jackson, Mississippi, USA
| | - Rui He
- Department of Radiation Oncology, University of MS Medical Center, Jackson, Mississippi, USA
| | - Claus Yang
- Department of Radiation Oncology, University of MS Medical Center, Jackson, Mississippi, USA
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Duggar WN, Morris B, He R, Yang CC. Predictors of Significant Patient Movement During Frameless Radiosurgery with the Gamma Knife® Icon™ Cone-Beam CT. Cureus 2022; 14:e21380. [PMID: 35198292 PMCID: PMC8853650 DOI: 10.7759/cureus.21380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/05/2022] Open
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Schasfoort J, Ruschin M, Sahgal A, MacDonald RL, Lee Y, van Pul C, Langenhuizen P, Hanssens P, Beute G, Wittkamper F, Sonke JJ. Quantifying the sensitivity of target dose on intra-fraction displacement in intra-cranial stereotactic radiosurgery. Pract Radiat Oncol 2021; 12:e221-e231. [PMID: 34929403 DOI: 10.1016/j.prro.2021.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/10/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND/PURPOSE Mask-immobilized stereotactic radiosurgery (SRS) using a gating window is an emerging technology. However, the amount of intracranial tumor motion that can be tolerated during treatment while satisfying clinical dosimetric goals is unknown. The purpose of this study was to quantify the sensitivity of target dose to tumor motion. METHODS In clinical SRS plans, where a nose marker was tracked as surrogate for target motion, translational and rotational target movements were simulated using nose-marker displacements of ±0.5mm, ±1.0mm or ±1.5mm. The effect on minimum dose to 99% of the target (D99) and percent target coverage by prescription dose was quantified using mixed-effect modelling with variables: displacement, target volume and location. RESULTS The effect on dose metrics is statistically larger for translational displacements compared to rotational displacements, and the effect of pitch rotations is statistically larger compared to yaw rotations. The mixed-effect model for translations showed that displacement and target volume are statistically significant variables, for rotation the variable target distance to rotation axis is additionally significant. For mean target volume (12.6cc) and translational nose-marker displacements of 0.5mm, 1.0mm, and 1.5mm, D99 decreased by 2.2%, 7.1% and 13.0%, and coverage by 0.4%, 1.8% and 4.4%, respectively. For mean target volume, mean distance midpoint-target to pitch axis (7.6cm), and rotational nose-marker displacement of 0.5mm, 1.0mm, and 1.5mm, D99 decreased by 1.0%, 3.6% and 6.9%, and coverage by 0.2%, 0.8% and 1.9%, respectively. For rotational yaw axis displacement, mean distance midpoint-target axis (4.2cm), D99 decreased by 0.3%, 1.2% and 2.5%, and coverage by 0.1%, 0.2% and 0.5%, respectively. CONCLUSION Simulated target displacements showed that sensitivity of tumor dose to motion depends on both target volume and target location. Suggesting that patient- and target-specific thresholds may be implemented for optimizing the balance between dosimetric plan accuracy and treatment prolongation caused by out-of-tolerance motion.
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Affiliation(s)
- Jannie Schasfoort
- Gamma Knife Center Tilburg, Department of Medical Physics, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - R Lee MacDonald
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Young Lee
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Carola van Pul
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Patrick Langenhuizen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Patrick Hanssens
- Gamma Knife Center Tilburg, Department of neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands; Gamma Knife Center Tilburg, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Guus Beute
- Gamma Knife Center Tilburg, Department of neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Frits Wittkamper
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Redistributing Central Target Dose Hot Spots for Hypofractionated Radiosurgery of Large Brain Tumors: A Proof-of-Principle Study. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021. [PMID: 34191065 DOI: 10.1007/978-3-030-69217-9_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
OBJECTIVE The present proof-of-principle study investigated radiobiological effects of redistributing central target dose hot spots across different treatment fractions during hypofractionated stereotactic radiosurgery (HSRS) of large intracranial tumors. METHODS Redistribution of central target dose hot spots during HSRS was simulated, and its effects were evaluated in eight cases of brain metastases. To assess dose variations in the target across N number of treatment fractions, a generalized biologically effective dose (gBED) was formulated. The gBED enhancement ratio was defined as the ratio of gBED in the tested treatment plan (with central target dose hot spot redistributions across fractions) to gBED in the conventional treatment plan (without central target dose hot spot redistributions). RESULTS At a median α value of 0.3/Gy, the tested treatment plans resulted in average gBED increases of 15.6 ± 3.5% and 8.3 ± 1.8% for α/β ratios of 2 and 10 Gy, respectively. In comparison with conventional treatment plans, the differences in the Paddick conformity index and gradient index did not exceed 2%. CONCLUSION Redistributing central target dose hot spots across different treatment fractions during HSRS may be considered promising for enhancing gBED in the target. It may be beneficial for management of large intracranial neoplasms; thus, it warrants further clinical testing.
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Spaniol M, Mai S, Zakrzewski T, Ehmann M, Stieler F. Inverse planning in Gamma Knife radiosurgery: A comparative planning study. Phys Med 2021; 82:269-278. [PMID: 33706117 DOI: 10.1016/j.ejmp.2021.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine the advantages of inverse planning using a prerelease version of Leksell Gamma Knife® (LGK) Lightning (Elekta AB, Sweden) compared to manual forward planning. METHODS Thirty-eight patients with metastases (MET, n = 15), vestibular schwannomas (VS, n = 11) and meningiomas (MEN, n = 12), treated with LGK Icon™ at our institution, were analyzed retrospectively. For each case, an inverse (inv) and inverse full coverage (fc) treatment plan was generated using LGK Lightning and compared to the clinical plans. Several dosimetry and efficiency characteristics were compared for each indication. The mean, median difference and interquartile range were reported and the significance was assessed with a paired-sample Wilcoxon test (significance level < 0.05). Further, the inter operator variability was analyzed for multiple users. RESULTS Inv and fc treatment plans show improved target coverage (up to 3.6%) for all analyzed paradigms. For inv plans, the selectivity is enhanced (MET: 2.9%; VS: 1.8%; MEN: 1%) and the organ at risk doses are significantly reduced (VS: up to 4.5%; MEN: up to 17.5%). For inv and fc plans, the beam on time (BOT) is shortened (MET: up to 7.9%; benign tumors: 49.5%). The inter operator variability analysis shows similar treatment plan quality with small differences in plan efficiency (difference in BOT: 1-3.3 min). CONCLUSIONS LGK Lightning allows to generate improved LGK treatment plans regarding plan quality with reduced BOT compared to manual forward plans. The inter operator variability showed that multiple users with different experiences can generate similar treatment plan quality using LGK Lightning.
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Affiliation(s)
- Manon Spaniol
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Sabine Mai
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tonja Zakrzewski
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Ehmann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Florian Stieler
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Takami H, Nassiri F, Moraes FY, Zadeh G, Bernstein M, Conrad T, Berlin A, Laperriere N, Millar BA, Shultz DB, Kongkham P. A Phase II Study of Neoadjuvant Stereotactic Radiosurgery for Large Brain Metastases: Clinical Trial Protocol. Neurosurgery 2021; 87:403-407. [PMID: 31673708 DOI: 10.1093/neuros/nyz442] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/05/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Brain metastases which require resection are treated with surgery followed by whole brain radiation therapy or postoperative cavity boost stereotactic radiosurgery (POCBS). Recently a novel strategy using neoadjuvant stereotactic radiosurgery (NaSRS) followed by resection was reported, demonstrating lower rates of postoperative leptomeningeal dissemination (LMD) and symptomatic radiation toxicity compared to a comparative cohort of patients treated with postoperative SRS. OBJECTIVE To determine if the rate of symptomatic radiation toxicity at 1 yr in patients who receive NaSRS differs significantly from historical rates for patients treated with POCBS. METHODS This is a multi-center, non-randomized, open phase II clinical trial. A total of 30 patients with up to 10 brain metastases, at least 1 of which is appropriate for surgical resection, will be enrolled for over 4 yr. All enrolled patients will be assigned to receive NaSRS followed by surgery. EXPECTED OUTCOME This study will clarify whether symptomatic radiation toxicity caused by NaSRS is significantly decreased compared to historical rates associated with POCBS. Secondary endpoints will include 1-yr local control (LC) of the treated lesion, 1-yr rates of LMD, median survival and 2-yr rates of progression-free and overall survival. Tertiary analyses will include correlation between LC and radiation toxicity with pretreatment clinical factors, serum markers, radiomic features, and molecular assessments of the resected tumors. DISCUSSION This prospective study will determine the toxicity associated with NaSRS and provide additional quantitative metrics of efficacy for future comparative trials.
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Affiliation(s)
- Hirokazu Takami
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Farshad Nassiri
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Fabio Y Moraes
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Mark Bernstein
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Tatiana Conrad
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Normand Laperriere
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Barbara-Ann Millar
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David Benjamin Shultz
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Paul Kongkham
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
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Bertholet J, Anastasi G, Noble D, Bel A, van Leeuwen R, Roggen T, Duchateau M, Pilskog S, Garibaldi C, Tilly N, García-Mollá R, Bonaque J, Oelfke U, Aznar MC, Heijmen B. Patterns of practice for adaptive and real-time radiation therapy (POP-ART RT) part II: Offline and online plan adaption for interfractional changes. Radiother Oncol 2020; 153:88-96. [PMID: 32579998 PMCID: PMC7758781 DOI: 10.1016/j.radonc.2020.06.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The POP-ART RT study aims to determine to what extent and how intrafractional real-time respiratory motion management (RRMM), and plan adaptation for interfractional anatomical changes (ART) are used in clinical practice and to understand barriers to implementation. Here we report on part II: ART using more than one plan per target per treatment course. MATERIALS AND METHODS A questionnaire on the current practice of ART, wishes for expansion or implementation, and barriers to implementation was distributed worldwide. Four types of ART were discriminated: daily online replanning, online plan library, protocolled offline replanning (all three based on a protocol), and ad-hoc offline replanning. RESULTS The questionnaire was completed by 177 centres from 40 countries. ART was used by 61% of respondents (31% with protocol) for a median (range) of 3 (1-8) tumour sites. CBCT/MVCT was the main imaging modality except for online daily replanning (11 users) where 10 users used MR. Two thirds of respondents wished to implement ART for a new tumour site; 40% of these had plans to do it in the next 2 years. Human/material resources and technical limitations were the main barriers to further use and implementation. CONCLUSIONS ART was used for a broad range of tumour sites, mainly with ad-hoc offline replanning and for a median of 3 tumour sites. There was a large interest in implementing ART for more tumour sites, mainly limited by human/material resources and technical limitations. Daily online replanning was primarily performed on MR-linacs.
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Affiliation(s)
- Jenny Bertholet
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, United Kingdom; Division of Medical Radiation Physics, Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Gail Anastasi
- Department of Medical Physics, Royal Surrey County Hospital, St. Luke's Cancer Centre, Guildford, United Kingdom
| | - David Noble
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, United Kingdom
| | - Arjan Bel
- Amsterdam UMC, Department of Radiation Oncology, The Netherlands
| | - Ruud van Leeuwen
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Toon Roggen
- Applied Research, Varian Medical Systems Imaging Laboratory GmbH, Dättwil, Switzerland
| | | | - Sara Pilskog
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway; Department of Physics and Technology, University of Bergen, Norway
| | - Cristina Garibaldi
- IEO, European Institute of Oncology IRCCS, Unit of Radiation Research, Milan, Italy
| | - Nina Tilly
- Elekta Instruments AB, Stockholm, Sweden; Medical Radiation Physics, Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Rafael García-Mollá
- Servicio de Radiofísica y Protección Radiológica, Consorcio Hospital General Universitario de Valencia, Spain
| | - Jorge Bonaque
- Servicio de Radiofísica y Protección Radiológica, Consorcio Hospitalario Provincial de Castellón, Castelló de la Plana, Spain
| | - Uwe Oelfke
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, United Kingdom
| | - Marianne C Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, United Kingdom; Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Ben Heijmen
- Erasmus MC Cancer Institute, Department of Radiation Oncology, Rotterdam, The Netherlands
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Joshi KC, Raghavan A, Muhsen B, Hsieh J, Borghei-Razavi H, Chao ST, Barnett GH, Suh JH, Neyman G, Kshettry VR, Recinos PF, Mohammadi AM, Angelov L. Fractionated Gamma Knife radiosurgery for skull base meningiomas: a single-institution experience. Neurosurg Focus 2020; 46:E8. [PMID: 31153152 DOI: 10.3171/2019.3.focus1963] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEGamma Knife radiosurgery (GKRS) has been successfully used for the treatment of intracranial meningiomas given its steep dose gradients and high-dose conformality. However, treatment of skull base meningiomas (SBMs) may pose significant risk to adjacent radiation-sensitive structures such as the cranial nerves. Fractionated GKRS (fGKRS) may decrease this risk, but until recently it has not been practical with traditional pin-based systems. This study reports the authors' experience in treating SBMs with fGKRS, using a relocatable, noninvasive immobilization system.METHODSThe authors performed a retrospective review of all patients who underwent fGKRS for SBMs between 2013 and 2018 delivered using the Extend relocatable frame system or the Icon system. Patient demographics, pre- and post-GKRS tumor characteristics, perilesional edema, prior treatment details, and clinical symptoms were evaluated. Volumetric analysis of pre-GKRS, post-GKRS, and subsequent follow-up visits was performed.RESULTSTwenty-five patients met inclusion criteria. Nineteen patients were treated with the Icon system, and 6 patients were treated with the Extend system. The mean pre-fGKRS tumor volume was 7.62 cm3 (range 4.57-13.07 cm3). The median margin dose was 25 Gy delivered in 4 (8%) or 5 (92%) fractions. The median follow-up time was 12.4 months (range 4.7-17.4 months). Two patients (9%) experienced new-onset cranial neuropathy at the first follow-up. The mean postoperative tumor volume reduction was 15.9% with 6 patients (27%) experiencing improvement of cranial neuropathy at the first follow-up. Median first follow-up scans were obtained at 3.4 months (range 2.8-4.3 months). Three patients (12%) developed asymptomatic, mild perilesional edema by the first follow-up, which remained stable subsequently.CONCLUSIONSfGKRS with relocatable, noninvasive immobilization systems is well tolerated in patients with SBMs and demonstrated satisfactory tumor control as well as limited radiation toxicity. Future prospective studies with long-term follow-up and comparison to single-session GKRS or fractionated stereotactic radiotherapy are necessary to validate these findings and determine the efficacy of this approach in the management of SBMs.
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Affiliation(s)
- Krishna C Joshi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | | | - Baha'eddin Muhsen
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Jason Hsieh
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
| | - Hamid Borghei-Razavi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Samuel T Chao
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gene H Barnett
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - John H Suh
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gennady Neyman
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Varun R Kshettry
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Pablo F Recinos
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Alireza M Mohammadi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Lilyana Angelov
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
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11
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Grimm MA, Köppen U, Stieler F, Welzel G, Ruder AM, Polednik M, Wenz F, Mai SK, Giordano FA. Prospective assessment of mask versus frame fixation during Gamma Knife treatment for brain metastases. Radiother Oncol 2020; 147:195-199. [PMID: 32416280 DOI: 10.1016/j.radonc.2020.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/14/2020] [Accepted: 05/08/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The newest generation of the Leksell Gamma Knife (GK) allows frame based as well as frameless treatment. We here report outcomes of a prospective non-randomized study on mask fixation (MF) versus frame fixation (FF) for GK treatment of brain metastases. METHODS The decision for FF or MF was made on a case-by-case basis. Factors considered were patients' preference, proximity of critical structures, V12 and treatment time. Either stereotactic radiosurgery or fractionated stereotactic radiotherapy in up to 3 fractions was performed. For MF, a PTV margin of 1 mm was added. Follow-up included quarterly MRI scans. The primary outcome was local control. Secondary endpoints were progression-free survival (PFS), overall survival (OS) and the incidence of radionecrosis. RESULTS A total of 197 lesions (169 FF and 28 MF) were treated in 76 patients (59 FF and 17 MF). 187 lesions were treated with SRS and 10 with FSRT. Median dose was 22 Gy in both groups and median follow-up was 9.3 months. There was a higher local failure rate (HR: 3.69; 95%CI: 1.13-12.0; p = 0.03) with 11 local failures in the FF and none in the MF cohort. No differences were observed between the groups for OS (median: n.r. vs. 16.9 months; HR:1.00; 95%CI: 0.41-2.46; p = 0.999) and PFS (median: 6.9 vs. 8.4 months; HR: 0.92; 95%CI: 0.47-1.79; p = 0.800). Three cases of radionecrosis occurred with FF but none with MF (p = 0.67). CONCLUSIONS Gamma Knife treatment with MF does not result in worse outcome or increased rates of radionecrosis in this non-randomized study.
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Affiliation(s)
- Mario A Grimm
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - Ulrich Köppen
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - Florian Stieler
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - Grit Welzel
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - Arne Mathias Ruder
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - Martin Polednik
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany; University Medical Center Freiburg, Germany
| | - Sabine K Mai
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany; Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany.
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Brehmer S, Grimm MA, Förster A, Seiz-Rosenhagen M, Welzel G, Stieler F, Wenz F, Groden C, Mai S, Hänggi D, Giordano FA. Study Protocol: Early Stereotactic Gamma Knife Radiosurgery to Residual Tumor After Surgery of Newly Diagnosed Glioblastoma (Gamma-GBM). Neurosurgery 2020; 84:1133-1137. [PMID: 29688510 DOI: 10.1093/neuros/nyy156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/27/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Glioblastoma (GBM) is the most common malignant brain tumor in adult patients. Tumor recurrence commonly occurs around the resection cavity, especially after subtotal resection (STR). Consequently, the extent of resection correlates with overall survival (OS), suggesting that depletion of postoperative tumor remnants will improve outcome. OBJECTIVE To assess safety and efficacy of adding stereotactic radiosurgery (SRS) to the standard treatment of GBM in patients with postoperative residual tumor. METHODS Gamma-GBM is a single center, open-label, prospective, single arm, phase II study that includes patients with newly diagnosed GBM (intraoperative via frozen sections) who underwent STR (residual tumor will be identified by native and contrast enhanced T1-weighted magnetic resonance imaging scans). All patients will receive SRS with 15 Gy (prescribed to the 50% isodose enclosing all areas of residual tumor) early (within 24-72 h) after surgery. Thereafter, all patients undergo standard-of-care therapy for GBM (radiochemotherapy with 60 Gy external beam radiotherapy [EBRT] plus concomitant temozolomide and 6 cycles of adjuvant temozolomide chemotherapy). The primary outcome is median progression-free survival, secondary outcomes are median OS, occurrence of radiation induced acute (<3 wk), early delayed (<3 mo), and late (>3 mo post-SRS) neurotoxicity and incidence of symptomatic radionecrosis. EXPECTED OUTCOMES We expect to detect efficacy and safety signals by the immediate application of SRS to standard-of-care therapy in newly diagnosed GBM. DISCUSSION Early postoperative SRS to areas of residual tumor could bridge the therapeutic gap between surgery and adjuvant therapies.
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Affiliation(s)
- Stefanie Brehmer
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Mario Alexander Grimm
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Alex Förster
- Department of Neuroradiology, Uni-versity Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Grit Welzel
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Florian Stieler
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Frederik Wenz
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Christoph Groden
- Department of Neuroradiology, Uni-versity Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Sabine Mai
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Frank Anton Giordano
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
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Chamunyonga C, Rutledge P, Caldwell PJ, Burbery J, Hargrave C. The Application of the Virtual Environment for Radiotherapy Training to Strengthen IGRT Education. J Med Imaging Radiat Sci 2020; 51:207-213. [PMID: 32220573 DOI: 10.1016/j.jmir.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/31/2020] [Accepted: 02/12/2020] [Indexed: 12/13/2022]
Abstract
The use of simulation to enhance the quality of preclinical teaching and learning in radiation therapy is increasing. This article discusses the use of the Virtual Environment for Radiotherapy Training (VERT) in supporting teaching on image-guided radiation therapy (IGRT) and image matching concepts. The authors review the capabilities of VERT and discuss how it is currently applied in undergraduate radiation therapy teaching. The integration of IGRT theory with hands-on image matching practice using VERT simulation in educational environments has many potential benefits. These include the potential to strengthen the students' knowledge and skills in online-image acquisition and review of planar two-dimensional images and cone beam computed tomography images. It is anticipated that learner engagement will improve as well as refine analytical skills and confident practice in critical assessment of IGRT images. The authors encourage the utilization of technology that provides students with hands-on skills so they are better prepared for clinical environments.
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Affiliation(s)
- Crispen Chamunyonga
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Peta Rutledge
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter J Caldwell
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie Burbery
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Catriona Hargrave
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia; Radiation Oncology Princess Alexandra Hospital-Raymond Terrace Campus, Brisbane, Queensland, Australia
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MacDonald RL, Lee Y, Schasfoort J, Soliman H, Sahgal A, Ruschin M. Real-Time Infrared Motion Tracking Analysis for Patients Treated With Gated Frameless Image Guided Stereotactic Radiosurgery. Int J Radiat Oncol Biol Phys 2019; 106:413-421. [PMID: 31655198 DOI: 10.1016/j.ijrobp.2019.10.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/24/2019] [Accepted: 10/18/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The transition from frame-based brain stereotactic radiosurgery (SRS) to frameless delivery is supported by real-time intrafraction monitoring to ensure accurate delivery. The purpose of this study is to characterize these real-time motion traces in a large cohort of patients treated with frameless gated brain SRS and to develop patient-specific predictions of tolerance violations. METHODS AND MATERIALS SRS patients treated on the Gamma Knife Icon were immobilized using a device-specific thermoplastic head mask. A motion marker was fixed to the patient's nose, with gating and cone beam computed tomography (CBCT)-based corrections to the treatment at excursions from baseline exceeding 1.5 mm. The traces of 1446 fractions were analyzed according to magnitude (932 unique treatment plans for 462 unique individual patients), directional distribution of displacement, and stability. A neural network model was developed to predict interruptions based on a subset of trace data. RESULTS The average displacement of the marker in the first fraction of all patients was 0.62 ± 0.25 mm with beam CBCT corrections, which would otherwise be modeled at 0.96 ± 0.96 mm without intrafraction motion correction (P < .0001). Twenty-nine percent of fractions delivered were interrupted, of which the Z-axis (superoinferior) motion was the largest contributor to excursion. Baseline corrections significantly compensated for the magnitude of motion in all 3 dimensions (P < .01). The motion relative to the first acquired CBCT was on average seen to consistently increase with treatment time, with the minimum P value occurring at 61.3 minutes. The neural network prediction model was able to predict treatment interruptions with 84% sensitivity on the first 5-minute sample of the trace. CONCLUSIONS Corrections to marker position significantly decreased marker excursions in all 3 axes compared with a single CBCT alignment. Patient-specific modeling may aid in the optimization of cases selected for frameless radiosurgery to increase the accuracy of planned delivery.
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Affiliation(s)
- R Lee MacDonald
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Young Lee
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Wright G, Schasfoort J, Harrold N, Hatfield P, Bownes P. Intra-fraction motion gating during frameless Gamma Knife ® Icon™ therapy: The relationship between cone beam CT assessed intracranial anatomy displacement and infrared-tracked nose marker displacement. JOURNAL OF RADIOSURGERY AND SBRT 2019; 6:67-76. [PMID: 30775076 PMCID: PMC6355448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/27/2018] [Indexed: 06/09/2023]
Abstract
METHODS Gamma Knife Icon™'s high-definition motion management (HDMM) system gates treatment delivery should intra-fraction displacement of a nose marker exceed some user-defined threshold. A method, previously-validated with a phantom, is used to relate intra-fractional displacements of the nose marker to displacements of patient targets. Additionally, novel analysis is performed to ascertain the relationship between nose marker displacement and displacement of a 3D grid of coordinates throughout stereotactic space. This spatial information is used to retrospectively review HDMM threshold levels based upon real target locations. RESULTS For 41 targets from 22 patients, the mean(standard deviation) and maximum target-to-nose displacement ratio was 0.54(0.32) and 1.65, respectively. On average, displacements typically exceed those of the nose only for coordinates at the most extreme peripheral corner of the investigated 3D grid of points. Allowing target displacement of up to a maximum of 0.8mm, retrospective review indicated that at the locations of the 41 targets a median(range) HDMM threshold of 1.4(1.0-1.9) mm could have been adopted, compared to our standard threshold of 1.0mm. CONCLUSIONS Intracranial targets typically displace by a magnitude around half that of the nose. Novel analysis to determine the spatial variation of target-to-nose displacement ratio suggests, for our 41 targets, HDMM threshold could have been increased from our standard. Cases for which HDMM threshold could be safely increased would minimise treatment gating events and expedite treatment delivery to offer patient comfort benefits.
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Affiliation(s)
- Gavin Wright
- Leeds Cancer Centre, St. James’s University Hospital, Leeds, LS9 7TF, UK
| | | | - Natalie Harrold
- Leeds Cancer Centre, St. James’s University Hospital, Leeds, LS9 7TF, UK
| | - Paul Hatfield
- Leeds Cancer Centre, St. James’s University Hospital, Leeds, LS9 7TF, UK
| | - Peter Bownes
- Leeds Cancer Centre, St. James’s University Hospital, Leeds, LS9 7TF, UK
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Leroy HA, Tuleasca C, Reyns N, Levivier M. Radiosurgery and fractionated radiotherapy for cavernous sinus meningioma: a systematic review and meta-analysis. Acta Neurochir (Wien) 2018; 160:2367-2378. [PMID: 30393820 DOI: 10.1007/s00701-018-3711-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/16/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Radiosurgery (RS) and fractionated radiotherapy (FRT) are part of the therapeutic armamentarium for the management of cavernous sinus meningiomas. We propose a systematic review of the local tumor control and clinical outcomes after monofractionated radiosurgical treatment, including gamma knife radiosurgery (GKRS) and linear accelerator (Linac RS), or fractionated radiotherapy. MATERIALS AND METHODS The current review and meta-analysis adhered to the PRISMA guidelines. We performed a search in PubMed, Embase, and Medline based on the following mesh terms, used alone or in diverse combinations, in both title and abstract: "cavernous sinus," "meningioma," "radiosurgery," "gamma knife," "linac," "cyberknife," and "radiotherapy". We screened 425 studies. We selected 36 studies, matching all selection criteria: 24 for GK, 5 for Linac, and 7 for FRT. RESULTS Were included 2817 patients (GKRS, n = 2047, LinacRS, n = 350, FRT, n = 420). Half of patients benefited from upfront RS or FRT; the other half benefited from adjuvant RS or FRT (combined approach or tumor recurrence). The mean gross target volume (GTV) was smaller for RS as compared to FRT (p = 0.07). The median marginal doses were 13.9 Gy (range, 11 to 28) for GKRS and 14 Gy (range, 12.8 to 17.7) for LinacRS. For FRT, patients received a mean dose of 51.2 Gy (25.5 fractions, 1.85 Gy each). The mean overall follow-up values were 48 months (range, 15 to 89) for GKRS, 69 months (range, 46 to 87) for Linac, and 59.5 months (range, 33 to 83) for FRT. PFS at 5 years for GKRS, LinacRS, and FRT were respectively 93.6%, 95.6%, and 97.4% (p = 0.32, the Kruskal-Wallis). Monofractionated treatments (GKRS and LinacRS) induced more tumor volume regression than FRT (p = 0.001). Tumor recurrence or progression ranged between 3 and 5.8%, without statistically significant differences between modalities (p > 0.05). Trigeminal symptoms improved in approximately 54%, and III-IV-VI cranial nerves (CN) palsies improved in approximately 45%. After GKRS, visual acuity improved in 21% (not enough data available for other modalities). De novo deficits occurred in 5 to 7.5%. Adverse radiation effects appeared in 4.6 to 9.3% (all techniques pooled). CONCLUSION RS achieved a twice-higher rate of tumor volume regression than FRT. GKRS series reported an improvement in visual acuity in 21% of the cases. GKRS, Linac, and FRT provided similar clinical post therapeutic outcomes for the trigeminal and oculomotor CN.
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Affiliation(s)
- Henri-Arthur Leroy
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
- Department of Neurosurgery and Neuro-oncology, CHU Lille, F-59000, Lille, France.
- Department of Neurosurgery, Lille University Hospital, Rue Emile Laine, 59037, Lille Cedex, France.
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Signal Processing Laboratory (LTS-5), Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Nicolas Reyns
- Department of Neurosurgery and Neuro-oncology, CHU Lille, F-59000, Lille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Black PJ, Smith DR, Chaudhary K, Xanthopoulos EP, Chin C, Spina CS, Hwang ME, Mayeda M, Wang YF, Connolly EP, Wang TJC, Wuu CS, Hei TK, Cheng SK, Wu CC. Velocity-based Adaptive Registration and Fusion for Fractionated Stereotactic Radiosurgery Using the Small Animal Radiation Research Platform. Int J Radiat Oncol Biol Phys 2018; 102:841-847. [PMID: 29891199 DOI: 10.1016/j.ijrobp.2018.04.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To implement Velocity-based image fusion and adaptive deformable registration to enable treatment planning for preclinical murine models of fractionated stereotactic radiosurgery (fSRS) using the small animal radiation research platform (SARRP). METHODS AND MATERIALS C57BL6 mice underwent 3 unique cone beam computed tomography (CBCT) scans: 2 in the prone position and a third supine. A single T1-weighted post-contrast magnetic resonance imaging (MRI) series of a murine metastatic brain tumor model was selected for MRI-to-CBCT registration and gross tumor volume (GTV) identification. Two arms were compared: Arm 1, where we performed 3 individual MRI-to-CBCT fusions using rigid registration, contouring GTVs on each, and Arm 2, where the authors performed MRI-to-CBCT fusion and contoured GTV on the first CBCT followed by Velocity-based adaptive registration. The first CBCT and associated GTV were exported from MuriPlan (Xstrahl Life Sciences) into Velocity (Varian Medical Systems, Inc, Palo Alto, CA). In Arm 1, the second and third CBCTs were exported similarly along with associated GTVs (Arm 1), while in Arm 2, the first (prone) CBCT was fused separately to the second (prone) and third (supine) CBCTs, performing deformable registrations on initial CBCTs and applying resulting matrices to the contoured GTV. Resulting GTVs were compared between Arms 1 and 2. RESULTS Comparing GTV overlays using repeated MRI fusion and GTV delineation (Arm 1) versus those of Velocity-based CBCT and GTV adaptive fusion (Arm 2), mean deviations ± standard deviation in the axial, sagittal, and coronal planes were 0.46 ± 0.16, 0.46 ± 0.22, and 0.37 ± 0.22 mm for prone-to-prone and 0.52 ± 0.27, 0.52 ± 0.36, and 0.68 ± 0.31 mm for prone-to-supine adaptive fusions, respectively. CONCLUSIONS Velocity-based adaptive fusion of CBCTs and contoured volumes allows for efficient fSRS planning using a single MRI-to-CBCT fusion. This technique is immediately implementable on current SARRP systems, facilitating advanced preclinical treatment paradigms using existing clinical treatment planning software.
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Affiliation(s)
- Paul J Black
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
| | - Deborah R Smith
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
| | - Kunal Chaudhary
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
| | - Eric P Xanthopoulos
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
| | - Christine Chin
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
| | - Catherine S Spina
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
| | - Mark E Hwang
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
| | - Mark Mayeda
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
| | - Yi-Fang Wang
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
| | - Eileen P Connolly
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York; Department of Neurological Surgery, Columbia University Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York
| | - Cheng-Shie Wuu
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
| | - Tom K Hei
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York; Center for Radiological Research, Columbia University, New York, New York
| | - Simon K Cheng
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
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Sharma M, Meola A, Bellamkonda S, Jia X, Montgomery J, Chao ST, Suh JH, Angelov L, Barnett GH. Long-Term Outcome Following Stereotactic Radiosurgery for Glomus Jugulare Tumors: A Single Institution Experience of 20 Years. Neurosurgery 2018; 83:1007-1014. [PMID: 29228343 DOI: 10.1093/neuros/nyx566] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/17/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Glomus jugulare tumors (GJTs) are rare benign tumors, which pose significant treatment challenges due to proximity to critical structures. OBJECTIVE To evaluate the long-term clinical and radiological outcome in patients undergoing stereotactic radiosurgery (SRS) for GJTs through retrospective study. METHODS Forty-two patients with 43 GJTs were treated using Gamma Knife radiosurgery (GKRS; Elekta AB, Stockholm, Sweden) at our institute from 1997 to 2016. Clinical, imaging, and radiosurgery data were collected from an institutional review board approved database. RESULTS Most patients were females (n = 35, 83.3%) and median age was 61 yr (range 23-88 yr). Median tumor volume and diameter were 5 cc and 3 cm, respectively, with a median follow-up of 62.3 mo (3.4-218.6 mo). Overall, 20 patients (47.6%) improved clinically and 14 (33.3%) remained unchanged at last follow-up. New onset or worsening of hearing loss was noted in 6 patients (17.2%) after SRS. The median prescription dose to the tumor margin was 15 Gy (12-18 Gy). Median reduction in tumor volume and maximum tumor diameter at last follow-up was 33.3% and 11.54%, respectively. The 5-yr and 10-yr tumor control rates were 87% ± 6% and 69% ± 13%, respectively. There was no correlation between maximum or mean dose to the internal acoustic canal and post-GK hearing loss (P > .05). CONCLUSION SRS is safe and effective in patients with GJTs and results in durable, long-term control. SRS has lower morbidity than that associated with surgical resection, particularly lower cranial nerve dysfunction, and can be a first-line management option in these patients.
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Affiliation(s)
- Mayur Sharma
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Antonio Meola
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sushma Bellamkonda
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Xuefei Jia
- Department of Biostatistics, Cleveland Clinic, Cleveland, Ohio
| | - Joshua Montgomery
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samuel T Chao
- Cleveland Clinic Taussig Cancer Institute, Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - John H Suh
- Cleveland Clinic Taussig Cancer Institute, Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Lilyana Angelov
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gene H Barnett
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Validation of frame-based positioning accuracy with cone-beam computed tomography in Gamma Knife Icon radiosurgery. Phys Med 2018; 52:93-97. [DOI: 10.1016/j.ejmp.2018.06.640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/29/2018] [Accepted: 06/30/2018] [Indexed: 11/23/2022] Open
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Ruschin M, Sahgal A, Soliman H, Myrehaug S, Tseng CL, Bola R, Yeboah C, Sarfehnia A, Chugh B, Eriksson M, Nordström H, Lee Y. Clinical Image Coregistration Variability on a Dedicated Radiosurgery Unit. Neurosurgery 2018; 85:E101-E108. [DOI: 10.1093/neuros/nyy334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/19/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mark Ruschin
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Hany Soliman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Ruby Bola
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Collins Yeboah
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Arman Sarfehnia
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Brige Chugh
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Young Lee
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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Stereotactic radiotherapy as primary definitive or postoperative treatment of intracranial meningioma of WHO grade II and III leads to better disease control than stereotactic radiotherapy of recurrent meningioma. J Neurooncol 2017; 134:407-416. [DOI: 10.1007/s11060-017-2540-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 06/25/2017] [Indexed: 10/19/2022]
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Tuleasca C, Leroy HA, Régis J, Levivier M. Gamma Knife radiosurgery for cervical spine lesions: expanding the indications in the new era of Icon. Acta Neurochir (Wien) 2016; 158:2235-2236. [PMID: 27663880 DOI: 10.1007/s00701-016-2962-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/07/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Rue de Bugnon 44-46, BH-08, Lausanne, 1011, Switzerland.
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
- Faculty of Biology and Medicine (FBM), University of Lausanne, Lausanne, Switzerland.
| | - Henri-Arthur Leroy
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Rue de Bugnon 44-46, BH-08, Lausanne, 1011, Switzerland
- Centre Hospitalier Régional Universitaire de Lille, Division of Neurosurgery, Lille, France
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Rue de Bugnon 44-46, BH-08, Lausanne, 1011, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne, Lausanne, Switzerland
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