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Zach L, Agami A, Furman O, Attia M, Cohen Z, Mizrachi IBB, Tam G, Zibly Z, Nissim O, Spiegelmann R, Huna-Baron R. Neuro-ophthalmologic outcomes of standard versus hypo-fractionated stereotactic radiotherapy of AVPM. Radiat Oncol 2021; 16:166. [PMID: 34454551 PMCID: PMC8403384 DOI: 10.1186/s13014-021-01879-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most anterior visual pathway meningiomas (AVPM) are benign and slow-growing, but these tumors may affect visual functions, including visual acuity (VA) and visual field (VF). Due to location, most are treated non-surgically by fractionated stereotactic radiotherapy (FSRT), aiming to prevent tumor progression and visual functions deterioration. Unfortunately, FSRT in itself may affect visual functions. The current preferred treatment regimen (in terms of safety and effectiveness) is undetermined. While most cases are treated with conventional fractionation (cFSRT)-50.4-54 Gy in 28-30 fractions of 1.8-2 Gy, advances in technology have allowed shortening of total treatment length to hypofractionation (hSRT)-25-27 Gy in 3-5 fractions of 5-9 Gy. Our aim was to evaluate the association of radiotherapy regimen for treating AVPM (cFSRT vs. hSRT) with visual function outcomes (VA, VF) at the last neuro-ophthalmologic evaluation. METHODS We conducted a retrospective cohort study of AVPM cases treated at Sheba Medical Center during 2004-2015. We compared cFSRT and hSRT regimens regarding visual function (VA, VF) outcomes at the last neuro-ophthalmologic evaluation. VA was determined by the logarithm of the minimum angle of resolution (LogMAR). VF was determined by the mean deviation (MD). A clinically relevant change in VA was defined as 0.2 LogMAR. RESULTS 48 patients (13 receiving hSRT, 35 receiving cFSRT) were included, with a median follow-up of 55 months. No significant difference was evident regarding LogMAR or MD of involved eyes at the last evaluation. Six (17%) patients in the cFSRT group experienced clinically relevant VA deterioration in the involved eye, compared with six (46%) in hSRT (p = 0.06). CONCLUSION Our findings, using comprehensive and meticulous investigation of visual outcomes, suggest that hSRT may be associated with higher risk for VA and VF deterioration in AVPM especially in ONSM. We recommend the use of cFSRT for ONSM.
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Affiliation(s)
- Leor Zach
- Neuro-Oncology Unit, Sheba Medical Center, Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Amir Agami
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Galilee Medical Center, Nahariyya, Israel
| | - Orit Furman
- Neuro-Oncology Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Moshe Attia
- Neurosurgery Department, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Cohen
- Neurosurgery Department, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Guy Tam
- Neuro-Ophthalmology Service, Sheba Medical Center, Ramat Gan, Israel
| | - Zion Zibly
- Neurosurgery Department, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ouzi Nissim
- Neurosurgery Department, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roberto Spiegelmann
- Neurosurgery Department, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruth Huna-Baron
- Neuro-Ophthalmology Service, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Svendsen K, Guénot D, Svensson JB, Petersson K, Persson A, Lundh O. A focused very high energy electron beam for fractionated stereotactic radiotherapy. Sci Rep 2021; 11:5844. [PMID: 33712653 PMCID: PMC7971008 DOI: 10.1038/s41598-021-85451-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/01/2021] [Indexed: 12/27/2022] Open
Abstract
An electron beam of very high energy (50-250 MeV) can potentially produce a more favourable radiotherapy dose distribution compared to a state-of-the-art photon based radiotherapy technique. To produce an electron beam of sufficiently high energy to allow for a long penetration depth (several cm), very large accelerating structures are needed when using conventional radio-frequency technology, which may not be possible due to economical or spatial constraints. In this paper, we show transport and focusing of laser wakefield accelerated electron beams with a maximum energy of 160 MeV using electromagnetic quadrupole magnets in a point-to-point imaging configuration, yielding a spatial uncertainty of less than 0.1 mm, a total charge variation below [Formula: see text] and a focal spot of [Formula: see text]. The electron beam was focused to control the depth dose distribution and to improve the dose conformality inside a phantom of cast acrylic slabs and radiochromic film. The phantom was irradiated from 36 different angles to obtain a dose distribution mimicking a stereotactic radiotherapy treatment, with a peak fractional dose of 2.72 Gy and a total maximum dose of 65 Gy. This was achieved with realistic constraints, including 23 cm of propagation through air before any dose deposition in the phantom.
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Affiliation(s)
| | - Diego Guénot
- Department of Physics, Lund University, P.O. Box 118, 22100, Lund, Sweden
| | - Jonas Björklund Svensson
- Department of Physics, Lund University, P.O. Box 118, 22100, Lund, Sweden
- Deutsches Elektronen-Synchrotron DESY, NotkestraSSe 85, 22607, Hamburg, Germany
| | - Kristoffer Petersson
- Department of Oncology, The Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
- Radiation Physics, Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Anders Persson
- Department of Physics, Lund University, P.O. Box 118, 22100, Lund, Sweden
| | - Olle Lundh
- Department of Physics, Lund University, P.O. Box 118, 22100, Lund, Sweden
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Laville A, Coutte A, Capel C, Maroote J, Lefranc M. Dosimetric and volumetric outcomes of combining cyst puncture through an Ommaya reservoir with index-optimized hypofractionated stereotactic radiotherapy in the treatment of craniopharyngioma. Clin Transl Radiat Oncol 2020; 23:66-71. [PMID: 32490217 PMCID: PMC7256109 DOI: 10.1016/j.ctro.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/26/2022] Open
Abstract
Large cystic craniopharyngioma management combining cyst puncture through an Ommaya reservoir with hypofractionated stereotactic radiotherapy was evaluated. The planning optimization was focused on the gradient and selectivity. Punctured and filled cyst treatment plans were compared with a retrospective analysis of volumetric and functional outcomes.
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Affiliation(s)
- Adrien Laville
- Department of Radiation Oncology, University Hospital, Amiens, France
| | - Alexandre Coutte
- Department of Radiation Oncology, University Hospital, Amiens, France
| | - Cyrille Capel
- Department of Neurosurgery, University Hospital, Amiens, France
| | - Justine Maroote
- Department of Radiation Oncology, University Hospital, Amiens, France
| | - Michel Lefranc
- Department of Neurosurgery, University Hospital, Amiens, France
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