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Ehret F, Kohlhase N, Eftimova D, Hofmann T, Fürweger C, Haidenberger A, Kufeld M, Muacevic A, Santacroce A. Self-Shielding Gyroscopic Radiosurgery: A Prospective Experience and Analysis of the First 100 Patients. Cureus 2024; 16:e56035. [PMID: 38606262 PMCID: PMC11008698 DOI: 10.7759/cureus.56035] [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] [Accepted: 03/10/2024] [Indexed: 04/13/2024] Open
Abstract
Background Stereotactic radiosurgery is a well-established treatment option for the management of various benign and malignant brain tumors. It can be delivered with several treatment platforms, usually requiring shielded radiation vaults to meet regulatory safety requirements. Recent technical advances have led to the first self-shielding platform enabling the delivery of gyroscopic radiosurgery (GRS). Given the limited number of GRS treatment platforms, the novelty of its characteristics, and the lack of available data, we report our prospective experience with the first 100 patients treated with GRS. Materials and methods Patients undergoing GRS for the treatment of intracranial tumors were enrolled in this prospective study. Patient and treatment characteristics, including patient satisfaction, were collected and analyzed. Results A total of 100 patients with 155 tumors were treated. The most commonly treated tumors comprised brain metastases (BM) (49%), vestibular schwannomas (31%), and meningiomas (14%). The median prescription dose for malignant and benign tumors was 20 and 13 Gy, respectively. The median prescription isodose line was 56%. Gross tumor volumes were small, with a median of 0.37 cc for BM and 0.92 cc for the other entities. The median total treatment time was 40 minutes. Dosimetric performance indices showed median values of 1.20 (conformity index), 1.24 (new conformity index), 1.74 (homogeneity index), and 3.13 (gradient index). Volumetric assessment of the treated tumors showed an overall decrease in size at the first available follow-up. Most patients were satisfied with the treatment experience. Conclusion Our first prospective experience of the use of GRS is favorable. Analyses of the dosimetric performance, treatment times, volumetric assessment, and patient satisfaction demonstrate its suitability for stereotactic treatments of intracranial tumors. Further prospective clinical and dosimetric analyses for GRS are pending.
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Affiliation(s)
- Felix Ehret
- Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, DEU
- Charité - Universitätsmedizin Berlin, German Cancer Consortium (DKTK) partner site Berlin, and German Cancer Research Center (DKFZ) Heidelberg, Berlin, DEU
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Nadja Kohlhase
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Dochka Eftimova
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Theresa Hofmann
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Christoph Fürweger
- Medical Physics, European Radiosurgery Center Munich, Munich, DEU
- Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, Cologne, DEU
| | | | - Markus Kufeld
- Radiosurgery, European Radiosurgery Center Munich, Munich, DEU
| | | | - Antonio Santacroce
- Radiosurgery, European Radiosurgery Center Munich, Munich, DEU
- Medicine, Faculty of Health, Witten/Herdecke University, Witten, DEU
- Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Hamm, DEU
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Wu B, Li S, Wang J, Wang J, Qiu W, Gao H. Bibliometric and visualization analysis of radiation brain injury from 2003 to 2023. Front Neurol 2024; 14:1275836. [PMID: 38298563 PMCID: PMC10828967 DOI: 10.3389/fneur.2023.1275836] [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: 08/12/2023] [Accepted: 12/15/2023] [Indexed: 02/02/2024] Open
Abstract
Background Over the past two decades, the field of radiation brain injury has attracted the attention of an increasing number of brain scientists, particularly in the areas of molecular pathology and therapeutic approaches. Characterizing global collaboration networks and mapping development trends over the past 20 years is essential. Objective The aim of this paper is to examine significant issues and future directions while shedding light on collaboration and research status in the field of radiation brain injury. Methods Bibliometric studies were performed using CiteSpaceR-bibliometrix and VOSviewer software on papers regarding radiation brain injury that were published before November 2023 in the Web of Science Core Collection. Results In the final analysis, we found 4,913 records written in 1,219 publications by 21,529 authors from 5,007 institutions in 75 countries. There was a noticeable increase in publications in 2014 and 2021. The majority of records listed were produced by China, the United States, and other high-income countries. The largest nodes in each cluster of the collaboration network were Sun Yat-sen University, University of California-San Francisco, and the University of Toronto. Galldiks N, Barnett GH, Langen KJ and Kim JH are known to be core authors in the field. The top 3 keywords in that time frame are radiation, radiation necrosis, and radiation-therapy. Conclusions The objective and thorough bibliometric analysis also identifies current research hotspots and potential future paths, providing a retrospective perspective on RBI and offering useful advice to researchers choosing research topics. Future development directions include the integration of multi-omics methodologies and novel imaging techniques to improve RBI's diagnostic effectiveness and the search for new therapeutic targets.
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Affiliation(s)
- Baofang Wu
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Shaojie Li
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Jian Wang
- Department of Pathology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Jiayin Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Weizhi Qiu
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Hongzhi Gao
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
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Hintelmann K, Petersen C, Borgmann K. Radiotherapeutic Strategies to Overcome Resistance of Breast Cancer Brain Metastases by Considering Immunogenic Aspects of Cancer Stem Cells. Cancers (Basel) 2022; 15:211. [PMID: 36612206 PMCID: PMC9818478 DOI: 10.3390/cancers15010211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Breast cancer is the most diagnosed cancer in women, and symptomatic brain metastases (BCBMs) occur in 15-20% of metastatic breast cancer cases. Despite technological advances in radiation therapy (RT), the prognosis of patients is limited. This has been attributed to radioresistant breast cancer stem cells (BCSCs), among other factors. The aim of this review article is to summarize the evidence of cancer-stem-cell-mediated radioresistance in brain metastases of breast cancer from radiobiologic and radiation oncologic perspectives to allow for the better interpretability of preclinical and clinical evidence and to facilitate its translation into new therapeutic strategies. To this end, the etiology of brain metastasis in breast cancer, its radiotherapeutic treatment options, resistance mechanisms in BCSCs, and effects of molecularly targeted therapies in combination with radiotherapy involving immune checkpoint inhibitors are described and classified. This is considered in the context of the central nervous system (CNS) as a particular metastatic niche involving the blood-brain barrier and the CNS immune system. The compilation of this existing knowledge serves to identify possible synergistic effects between systemic molecularly targeted therapies and ionizing radiation (IR) by considering both BCSCs' relevant resistance mechanisms and effects on normal tissue of the CNS.
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Affiliation(s)
- Katharina Hintelmann
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- Laboratory of Radiobiology and Experimental Radiooncology, Center of Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Cordula Petersen
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Kerstin Borgmann
- Laboratory of Radiobiology and Experimental Radiooncology, Center of Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Lehrer EJ, Kowalchuk RO, Ruiz-Garcia H, Merrell KW, Brown PD, Palmer JD, Burri SH, Sheehan JP, Quninoes-Hinojosa A, Trifiletti DM. Preoperative stereotactic radiosurgery in the management of brain metastases and gliomas. Front Surg 2022; 9:972727. [PMID: 36353610 PMCID: PMC9637863 DOI: 10.3389/fsurg.2022.972727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023] Open
Abstract
Stereotactic radiosurgery (SRS) is the delivery of a high dose ionizing radiation in a highly conformal manner, which allows for significant sparing of nearby healthy tissues. It is typically delivered in 1-5 sessions and has demonstrated safety and efficacy across multiple intracranial neoplasms and functional disorders. In the setting of brain metastases, postoperative and definitive SRS has demonstrated favorable rates of tumor control and improved cognitive preservation compared to conventional whole brain radiation therapy. However, the risk of local failure and treatment-related complications (e.g. radiation necrosis) markedly increases with larger postoperative treatment volumes. Additionally, the risk of leptomeningeal disease is significantly higher in patients treated with postoperative SRS. In the setting of high grade glioma, preclinical reports have suggested that preoperative SRS may enhance anti-tumor immunity as compared to postoperative radiotherapy. In addition to potentially permitting smaller target volumes, tissue analysis may permit characterization of DNA repair pathways and tumor microenvironment changes in response to SRS, which may be used to further tailor therapy and identify novel therapeutic targets. Building on the work from preoperative SRS for brain metastases and preclinical work for high grade gliomas, further exploration of this treatment paradigm in the latter is warranted. Presently, there are prospective early phase clinical trials underway investigating the role of preoperative SRS in the management of high grade gliomas. In the forthcoming sections, we review the biologic rationale for preoperative SRS, as well as pertinent preclinical and clinical data, including ongoing and planned prospective clinical trials.
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Affiliation(s)
- Eric J. Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Roman O. Kowalchuk
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Henry Ruiz-Garcia
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Kenneth W. Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Paul D. Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Joshua D. Palmer
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Stuart H. Burri
- Department of Radiation Oncology, Atrium Health, Charlotte, NC, United States
| | - Jason P. Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | | | - Daniel M. Trifiletti
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States,Correspondence: Daniel M. Trifiletti
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Rawls AE. Surgical Therapies for Parkinson Disease. Continuum (Minneap Minn) 2022; 28:1301-1313. [DOI: 10.1212/con.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Pérez P, Torres PR, Bruna A, Brunetto M, Aon E, Franco D, Mattea F, Figueroa R, Santibáñez M, Valente M. Fricke gel xylenol orange dosimeter layers for stereotactic radiosurgery: A preliminary approach. Appl Radiat Isot 2021; 178:109936. [PMID: 34592691 DOI: 10.1016/j.apradiso.2021.109936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 12/15/2022]
Abstract
Investigations regarding the feasibility, reliability, and accuracy of Fricke gel dosimeter layers for stereotactic radiosurgery are presented. A representative radiosurgery plan consisting of two targets has been investigated. Absorbed dose distributions measured using radiochromic films and gelatin Fricke Gel dosimetry in layers have been compared with dose distributions calculated by using a treatment planning system and Monte Carlo simulations. The different dose distributions have been compared by means of the gamma index demonstrating that gelatin Fricke gel dosimeter layers showed agreements of 100%, 100%, and 93%, with dose and distance tolerances of 2% and 2 mm, with respect to film dosimetry, treatment planning system and Monte Carlo simulations, respectively. The capability of the developed system for three-dimensional dose mapping was shown, obtaining promising results when compared with well-established dosimetry methods. The obtained results support the viability of Fricke gel dosimeter layers analyzed by optical methods for stereotactic radiosurgery.
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Affiliation(s)
- P Pérez
- Laboratorio de Investigación e Instrumentación en Física Aplicada a la Medicina e Imágenes de Rayos X (LIIFAMIR(x)), Facultad de Matemática, Astronomía, Física y Computación, Universidad Nacional de Córdoba, Córdoba, Argentina; Instituto de Física Enrique Gaviola (IFEG), CONICET, Córdoba, Argentina.
| | - P Rico Torres
- Laboratorio de Investigación e Instrumentación en Física Aplicada a la Medicina e Imágenes de Rayos X (LIIFAMIR(x)), Facultad de Matemática, Astronomía, Física y Computación, Universidad Nacional de Córdoba, Córdoba, Argentina; Instituto Venezolano de Investigaciones Científicas, Venezuela
| | - A Bruna
- FiMe - Física Médica SRL, Argentina
| | - M Brunetto
- Centro Médico Privado Deán Funes, Córdoba, Argentina
| | - E Aon
- Centro Médico Privado Deán Funes, Córdoba, Argentina
| | - D Franco
- Centro Médico Privado Deán Funes, Córdoba, Argentina
| | - F Mattea
- Laboratorio de Investigación e Instrumentación en Física Aplicada a la Medicina e Imágenes de Rayos X (LIIFAMIR(x)), Facultad de Matemática, Astronomía, Física y Computación, Universidad Nacional de Córdoba, Córdoba, Argentina; Departamento de Química Orgánica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Argentina; Instituto de Investigación y Desarrollo en Ingeniería de Procesos y Química Aplicada (IPQA), CONICET, Córdoba, Argentina
| | - R Figueroa
- Centro de excelencia de Física e Ingeniería en Salud (CFIS), Universidad de la Frontera, Temuco, Chile; Departamento de Ciencias Físicas, Universidad de la Frontera, Temuco, Chile
| | - M Santibáñez
- Departamento de Ciencias Físicas, Universidad de la Frontera, Temuco, Chile
| | - M Valente
- Laboratorio de Investigación e Instrumentación en Física Aplicada a la Medicina e Imágenes de Rayos X (LIIFAMIR(x)), Facultad de Matemática, Astronomía, Física y Computación, Universidad Nacional de Córdoba, Córdoba, Argentina; Instituto de Física Enrique Gaviola (IFEG), CONICET, Córdoba, Argentina; Centro de excelencia de Física e Ingeniería en Salud (CFIS), Universidad de la Frontera, Temuco, Chile; Departamento de Ciencias Físicas, Universidad de la Frontera, Temuco, Chile.
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Lara-Velazquez M, Shireman JM, Lehrer EJ, Bowman KM, Ruiz-Garcia H, Paukner MJ, Chappell RJ, Dey M. A Comparison Between Chemo-Radiotherapy Combined With Immunotherapy and Chemo-Radiotherapy Alone for the Treatment of Newly Diagnosed Glioblastoma: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:662302. [PMID: 34046356 PMCID: PMC8144702 DOI: 10.3389/fonc.2021.662302] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background Immunotherapy for GBM is an emerging field which is increasingly being investigated in combination with standard of care treatment options with variable reported success rates. Objective To perform a systematic review of the available data to evaluate the safety and efficacy of combining immunotherapy with standard of care chemo-radiotherapy following surgical resection for the treatment of newly diagnosed GBM. Methods A literature search was performed for published clinical trials evaluating immunotherapy for GBM from January 1, 2000, to October 1, 2020, in PubMed and Cochrane using PICOS/PRISMA/MOOSE guidelines. Only clinical trials with two arms (combined therapy vs. control therapy) were included. Outcomes were then pooled using weighted random effects model for meta-analysis and compared using the Wald-type test. Primary outcomes included 1-year overall survival (OS) and progression-free survival (PFS), secondary outcomes included severe adverse events (SAE) grade 3 or higher. Results Nine randomized phase II and/or III clinical trials were included in the analysis, totaling 1,239 patients. The meta-analysis revealed no statistically significant differences in group’s 1-year OS [80.6% (95% CI: 68.6%–90.2%) vs. 72.6% (95% CI: 65.7%–78.9%), p = 0.15] or in 1-year PFS [37% (95% CI: 26.4%–48.2%) vs. 30.4% (95% CI: 25.4%–35.6%) p = 0.17] when the immunotherapy in combination with the standard of care group (combined therapy) was compared to the standard of care group alone (control). Severe adverse events grade 3 to 5 were more common in the immunotherapy and standard of care group than in the standard of care group (47.3%, 95% CI: 20.8–74.6%, vs 43.8%, 95% CI: 8.7–83.1, p = 0.81), but this effect also failed to reach statistical significance. Conclusion Our results suggests that immunotherapy can be safely combined with standard of care chemo-radiotherapy without significant increase in grade 3 to 5 SAE; however, there is no statistically significant increase in overall survival or progression free survival with the combination therapy.
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Affiliation(s)
- Montserrat Lara-Velazquez
- Department of Neurosurgery, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, United States
| | - Jack M Shireman
- Department of Neurosurgery, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, United States
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kelsey M Bowman
- Department of Neurosurgery, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, United States
| | - Henry Ruiz-Garcia
- Department of Neurosurgery and Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Mitchell J Paukner
- Department of Statistics, Biostatistics and Medical Informatics, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, United States
| | - Richard J Chappell
- Department of Statistics, Biostatistics and Medical Informatics, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, United States
| | - Mahua Dey
- Department of Neurosurgery, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, United States
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