1
|
Wang Z, Sun X, Wang W, Zhang T, Chen L, Duan J, Feng S, Chen Y, Wei Z, Zang J, Xiao F, Zhao L. Characterization and commissioning of a new collaborative multi-modality radiotherapy platform. Phys Eng Sci Med 2023; 46:981-994. [PMID: 37378823 PMCID: PMC10480288 DOI: 10.1007/s13246-023-01255-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/31/2023] [Indexed: 06/29/2023]
Abstract
TaiChi, a new multi-modality radiotherapy platform that integrates a linear accelerator, a focusing gamma system, and a kV imaging system within an enclosed O-ring gantry, was introduced into clinical application. This work aims to assess the technological characteristics and commissioning results of the TaiChi platform. The acceptance testing and commissioning were performed following the manufacturer's customer acceptance tests (CAT) and several AAPM Task Group (TG) reports/guidelines. Regarding the linear accelerator (linac), all applicable validation measurements recommended by the MPPG 5.a (basic photon beam model validation, intensity-modulated radiotherapy (IMRT)/volumetric-modulated arc therapy (VMAT) validation, end-to-end(E2E) tests, and patient-specific quality assurance (QA)) were performed. For the focusing gamma system, the absorbed doses were measured using a PTW31014 ion chamber (IC) and PTW60016 diode detector. EBT3 films and a PTW60016 diode detector were employed to measure the relative output factors (ROFs). The E2E tests were performed using PTW31014 IC and EBT3 films. The coincidences between the imaging isocenter and the linac/gamma mechanical isocenter were investigated using EBT3 films. The image quality was evaluated regarding the contrast-to-noise ratio (CNR), spatial resolution, and uniformity. All tests included in the CAT met the manufacturer's specifications. All MPPG 5.a measurements complied with the tolerances. The confidence limits for IMRT/VMAT point dose and dose distribution measurements were achieved according to TG-119. The point dose differences were below 1.68% and gamma passing rates (3%/2 mm) were above 95.1% for the linac E2E tests. All plans of patient-specific QA had point dose differences below 1.79% and gamma passing rates above 96.1% using the 3%/2 mm criterion suggested by TG-218. For the focusing gamma system, the differences between the calculated and measured absorbed doses were below 1.86%. The ROFs calculated by the TPS were independently confirmed within 2% using EBT3 films and a PTW60016 detector. The point dose differences were below 2.57% and gamma passing rates were above 95.3% using the 2%/1 mm criterion for the E2E tests. The coincidences between the imaging isocenter and the linac/gamma mechanical isocenter were within 0.5 mm. The image quality parameters fully complied with the manufacturer's specifications regarding the CNR, spatial resolution, and uniformity. The multi-modality radiotherapy platform complies with the CAT and AAPM commissioning criteria. The commissioning results demonstrate that this platform performs well in mechanical and dosimetry accuracy.
Collapse
Affiliation(s)
- Zhongfei Wang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, P.R. China
| | - Xiaohuan Sun
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, P.R. China
| | - Wei Wang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, P.R. China
| | - Te Zhang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, P.R. China
| | - Liting Chen
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, P.R. China
| | - Jie Duan
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, P.R. China
| | - Siqi Feng
- Our United Corporation, 710018, Xi'an, Shaanxi Province, P.R. China
| | - Yinzhu Chen
- Our United Corporation, 710018, Xi'an, Shaanxi Province, P.R. China
| | - Zhiwei Wei
- Our United Corporation, 710018, Xi'an, Shaanxi Province, P.R. China
| | - Jian Zang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, P.R. China
| | - Feng Xiao
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, P.R. China.
| | - Lina Zhao
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, P.R. China.
| |
Collapse
|
2
|
Desai AD, Shah VP, Tseng CC, Povolotskiy R, Wackym PA, Ying YLM. Impact of Social Determinants of Health on Stereotactic Radiotherapy for Vestibular Schwannoma. Laryngoscope 2022; 132:2232-2240. [PMID: 35076095 DOI: 10.1002/lary.30016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/02/2021] [Accepted: 01/04/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Linear accelerator (LINAC) and Gamma Knife (GK) are common stereotactic radiation therapies for treating vestibular schwannoma (VS). There is currently limited literature examining specific demographic and socioeconomic factors, which influence the type of stereotactic radiation therapy a patient with VS receives. STUDY DESIGN Retrospective database review. METHODS The National Cancer Database was queried for cases of VS between 2004 and 2016. Patient demographic characteristics were compared using chi-squared and t-tests between GK and LINAC treated groups. Multivariate regression analysis was performed to assess predictors of stereotactic radiation therapy received. RESULTS Of the 6,208 included patients, 5,306 (85.5%) received GK and 902 (14.5%) received LINAC. The mean age of GK patients was significantly lower than that of LINAC patients (58.0 vs. 59.7, P < .001). Individuals treated with GK had greater proportions of private insurance (P < .001) and incomes greater than $63,332 (P = .003). A greater proportion of GK patients were treated in academic centers (P < .001), in high-volume facilities (P < .001), in metropolitan areas (P < .001), and in the Northeastern United States (P < .001). On multivariate logistic regression analysis, region, metropolitan area, facility type, tumor size, and distance traveled by patients independently predict receipt of GK versus LINAC. CONCLUSION Differences in patient demographics and other social determinants of health influence choice of GK versus LINAC therapy for VS patients. Future studies focused on addressing barriers to care, which may influence postprocedural quality of life and clinical outcomes associated with these two treatments are necessary to better understand the impact of these social differences. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
Collapse
Affiliation(s)
- Amar D Desai
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Vraj P Shah
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Christopher C Tseng
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Roman Povolotskiy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - P Ashley Wackym
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Yu-Lan Mary Ying
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| |
Collapse
|
3
|
Hunugundmath SM, Basu S, Zade B, Maiya V, Sharma R, Bhanage A, Vatyam S. The Outcomes of Radiosurgery for Arteriovenous Malformations—Experience of a Tertiary Cancer Center from India. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1724464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Objectives This article assesses the treatment outcomes in the patients diagnosed with arteriovenous malformations (AVMs) treated with stereotactic radiosurgery.
Materials and Methods We retrospectively analyzed 30 patients diagnosed with AVM treated between 2010 and 2018.The median age at presentation was 30 years (range: 14–60 years). The median planning target volume (PTV) was 6.8 mL (range: 0.9–54 mL). The median dose prescribed was 18 Gy (range: 16–24 Gy). Modified radiosurgery-based AVM grading score was calculated for all the patients.
Results The median follow-up of the entire cohort was 60 months (range: 24–96 months). The obliteration rates for patients followed up for 3 and 5 years were 75 and 86.1%, respectively. Age (< 35 years; p = 0.007) and PTV (< 7 mL; p = 0.04), had better obliteration rates. Three patients had hemorrhage, from the AVM after irradiation. None of them were fatal.
Conclusion Stereotactic radiosurgery is a preferred noninvasive treatment modality with acceptable morbidity.
Collapse
Affiliation(s)
| | - Sumit Basu
- Ruby Hall Clinic, Pune, Maharashtra, India
| | | | | | | | | | | |
Collapse
|
4
|
Sachdev S, Sita TL, Shlobin NA, Gopalakrishnan M, Sucholeiki R, Régis J, Bandt SK. Completion Corpus Callosotomy with Stereotactic Radiosurgery for Drug-Resistant, Intractable Epilepsy. World Neurosurg 2020; 143:440-444. [PMID: 32827745 DOI: 10.1016/j.wneu.2020.08.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) offers a noninvasive technique for division of the corpus callosum, which can confer improved seizure control to patients suffering from frequent atonic seizures due to rapid interhemispheric generalization. This noninvasive approach is well-suited for use in a palliative intervention for improved seizure control in this patient population. To our knowledge, this is the first report of radiosurgical completion corpus callosotomy in an adult in the United States. CASE DESCRIPTION A 20-year-old ambidextrous nonverbal man with a history of refractory generalized epilepsy status post open anterior corpus callosotomy at age 10 years, Lennox-Gastaut syndrome, and autism presented after 2 years of incremental, progressive deterioration in seizure control and behavior including 1 year. The family decided to pursue SRS corpus callosotomy. Under general anesthesia, a volume of interest encompassing a full midsagittal plane of the corpus callosum was defined to deliver 60 Gy to the 50% isodose line fully encompassing the target. Gamma Knife was used with 2 isocenters at 90° and 1 at 110° and isodose lines of 60, 20, and 12 Gy. Treatment was carried out without difficulty or complications while the patient remained under close monitoring. The patient was discharged the next day with a 2-week taper of dexamethasone. CONCLUSIONS Eight months postradiosurgical corpus callosotomy, the patient is free of atonic seizures and is ambulatory. In carefully selected cases and with protective radiosurgical planning, SRS for completion corpus callosotomy represents an effective option for refractory seizure control.
Collapse
Affiliation(s)
- Sean Sachdev
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Timothy L Sita
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mahesh Gopalakrishnan
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Roy Sucholeiki
- Department of Neurology, Northwestern Medicine Central Dupage Hospital, Winfield, Illinois, USA
| | - Jean Régis
- Functional and Stereotactic Neurosurgery Service and Gamma Knife Unit, Centre Hospitalier Universitaire La Timone Assistance Publique-Hopitaux de Marseille, Université de la Méditerranée, Marseille, France
| | - S Kathleen Bandt
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| |
Collapse
|
5
|
Liu J, Rojas R, Lam FC, Mirza FA, Mahadevan A, Kasper EM. Indications, feasibility, safety, and efficacy of CyberKnife radiotherapy for the treatment of olfactory groove meningiomas: a single institutional retrospective series. Radiat Oncol 2020; 15:63. [PMID: 32164781 PMCID: PMC7069021 DOI: 10.1186/s13014-020-01506-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 02/27/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose To assess the safety and efficacy of CyberKnife® radiotherapy (CKRT) for the treatment of olfactory groove meningiomas (OGMs). Methods A retrospective review was performed of 13 patients with OGM treated with CKRT from September 2005 to May 2018 at our institution. Nine patients were treated primarily with CKRT, 3 for residual disease following resection, and 1 for disease recurrence. Results Five patients were treated with stereotactic radiosurgery (SRS), 6 with hypofractionated stereotactic radiotherapy (HSRT), and 2 with fractionated stereotactic radiotherapy (FSRT). The median tumor volume was 8.12 cm3. The median prescribed dose was 14.8 Gy for SRS, 27.3 Gy for HSRT, and 50.2 Gy for FSRT. The median maximal dose delivered was 32.27 Gy. Median post treatment follow-up was 48 months. Twelve of 13 patients yielded a 100% regional control rate with a median tumor volume reduction of 31.7%. Six of the 12 patients had reduced tumor volumes while the other 6 had no changes. The thirteenth patient had significant radiation-induced edema requiring surgical decompression. Twelve patients were alive and neurologically stable at the time of the review. One patient died from pneumonia unrelated to his CKRT treatment. Conclusions CKRT appears to be safe and effective for the treatment of OGMs.
Collapse
Affiliation(s)
- Jianmin Liu
- Department of Neurosurgery, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Rafael Rojas
- Department of Radiology, Division of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Fred C Lam
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, McMaster University Faculty of Health Sciences, 237 Barton Street East, Hamilton, ON, L2L 8X8, Canada
| | - Farhan A Mirza
- Division of Neurosurgery, Kentucky Neuroscience Institute, University of Kentucky, Lexington, KT, USA
| | - Anand Mahadevan
- Department of Radiation Oncology, Geisinger Medical Group, Danville, PA, USA
| | - Ekkehard M Kasper
- Department of Radiology, Division of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. .,Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, McMaster University Faculty of Health Sciences, 237 Barton Street East, Hamilton, ON, L2L 8X8, Canada.
| |
Collapse
|
6
|
Wang D, DeNittis A, Hu Y. Strategies to optimize stereotactic radiosurgery plans for brain tumors with volumetric-modulated arc therapy. J Appl Clin Med Phys 2020; 21:45-51. [PMID: 32043810 PMCID: PMC7075387 DOI: 10.1002/acm2.12818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/20/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose Prescription practice in SRS plans for brain tumors differs significantly for different modalities. In this retrospective study, the strategies to optimize SRS plans for brain tumors with volumetric arc therapy (VMAT) were presented. Methods Fifty clinically treated cases were stratified by the maximum target size into two groups (≥ 2 cm in 25 cases and <2 cm but ≥1 cm in 25 cases), which were optimized using traditional LINAC MLC‐based approaches with the average prescription isodose line (P‐IDL) of (91.4 ± 0.6)%. Four to five plans have been created for each case with variation of the P‐IDL from 65% to 90%. The optimization strategies to select an optimal P‐IDL, to use tuning structures within the target and beyond as well as to use NTO (normal tissue objectives), were applied to all new plans. Results The optimal P‐IDL was found to be around 75%. After applying the new optimization strategies with an average P‐IDL of 74.8%, the mean modified gradient index (mGI) and V12 were reduced by 25% and 35%, respectively for both groups. The Paddick conformity index (PCI) was averagely improved by 8%. The average homogeneity index (HI) and focal index (FI) were increased by 22% and 50%, respectively. The mGI was inversely proportional to the PTV volumes. The shape of the dose distribution in target was also changed from concave to convex. The comparison of PCI with historical data from other institutes and modalities shows that the plans in this study have the best conformity near the target. Conclusions With the new optimization strategies for VMAT SRS plan of brain tumor more conformal plans in both high and intermediate dose region (~50% of the PD) were created, in which the dose in the core of the target was notably increased while V12 and mGI were significantly decreased, and PCI was improved. The mGI was inversely proportional to the PTV volumes. The optimal P‐IDL is around 75%. The average PCI is the best in this study compared with the published historical data. These strategies are applicable to treatment planning for multiple brain and liver tumors where sparing the tissue peripheral to the target is critical.
Collapse
Affiliation(s)
- David Wang
- Lankenau Medical Center, Wynnewood, PA, USA
| | - Albert DeNittis
- Lankenau Medical Center, Wynnewood, PA, USA.,Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Yibing Hu
- Lankenau Medical Center, Wynnewood, PA, USA
| |
Collapse
|
7
|
Pannullo SC, Julie DAR, Chidambaram S, Balogun OD, Formenti SC, Apuzzo MLJ, Knisely JPS. Worldwide Access to Stereotactic Radiosurgery. World Neurosurg 2020; 130:608-614. [PMID: 31581410 DOI: 10.1016/j.wneu.2019.04.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/18/2019] [Accepted: 03/28/2019] [Indexed: 12/31/2022]
Abstract
Stereotactic radiosurgery is a safe and effective technology that can address a variety of neurosurgical conditions, but in many parts of the world, access remains an issue. Although the technology is increasingly available in the United States, Canada, Europe, and parts of Asia, poor access to central nervous system (CNS) imaging and inadequate treatment equipment in other parts of the world limit the availability of radiosurgery as a treatment option. In addition, epidemiologic data about cancer and CNS metastases in low-income countries are sparse and much less complete than in more developed countries, and the need for radiosurgery may be underestimated as a result. Current radiosurgical platforms can be expensive to install and require a substantial amount of personnel training for safe operation. Socioeconomic and political forces are relevant to limitations to and opportunities for improving access to care. Here we examine the current barriers to access and propose areas for future efforts to improve global availability of radiosurgery for neurosurgical conditions.
Collapse
Affiliation(s)
- Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
| | - Diana A R Julie
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Swathi Chidambaram
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Onyinye D Balogun
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | | | - Michael L J Apuzzo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Jonathan P S Knisely
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
8
|
McClelland S, Degnin C, Chen Y, Watson GA, Jaboin JJ. Impact of the American Tax Payer Relief Act on stereotactic radiosurgery utilization in the United States. J Neurooncol 2019; 145:159-165. [PMID: 31485922 DOI: 10.1007/s11060-019-03283-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/29/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Single-fraction stereotactic radiosurgery (SRS) is delivered predominantly via two modalities: Gamma Knife, and linear accelerator (LINAC). Implementation of the American Tax Payer Relief Act (ATRA) in 2013 represented the first time limitations specifically targeting SRS reimbursement were introduced into federal law. The subsequent impact of the ATRA on SRS utilization in the United States (US) has yet to be examined. METHODS The National Cancer Database from 2010-2016 identified brain metastases patients from non-small cell lung cancer throughout the US having undergone SRS. Utilization between GKRS and LINAC was assessed before (2010-2012), during (2013-2014) and after (2015-2016) ATRA implementation. RESULTS In 2013, there was a substantial decrease of LINAC SRS in favor of GKRS in non-academic centers. Over the 3-year span immediately preceding ATRA implementation, 39% of all eligible SRS cases received LINAC. There was a modest decrease in LINAC utilization over the 2 years immediately following ATRA implementation (35%), followed by an increase over the next two years (40%). SRS modality showed differences over the three time periods (unadjusted, p = 0.043), primarily in non-academic centers (unadjusted, p = 0.003). CONCLUSIONS ATRA implementation in 2013 caused an initial spike in Gamma Knife SRS utilization, followed by a decline to rates similar to the years before implementation. These findings indicate that the ATRA provision mandating Medicare reduction of outpatient payment rates for Gamma Knife to be equivalent with those of LINAC SRS had a significant short-term impact on the radiosurgical treatment of metastatic brain disease throughout the US, serving as a reminder of the importance/impact of public policy on treatment modality utilization by physicians and hospitals.
Collapse
Affiliation(s)
- Shearwood McClelland
- Department of Radiation Oncology, Indiana University School of Medicine, 535 Barnhill Drive, RT 041, Indianapolis, IN, 46202, USA.
| | - Catherine Degnin
- Biostatistics Shared Resource, Oregon Health and Science University, Portland, OR, USA
| | - Yiyi Chen
- Biostatistics Shared Resource, Oregon Health and Science University, Portland, OR, USA
| | - Gordon A Watson
- Department of Radiation Oncology, Indiana University School of Medicine, 535 Barnhill Drive, RT 041, Indianapolis, IN, 46202, USA
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
9
|
McClelland S, Watson GA. Impact of MRI Timing on Accuracy of Stereotactic Radiosurgical Planning: Visualizing the Forest From the Trees. Int J Radiat Oncol Biol Phys 2019; 103:1012-1013. [PMID: 30784517 DOI: 10.1016/j.ijrobp.2018.11.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 11/09/2018] [Accepted: 11/10/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Shearwood McClelland
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gordon A Watson
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
10
|
Martínez-Moreno NE, Sahgal A, De Salles A, Hayashi M, Levivier M, Ma L, Paddick I, Régis J, Ryu S, Slotman BJ, Martínez-Álvarez R. Stereotactic radiosurgery for tremor: systematic review. J Neurosurg 2019; 130:589-600. [PMID: 29473775 DOI: 10.3171/2017.8.jns17749] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/15/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this systematic review is to offer an objective summary of the published literature relating to stereotactic radiosurgery (SRS) for tremor and consensus guideline recommendations. METHODS This systematic review was performed up to December 2016. Article selection was performed by searching the MEDLINE (PubMed) and EMBASE electronic bibliographic databases. The following key words were used: "radiosurgery" and "tremor" or "Parkinson's disease" or "multiple sclerosis" or "essential tremor" or "thalamotomy" or "pallidotomy." The search strategy was not limited by study design but only included key words in the English language, so at least the abstract had to be in English. RESULTS A total of 34 full-text articles were included in the analysis. Three studies were prospective studies, 1 was a retrospective comparative study, and the remaining 30 were retrospective studies. The one retrospective comparative study evaluating deep brain stimulation (DBS), radiofrequency thermocoagulation (RFT), and SRS reported similar tremor control rates, more permanent complications after DBS and RFT, more recurrence after RFT, and a longer latency period to clinical response with SRS. Similar tremor reduction rates in most of the reports were observed with SRS thalamotomy (mean 88%). Clinical complications were rare and usually not permanent (range 0%-100%, mean 17%, median 2%). Follow-up in general was too short to confirm long-term results. CONCLUSIONS SRS to the unilateral thalamic ventral intermediate nucleus, with a dose of 130-150 Gy, is a well-tolerated and effective treatment for reducing medically refractory tremor, and one that is recommended by the International Stereotactic Radiosurgery Society.
Collapse
Affiliation(s)
- Nuria E Martínez-Moreno
- 1Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - Arjun Sahgal
- 2Department of Radiation Oncology, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Antonio De Salles
- 3Department of Neurosurgery, University of California, Los Angeles, California
| | - Motohiro Hayashi
- 4Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Marc Levivier
- 5Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Lijun Ma
- 6Division of Physics, Department of Radiation Oncology, University of California, San Francisco, California
| | - Ian Paddick
- 7Division of Physics, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jean Régis
- 8Department of Functional Neurosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Sam Ryu
- 9Department of Radiation Oncology, Stony Brook University, Stony Brook, New York; and
| | - Ben J Slotman
- 10Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Roberto Martínez-Álvarez
- 1Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| |
Collapse
|
11
|
Desideri I, Francolini G, Carta GA, Di Cataldo V, Masi L, Meattini I, Bonomo P, Loi M, Greto D, Visani L, Lo Russo M, Grassi R, Teriaca MA, Garlatti P, Nardi C, Livi L. Efficacy and Tolerability of CyberKnife Stereotactic Robotic Radiotherapy for Primary or Secondary Orbital Lesions: A Single-Center Retrospective Experience. Technol Cancer Res Treat 2019; 18:1533033818818561. [PMID: 30803353 PMCID: PMC6373998 DOI: 10.1177/1533033818818561] [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] [Indexed: 11/18/2022] Open
Abstract
Introduction: Orbital lesions are rare, but are likely to become symptomatic and can impact on
patients’ quality of life. Local control is often difficult to obtain, because of
proximity to critical structures. CyberKnife stereotactic robotic radiotherapy could
represent a viable treatment option. Materials and Methods: Data on patients treated for intraorbital lesions from solid malignancies were
retrospectively collected. All patients underwent treatment with CyberKnife system. We
analyzed local control, response rate, symptoms control, progression-free survival and
overall survival, acute and late toxicity. Results: From January 2012 to May 2017, 20 treatments on 19 patients were performed, with dose
ranging from 24 to 35 Gy in 1 to 5 fractions, prescribed at an average isodose line of
79.5% (range: 78-81). After a mean follow-up of 14.26 months (range: 0-58), overall
response rate was 75%, with 2 and 4 patients presenting a partial and complete response,
respectively. Mean time to best measured response was 15.16 months (range: 2-58).
Thirteen patients were alive, with a local control rate of 79%. Mean time to local
progression was 5 months (range: 3-7). Three patients reported improvement in symptoms
after treatment. Mean planning target volume dose coverage was 97.2% (range: 93.5-99.7).
Mean maximum dose (D max) to eye globe, optic nerve, optic chiasm, and lens was 2380.8
cGy (range: 290-3921), 1982.82 cGy (range: 777.3-2897.8), 713.14 cGy (range:
219.5-2273), and 867.9 cGy (range: 38-3118.5). Four patients presented acute
toxicity. Conclusion: This current retrospective series demonstrated that CyberKnife robotic stereotactic
radiotherapy is a feasible and tolerable approach for intraorbital lesions.
Collapse
Affiliation(s)
- Isacco Desideri
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulio Francolini
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulio Alberto Carta
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Vanessa Di Cataldo
- 2 CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
| | - Laura Masi
- 2 CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
| | - Icro Meattini
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Pierluigi Bonomo
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Mauro Loi
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Daniela Greto
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Luca Visani
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Monica Lo Russo
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Roberta Grassi
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Maria Ausilia Teriaca
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Pietro Garlatti
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cosimo Nardi
- 3 Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| |
Collapse
|
12
|
Dong P, Pérez-Andújar A, Pinnaduwage D, Braunstein S, Theodosopoulos P, McDermott M, Sneed P, Ma L. Dosimetric characterization of hypofractionated Gamma Knife radiosurgery of large or complex brain tumors versus linear accelerator-based treatments. J Neurosurg 2018; 125:97-103. [PMID: 27903198 DOI: 10.3171/2016.7.gks16881] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Noninvasive Gamma Knife (GK) platforms, such as the relocatable frame and on-board imaging, have enabled hypofractionated GK radiosurgery of large or complex brain lesions. This study aimed to characterize the dosimetric quality of such treatments against linear accelerator-based delivery systems that include the CyberKnife (CK) and volumetric modulated arc therapy (VMAT). METHODS Ten patients treated with VMAT at the authors' institution for large brain tumors (> 3 cm in maximum diameter) were selected for the study. The median prescription dose was 25 Gy (range 20-30 Gy) in 5 fractions. The median planning target volume (PTV) was 9.57 cm3 (range 1.94-24.81 cm3). Treatment planning was performed using Eclipse External Beam Planning V11 for VMAT on the Varian TrueBeam system, Multiplan V4.5 for the CyberKnife VSI System, and Leksell GammaPlan V10.2 for the Gamma Knife Perfexion system. The percentage of the PTV receiving at least the prescription dose was normalized to be identical across all platforms for individual cases. The prescription isodose value for the PTV, conformity index, Paddick gradient index, mean and maximum doses for organs at risk, and normal brain dose at variable isodose volumes ranging from the 5-Gy isodose volume (V5) to the 15-Gy isodose volume (V15) were compared for all of the cases. RESULTS The mean Paddick gradient index was 2.6 ± 0.2, 3.2 ± 0.5, and 4.3 ± 1.0 for GK, CK, and VMAT, respectively (p < 0.002). The mean V15 was 7.5 ± 3.7 cm3 (range 1.53-13.29 cm3), 9.8 ± 5.5 cm3 (range 2.07-18.45 cm3), and 16.1 ± 10.6 cm3 (range 3.58-36.53 cm3) for GK, CK, and VMAT, respectively (p ≤ 0.03, paired 2-tailed t-tests). However, the average conformity index was 1.18, 1.12, and 1.21 for GK, CK, and VMAT, respectively (p > 0.06). The average prescription isodose values were 52% (range 47%-69%), 60% (range 46%-68%), and 88% (range 70%-94%) for GK, CK, and VMAT, respectively, thus producing significant variations in dose hot spots among the 3 platforms. Furthermore, the mean V5 values for GK and CK were similar (p > 0.79) at 71.9 ± 36.2 cm3 and 73.3 ± 31.8 cm3, respectively, both of which were statistically lower (p < 0.01) than the mean V5 value of 124.6 ± 67.1 cm3 for VMAT. CONCLUSIONS Significantly better near-target normal brain sparing was noted for hypofractionated GK radiosurgery versus linear accelerator-based treatments. Such a result supports the use of a large number of isocenters or confocal beams for the benefit of normal tissue sparing in hypofractionated brain radiosurgery.
Collapse
Affiliation(s)
- Peng Dong
- Departments of 1 Radiation Oncology and.,Department of Radiation Oncology, Stanford University, Stanford, California; and
| | | | - Dilini Pinnaduwage
- Department of Radiation Oncology, The University of Arizona School of Medicine and St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | | | | | | | - Lijun Ma
- Departments of 1 Radiation Oncology and
| |
Collapse
|
13
|
Fareed MM, Eldib A, Weiss SE, Hayes SB, Li J, Ma CCM. A treatment planning comparison between a novel rotating gamma system and robotic linear accelerator based intracranial stereotactic radiosurgery/radiotherapy. Phys Med Biol 2018; 63:035029. [PMID: 29300187 DOI: 10.1088/1361-6560/aaa517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To compare the dosimetric parameters of a novel rotating gamma ray system (RGS) with well-established CyberKnife system (CK) for treating malignant brain lesions. RGS has a treatment head of 16 cobalt-60 sources focused to the isocenter, which can rotate 360° on the ring gantry and swing 35° in the superior direction. We compared several dosimetric parameters in 10 patients undergoing brain stereotactic radiosurgery including plan normalization, number of beams and nodes for CK and shots for RGS, collimators used, estimated treatment time, D 2 cm and conformity index (CI) among two modalities. The median plan normalization for RGS was 56.7% versus 68.5% (p = 0.002) for CK plans. The median number of shots from RGS was 7.5 whereas the median number of beams and nodes for CK was 79.5 and 46. The median collimator's diameter used was 3.5 mm for RGS as compared to 5 mm for CK (p = 0.26). Mean D 2 cm was 5.57 Gy for CyberKnife whereas it was 3.11 Gy for RGS (p = 0.99). For RGS plans, the median CI was 1.4 compared to 1.3 for the CK treatment plans (p = 0.98). The average minimum and maximum doses to optic chiasm were 21 and 93 cGy for RGS as compared to 32 and 209 cGy for CK whereas these were 0.5 and 364 cGy by RGS and 18 and 399 cGy by CK to brainstem. The mean V12 Gy for brain predicting for radionecrosis with RGS was 3.75 cm3 as compared to 4.09 cm3 with the CK (p = 0.41). The dosimetric parameters of a novel RGS with a ring type gantry are comparable with CyberKnife, allowing its use for intracranial lesions and is worth exploring in a clinical setting.
Collapse
Affiliation(s)
- Muhammad M Fareed
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia PA, United States of America. The first two authors contributed equally to the study
| | | | | | | | | | | |
Collapse
|
14
|
Vavassori A, Jereczek-Fossa BA, Beltramo G, De Cicco L, Fariselli L, Bianchi LC, Possanzini M, Bergantin A, DeCobelli O, Orecchia R. Image-Guided Robotic Radiosurgery as Salvage Therapy for Locally Recurrent Prostate Cancer after External Beam Irradiation: Retrospective Feasibility Study on Six Cases. TUMORI JOURNAL 2018; 96:71-5. [DOI: 10.1177/030089161009600112] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Technological advances in treatment planning and execution are providing new potential opportunities in the treatment of recurrent prostate cancer. This study was conducted to evaluate the feasibility and safety of reirradiation with image-guided radiosurgery using CyberKnife, a robotic arm-driven compact linear accelerator, for intraprostatic recurrence after external beam radiotherapy (EBRT). Methods Between September 2007 and May 2008, 6 patients diagnosed with locally recurrent prostate cancer after EBRT were treated using the CyberKnife system. The total reirradiation dose was 30 Gy in five fractions. Prior to radiosurgery four patients were treated with androgen-deprivation therapy. Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria and the Houston-Phoenix definition (PSA nadir + 2 ng/mL) were used for toxicity and biochemical failure evaluation, respectively. Results After a median follow-up of 11.2 months (range, 9.6–18.6 months), all patients are alive with no evidence of severe urinary or rectal acute morbidity. Local control cannot be exactly determined due to the short follow-up and the bias of the use of androgen ablation. Four patients had biochemical failure, three of them with clinical failure evidence (lymph node, bone and lung metastasis, respectively): none of these patients had clinical evidence of tumor persistence in the prostate. Conclusions Salvage radiosurgery with CyberKnife after irradiation is feasible with low urinary and rectal morbidity. A longer follow-up and a larger number of patients are necessary to evaluate its effectiveness and optimal patient selection criteria.
Collapse
Affiliation(s)
- Andrea Vavassori
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | | | - Giancarlo Beltramo
- Department of Radiotherapy, CyberKnife Unit, Centro Diagnostico Italiano, Milan, Italy
| | - Luigi De Cicco
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Laura Fariselli
- Radiotherapy Unit of the C Besta Neurological Institute Foundation, Milan, Italy
| | - Livia Corinna Bianchi
- Department of Radiotherapy, CyberKnife Unit, Centro Diagnostico Italiano, Milan, Italy
| | - Marco Possanzini
- Department of Radiotherapy, CyberKnife Unit, Centro Diagnostico Italiano, Milan, Italy
| | - Achille Bergantin
- Department of Medical Physics, CyberKnife Unit, Centro Diagnostico Italiano, Milan, Italy
| | - Ottavio DeCobelli
- University of Milan, Milan, Italy
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Roberto Orecchia
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| |
Collapse
|
15
|
Dimitriadis A, Palmer AL, Thomas RAS, Nisbet A, Clark CH. Adaptation and validation of a commercial head phantom for cranial radiosurgery dosimetry end-to-end audit. Br J Radiol 2017; 90:20170053. [PMID: 28452563 DOI: 10.1259/bjr.20170053] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To adapt and validate an anthropomorphic head phantom for use in a cranial radiosurgery audit. METHODS Two bespoke inserts were produced for the phantom: one for providing the target and organ at risk for delineation and the other for performing dose measurements. The inserts were tested to assess their positional accuracy. A basic treatment plan dose verification with an ionization chamber was performed to establish a baseline accuracy for the phantom and beam model. The phantom and inserts were then used to perform dose verification measurements of a radiosurgery plan. The dose was measured with alanine pellets, EBT extended dose film and a plastic scintillation detector (PSD). RESULTS Both inserts showed reproducible positioning (±0.5 mm) and good positional agreement between them (±0.6 mm). The basic treatment plan measurements showed agreement to the treatment planning system (TPS) within 0.5%. Repeated film measurements showed consistent gamma passing rates with good agreement to the TPS. For 2%-2 mm global gamma, the mean passing rate was 96.7% and the variation in passing rates did not exceed 2.1%. The alanine pellets and PSD showed good agreement with the TPS (-0.1% and 0.3% dose difference in the target) and good agreement with each other (within 1%). CONCLUSION The adaptations to the phantom showed acceptable accuracies. The presence of alanine and PSD do not affect film measurements significantly, enabling simultaneous measurements by all three detectors. Advances in knowledge: A novel method for thorough end-to-end test of radiosurgery, with capability to incorporate all steps of the clinical pathway in a time-efficient and reproducible manner, suitable for a national audit.
Collapse
Affiliation(s)
- Alexis Dimitriadis
- 1 Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK.,2 Department of Medical Physics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.,3 Radiation Dosimetry Group, National Physical Laboratory, Teddington, UK
| | - Antony L Palmer
- 1 Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK.,4 Medical Physics Department, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Russell A S Thomas
- 3 Radiation Dosimetry Group, National Physical Laboratory, Teddington, UK
| | - Andrew Nisbet
- 1 Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK.,2 Department of Medical Physics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Catharine H Clark
- 1 Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK.,3 Radiation Dosimetry Group, National Physical Laboratory, Teddington, UK
| |
Collapse
|
16
|
Mahboubi H, Sahyouni R, Moshtaghi O, Tadokoro K, Ghavami Y, Ziai K, Lin HW, Djalilian HR. CyberKnife for Treatment of Vestibular Schwannoma: A Meta-analysis. Otolaryngol Head Neck Surg 2017; 157:7-15. [PMID: 28441508 DOI: 10.1177/0194599817695805] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives (1) Perform a meta-analysis of the available data on the outcomes of CyberKnife radiosurgery for treatment of vestibular schwannomas (VSs) in the published English-language literature and (2) evaluate the collective outcomes of CyberKnife treatment with respect to tumor control and hearing preservation. Data Sources A thorough literature search of published English-language articles was performed in the PubMed, Ovid, and Cochrane databases. Review Methods A database search was conducted with the keywords "CyberKnife" and "vestibular schwannoma" or "acoustic neuroma." A total of 25 papers were found and reviewed. Data were extracted for patient demographics, number of patients with neurofibromatosis type 2, pretreatment hearing status, tumor size, margin dose, and follow-up duration. The primary outcome variables evaluated were tumor control and hearing preservation. Results After careful review of the published articles, 11 papers reported data on outcomes of CyberKnife treatment for VS and were included in the analysis, comprising 800 patients studied during 1998 to 2012. The reported mean tumor volume ranged from 0.02 to 19.8 cm3, and the follow-up duration ranged from 6 to 120 months. Margin dose varied from 14 to 25 Gy. The collective mean tumor control rate was 96.3% (95% CI: 94.0%-98.5%). The collective hearing preservation rate was 79.1% (95% CI: 71.0%-87.3%) in 427 patients with measurable hearing. Conclusion Clinical data on outcomes of CyberKnife radiosurgery for treatment of VSs are sparse and primarily limited to single-institution analyses, with considerable variation in tumor volume and follow-up time. This meta-analysis not only provides an in-depth analysis of available data in the literature but also reviews reported outcomes and complications.
Collapse
Affiliation(s)
- Hossein Mahboubi
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Ronald Sahyouni
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA.,2 Department of Biomedical Engineering, University of California, Irvine, California, USA
| | - Omid Moshtaghi
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Kent Tadokoro
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Yaser Ghavami
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Kasra Ziai
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Harrison W Lin
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Hamid R Djalilian
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA.,2 Department of Biomedical Engineering, University of California, Irvine, California, USA
| |
Collapse
|
17
|
Chiu J, Pierce M, Braunstein SE, Theodosopoulos PV, McDermott MW, Sneed PK, Ma L. Sharpening peripheral dose gradient via beam number enhancement from patient head tilt for stereotactic brain radiosurgery. Phys Med Biol 2016; 61:N532-N541. [DOI: 10.1088/0031-9155/61/20/n532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
18
|
Moore D, Ruan D, Sawant A. Fast leaf-fitting with generalized underdose/overdose constraints for real-time MLC tracking. Med Phys 2016; 43:465. [PMID: 26745939 DOI: 10.1118/1.4938586] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Real-time multileaf collimator (MLC) tracking is a promising approach to the management of intrafractional tumor motion during thoracic and abdominal radiotherapy. MLC tracking is typically performed in two steps: transforming a planned MLC aperture in response to patient motion and refitting the leaves to the newly generated aperture. One of the challenges of this approach is the inability to faithfully reproduce the desired motion-adapted aperture. This work presents an optimization-based framework with which to solve this leaf-fitting problem in real-time. METHODS This optimization framework is designed to facilitate the determination of leaf positions in real-time while accounting for the trade-off between coverage of the PTV and avoidance of organs at risk (OARs). Derived within this framework, an algorithm is presented that can account for general linear transformations of the planned MLC aperture, particularly 3D translations and in-plane rotations. This algorithm, together with algorithms presented in Sawant et al. ["Management of three-dimensional intrafraction motion through real-time DMLC tracking," Med. Phys. 35, 2050-2061 (2008)] and Ruan and Keall [Presented at the 2011 IEEE Power Engineering and Automation Conference (PEAM) (2011) (unpublished)], was applied to apertures derived from eight lung intensity modulated radiotherapy plans subjected to six-degree-of-freedom motion traces acquired from lung cancer patients using the kilovoltage intrafraction monitoring system developed at the University of Sydney. A quality-of-fit metric was defined, and each algorithm was evaluated in terms of quality-of-fit and computation time. RESULTS This algorithm is shown to perform leaf-fittings of apertures, each with 80 leaf pairs, in 0.226 ms on average as compared to 0.082 and 64.2 ms for the algorithms of Sawant et al., Ruan, and Keall, respectively. The algorithm shows approximately 12% improvement in quality-of-fit over the Sawant et al. approach, while performing comparably to Ruan and Keall. CONCLUSIONS This work improves upon the quality of the Sawant et al. approach, but does so without sacrificing run-time performance. In addition, using this framework allows for complex leaf-fitting strategies that can be used to account for PTV/OAR trade-off during real-time MLC tracking.
Collapse
Affiliation(s)
- Douglas Moore
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas 75390
| | - Dan Ruan
- Department of Radiation Oncology, University of California, Los Angeles, California 90095
| | - Amit Sawant
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas 75390
| |
Collapse
|
19
|
Park HS, Wang EH, Rutter CE, Corso CD, Chiang VL, Yu JB. Changing practice patterns of Gamma Knife versus linear accelerator-based stereotactic radiosurgery for brain metastases in the US. J Neurosurg 2016; 124:1018-24. [DOI: 10.3171/2015.4.jns1573] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECT
Single-fraction stereotactic radiosurgery (SRS) is a crucial component in the management of limited brain metastases from non-small cell lung cancer (NSCLC). Intracranial SRS has traditionally been delivered using a frame-based Gamma Knife (GK) platform, but stereotactic modifications to the linear accelerator (LINAC) have made an alternative approach possible. In the absence of definitive prospective trials comparing the efficacy and toxicities of treatment between the 2 techniques, nonclinical factors (such as technology accessibility, costs, and efficiency) may play a larger role in determining which radiosurgery system a facility may choose to install. To the authors’ knowledge, this study is the first to investigate national patterns of GK SRS versus LINAC SRS use and to determine which factors may be associated with the adoption of these radiosurgery systems.
METHODS
The National Cancer Data Base was used to identify patients > 18 years old with NSCLC who were treated with single-fraction SRS to the brain between 2003 and 2011. Patients who received “SRS not otherwise specified” or who did not receive a radiotherapy dose within the range of 12–24 Gy were excluded to reduce the potential for misclassification. The chi-square test, t-test, and multivariable logistic regression analysis were used to compare potential demographic, clinicopathologic, and health care system predictors of GK versus LINAC SRS use, when appropriate.
RESULTS
This study included 1780 patients, among whom 1371 (77.0%) received GK SRS and 409 (23.0%) underwent LINAC SRS. Over time, the proportion of patients undergoing LINAC SRS steadily increased, from 3.2% in 2003 to 30.8% in 2011 (p < 0.001). LINAC SRS was adopted more rapidly by community versus academic facilities (overall 29.2% vs 17.2%, p < 0.001). On multivariable analysis, 4 independent predictors of increased LINAC SRS use emerged, including year of diagnosis in 2008–2011 versus 2003–2007 (adjusted OR [AOR] 2.04, 95% CI 1.52–2.73, p < 0.001), community versus academic facility type (AOR 2.04, 95% CI 1.60–2.60, p < 0.001), non-West versus West geographic location (AOR 4.50, 95% CI 2.87–7.09, p < 0.001), and distance from cancer reporting facility of < 20 versus ≥ 20 miles (AOR 1.57, 95% CI 1.21–2.04, p = 0.001).
CONCLUSIONS
GK remains the most commonly used single-fraction SRS modality for NSCLC brain metastases in the US. However, LINAC-based SRS has been rapidly disseminating in the past decade, especially in the community setting. Wide geographic variation persists in the distribution of GK and LINAC SRS cases. Further comparative effectiveness research will be needed to evaluate the impact of these shifts on SRS-related toxicities, local control, and survival, as well as treatment costs and efficiency.
Collapse
Affiliation(s)
| | | | | | | | - Veronica L. Chiang
- Departments of 1Therapeutic Radiology and
- 2Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | | |
Collapse
|
20
|
Figueroa RG, Valente M. Physical characterization of single convergent beam device for teletherapy: theoretical and Monte Carlo approach. Phys Med Biol 2015; 60:7191-206. [DOI: 10.1088/0031-9155/60/18/7191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
21
|
Nanomedicine to overcome radioresistance in glioblastoma stem-like cells and surviving clones. Trends Pharmacol Sci 2015; 36:236-52. [PMID: 25799457 DOI: 10.1016/j.tips.2015.02.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/28/2015] [Accepted: 02/03/2015] [Indexed: 12/14/2022]
Abstract
Radiotherapy is one of the standard treatments for glioblastoma, but its effectiveness often encounters the phenomenon of radioresistance. This resistance was recently attributed to distinct cell contingents known as glioblastoma stem-like cells (GSCs) and dominant clones. It is characterized in particular by the activation of signaling pathways and DNA repair mechanisms. Recent advances in the field of nanomedicine offer new possibilities for radiosensitizing these cell populations. Several strategies have been developed in this direction, the first consisting of encapsulating a contrast agent or synthesizing metal-based nanocarriers to concentrate the dose gradient at the level of the target tissue. In the second strategy the physicochemical properties of the vectors are used to encapsulate a wide range of pharmacological agents which act in synergy with the ionizing radiation to destroy the cancerous cells. This review reports on the various molecular anomalies present in GSCs and the predominant role of nanomedicines in the development of radiosensitization strategies.
Collapse
|
22
|
Yeh CY, Tung CJ, Chao TC, Lin MH, Lee CC. A dual resolution measurement based Monte Carlo simulation technique for detailed dose analysis of small volume organs in the skull base region. Radiat Phys Chem Oxf Engl 1993 2014. [DOI: 10.1016/j.radphyschem.2013.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
23
|
Ma L, Sahgal A, Larson DA, Pinnaduwage D, Fogh S, Barani I, Nakamura J, McDermott M, Sneed P. Impact of millimeter-level margins on peripheral normal brain sparing for gamma knife radiosurgery. Int J Radiat Oncol Biol Phys 2014; 89:206-13. [PMID: 24725703 DOI: 10.1016/j.ijrobp.2014.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/04/2014] [Accepted: 01/08/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate how millimeter-level margins beyond the gross tumor volume (GTV) impact peripheral normal brain tissue sparing for Gamma Knife radiosurgery. METHODS AND MATERIALS A mathematical formula was derived to predict the peripheral isodose volume, such as the 12-Gy isodose volume, with increasing margins by millimeters. The empirical parameters of the formula were derived from a cohort of brain tumor and surgical tumor resection cavity cases (n=15) treated with the Gamma Knife Perfexion. This was done by first adding margins from 0.5 to 3.0 mm to each individual target and then creating for each expanded target a series of treatment plans of nearly identical quality as the original plan. Finally, the formula was integrated with a published logistic regression model to estimate the treatment-induced complication rate for stereotactic radiosurgery when millimeter-level margins are added. RESULTS Confirmatory correlation between the nominal target radius (ie, RT) and commonly used maximum target size was found for the studied cases, except for a few outliers. The peripheral isodose volume such as the 12-Gy volume was found to increase exponentially with increasing Δ/RT, where Δ is the margin size. Such a curve fitted the data (logarithmic regression, R(2) >0.99), and the 12-Gy isodose volume was shown to increase steeply with a 0.5- to 3.0-mm margin applied to a target. For example, a 2-mm margin on average resulted in an increase of 55% ± 16% in the 12-Gy volume; this corresponded to an increase in the symptomatic necrosis rate of 6% to 25%, depending on the Δ/RT values for the target. CONCLUSIONS Millimeter-level margins beyond the GTV significantly impact peripheral normal brain sparing and should be applied with caution. Our model provides a rapid estimate of such an effect, particularly for large and/or irregularly shaped targets.
Collapse
Affiliation(s)
- Lijun Ma
- Department of Radiation Oncology, University of California, San Francisco, California.
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - David A Larson
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Dilini Pinnaduwage
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Shannon Fogh
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Igor Barani
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Jean Nakamura
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Michael McDermott
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Penny Sneed
- Department of Radiation Oncology, University of California, San Francisco, California
| |
Collapse
|
24
|
Lo WL, Yang KY, Huang YJ, Chen WF, Liao CC, Huang YH. Experience with Novalis stereotactic radiosurgery for vestibular schwannomas. Clin Neurol Neurosurg 2014; 121:30-4. [PMID: 24793471 DOI: 10.1016/j.clineuro.2014.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 01/28/2014] [Accepted: 03/09/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Novalis linear accelerator system, a well developed modality, can be used for stereotactic radiosurgery (SRS). The aim of this study was to clarify the efficiency and safety of Novalis SRS in treating vestibular schwannomas. MATERIALS AND METHODS This 4-year retrospective study enrolled 23 patients with 26 vestibular schwannomas (3 patients suffered from neurofibromatosis Type II). Five patients had undergone tumor resection. All 26 tumors were treated using Novalis SRS, with a prescription dose that varied between 10 and 16Gy (mean, 11.8±1.7Gy). The average follow-up period was 56.5±22.1 months (range, 17-87 months). RESULTS There were 9 men and 14 women. Their mean age at the time of treatment was 54.0±14.6 years (range, 27-84 years). On average, the original size of the tumor was 19.0±7.2mm in maximal diameter (range, 4.6-39.9mm). At the last follow-up, 20 tumors had regressed (76.9%), and there was no observed change in the size of 3 tumors (11.5%). Three of 26 tumors (11.5%) enlarged more than 2mm in one direction. Thus the ultimate radiological tumor control rate was 88.5% (23/26). In addition, 20 (87.0%) patients retained their pre-irradiation hearing function. Facial and trigeminal nerve function were both preserved in all patients. No death occurred during the follow-up, and no patient was treated with a second SRS or converted to tumor resection. CONCLUSION Novalis SRS is a reliable treatment option for vestibular schwannomas. With an optimal radiation dose, satisfactory tumor control can be achieved while preserving cranial nerve function.
Collapse
Affiliation(s)
- Wei-Lun Lo
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Neurosurgery, Shung-ho Hospital and Taipei Medical University, Teipei, Taiwan
| | - Ka-Yen Yang
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Jie Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wu-Fu Chen
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Chieh Liao
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Hua Huang
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| |
Collapse
|
25
|
Sio TT, Jang S, Lee SW, Curran B, Pyakuryal AP, Sternick ES. Comparing gamma knife and cyberknife in patients with brain metastases. J Appl Clin Med Phys 2014; 15:4095. [PMID: 24423830 PMCID: PMC5711245 DOI: 10.1120/jacmp.v15i1.4095] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/12/2013] [Accepted: 08/12/2013] [Indexed: 11/24/2022] Open
Abstract
The authors compared the relative dosimetric merits of Gamma Knife (GK) and CyberKnife (CK) in 15 patients with 26 brain metastases. All patients were initially treated with the Leksell GK 4C. The same patients were used to generate comparative CK treatment plans. The tissue volume receiving more than 12 Gy (V12), the difference between V12 and tumor volume (V12net), homogeneity index (HI), and gradient indices (GI25, GI50) were calculated. Peripheral dose falloff and three conformity indices were compared. The median tumor volume was 2.50 cm3 (range, 0. 044‐19.9). A median dose of 18 Gy (range, 15‐22) was prescribed. In GK and CK plans, doses were prescribed to the 40‐50% and 77‐92% isodose lines, respectively. Comparing GK to CK, the respective parametric values (median±standard deviation) were: minimum dose (18.2±3.4 vs. 17.6±2.4 Gy, p=0.395); mean dose (29.6±5.1 vs.20.6±2.8 Gy, p<0.00001); maximum dose (40.3±6.5 vs.22.7±3.3 Gy, p<0.00001); and HI (2.22±0.19 vs. 1.18±0.06, p<0.00001). The median dosimetric indices (GK vs. CK, with range) were: RTOG_CI, 1.76 (1.12‐4.14) vs. 1.53 (1.16‐2.12), p=0.0220; CI, 1.76 (1.15‐4.14) vs. 1.55 (1.18‐2.21), p=0.050; nCI, 1.76 (1.59‐4.14) vs. 1.57 (1.20‐2.30), p=0.082; GI50, 2.91 (2.48‐3.67) vs. 4.90 (3.42‐11.68), p<0.00001; GI25, 6.58 (4.18‐10.20) vs. 14.85 (8.80‐48.37), p<0.00001. Average volume ratio (AVR) differences favored GK at multiple normalized isodose levels (p<0.00001). We concluded that in patients with brain metastases, CK and GK resulted in dosimetrically comparable plans that were nearly equivalent in several metrics, including target coverage and minimum dose within the target. Compared to GK, CK produced more homogenous plans with significantly lower mean and maximum doses, and achieved more conformal plans by RTOG_CI criteria. By GI and AVR analyses, GK plans had sharper peripheral dose falloff in most cases. PACS number: 89.20.‐a
Collapse
|
26
|
Marquet F, Boch AL, Pernot M, Montaldo G, Seilhean D, Fink M, Tanter M, Aubry JF. Non-invasive ultrasonic surgery of the brain in non-human primates. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2013; 134:1632-1639. [PMID: 23927203 DOI: 10.1121/1.4812888] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
High-intensity focused ultrasound causes selective tissue necrosis efficiently and safely, namely, in the prostate, liver, and uterine fibroid. Nevertheless, ablation of brain tissue using focused ultrasound remains limited due to strong aberrations induced by the skull. To achieve ultrasonic transcranial brain ablation, such aberrations have to be compensated. In this study, non-invasive therapy was performed on monkeys using adaptive correction of the therapeutic beam and 3D simulations of transcranial wave propagation based on 3D computed tomographic (CT) scan information. The aim of the study was two-fold: induce lesions in a non-human primate brain non-invasively and investigate the potential side effects. Stereotactic targeting was performed on five Macaca fascicularis individuals. Each hemisphere was treated separately with a 15-day interval and animals were sacrificed two days after the last treatment. The ultrasonic dose delivered at the focus was increased from one treatment location to the other to estimate the thermal dose for tissue alteration. Thermal doses in the brain were determined by numerical computations. Treatment efficiency and safety were evaluated histologically. The threshold for tissue damage in the brain was measured to be between 90 and 280 cumulative equivalent minutes at 43 °C. Intravenous injection of corticoids before the treatment limited the side effects.
Collapse
Affiliation(s)
- Fabrice Marquet
- Institut Langevin, ESPCI-ParisTech, CNRS UMR7587, INSERM U979, Paris, France
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Nguyen T, Hsu W, Lim M, Naff N. Delivery of stereotactic radiosurgery: a cross-platform comparison. Neurol Res 2013; 33:787-91. [DOI: 10.1179/016164111x13123658647409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
28
|
Bhatt AD, Schuler JC, Boakye M, Woo SY. Current and emerging concepts in non-invasive and minimally invasive management of spine metastasis. Cancer Treat Rev 2013; 39:142-52. [DOI: 10.1016/j.ctrv.2012.08.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 08/08/2012] [Accepted: 08/09/2012] [Indexed: 01/31/2023]
|
29
|
Place de la radiochirurgie et de la radiothérapie stéréotaxique hypofractionnée dans la prise en charge des métastases cérébrales. Bull Cancer 2013; 100:75-81. [DOI: 10.1684/bdc.2012.1683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
30
|
Gutiérrez-Aceves GA, Moreno-Jiménez S, Celis MÁ, Hernández-Bojórquez M. Radiosurgical third ventriculostomy: Technical note. Surg Neurol Int 2012; 3:121. [PMID: 23226607 PMCID: PMC3512342 DOI: 10.4103/2152-7806.102338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 08/29/2012] [Indexed: 12/25/2022] Open
Abstract
Background: We describe a minimally invasive technique to perform a radiosurgical third ventriculostomy in a patient with mild obstructive hydrocephalus secondary to malignant pathology. Methods: A 42 years old woman with diagnosis of clear cells renal carcinoma and with right nefrectomy performed last year. Cranial Magnetic Resonance Imaging showed two brain metastasis: one right temporal, and other in the pons with Sylvian aqueduct partial obliteration and mild ventricular enlargement. The patient received radiosurgical treatment for brain metastasis; after this procedure a new target was defined on the floor of the third ventricle, in the midpoint between the mamillary bodies and the infundibular recess where we delivered 100 Gy delivered by an isocentric multiple noncoplanar arcs technique, with a 6 MV Novalis® dedicated LINAC. A series of 21 arcs was arranged with a radiation field generated by a 4 mm circular collimator. Results: One week pos-irradiation in the head CT we did not find significant changes in the metastatic lesions; however the VSI diminished 4%, despite of persistent aqueduct obliteration. At three months we perform 3.0 T MRI where we confirmed the presence of the third ventriculostomy (2.63 mm diameter). Conclusion: This report demonstrates, for the first time, the ability of a dedicated LINAC to perform a precise third ventriculostomy without associate morbility in short term.
Collapse
|
31
|
Binello E, Green S, Germano IM. Radiosurgery for high-grade glioma. Surg Neurol Int 2012; 3:S118-26. [PMID: 22826815 PMCID: PMC3400492 DOI: 10.4103/2152-7806.95423] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 03/28/2012] [Indexed: 01/08/2023] Open
Abstract
Background: For patients with newly diagnosed high-grade gliomas (HGG), the current standard-of-care treatment involves surgical resection, followed by concomitant temozolomide (TMZ) and external beam radiation therapy (XRT), and subsequent TMZ chemotherapy. For patients with recurrent HGG, there is no standard of care. Stereotactic radiosurgery (SRS) is used to deliver focused, relatively large doses of radiation to a small, precisely defined target. Treatment is usually delivered in a single fraction, but may be delivered in up to five fractions. The role of SRS in the management of patients with HGG is not well established. Methods: The PubMed database was searched with combinations of relevant MESH headings and limits. Case reports and/or small case series were excluded. Attention was focused on overall median survival as an objective measure, and data were examined separately for newly diagnosed and recurrent HGG. Results: With respect to newly diagnosed HGG, there is strong evidence that addition of an SRS boost prior to standard XRT provides no survival benefit. However, recent retrospective evidence suggests a possible survival benefit when SRS is performed after XRT. With respect to recurrent HGG, there is suggestion that SRS may confer a survival benefit but with potentially higher complication rates. Newer studies are investigating the combination of SRS with targeted molecular agents. Controlled prospective clinical trials using advanced imaging techniques are necessary for a complete assessment. Conclusions: SRS has the potential to provide a survival benefit for patients with HGG. Further research is clearly warranted to define its role in the management of newly diagnosed and recurrent HGG.
Collapse
Affiliation(s)
- Emanuela Binello
- Department of Neurosurgery, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10129, USA
| | | | | |
Collapse
|
32
|
Klingenstein A, Kufeld M, Wowra B, Muacevic A, Fürweger C, Schaller UC. CyberKnife radiosurgery for the treatment of orbital metastases. Technol Cancer Res Treat 2012; 11:433-9. [PMID: 22475063 DOI: 10.7785/tcrt.2012.500257] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose of this study is to evaluate radiographic therapy response, clinical outcome and adverse effects of CyberKnife radiosurgery in patients suffering from orbital metastases. Sixteen orbital metastases originating from different solid cancers in fourteen patients were treated by single fraction CyberKnife radiosurgery. Radiographic response and clinical outcome were evaluated. The treated tumor volume ranged from 0.2 to 35 cm3 (median 2.3 cm3, mean 7.0 cm3, SD 6 10.4 cm3, CI 0.9-9.4 cm3). The prescription dose ranged from 16.5-21 Gy (median 18 Gy, mean 18.2 Gy, SD 6 1.2 Gy, CI 17.0-18.4 Gy). A no change situation was observed in nine lesions, partial remission in four as well as complete remission in one metastasis. Tumor growth was stabilized or regressive following CyberKnife therapy in 87% of the cases. Recurrence was observed in two cases (13%). Before therapy, three patients suffered from visual disturbance and five patients reported diplopia. Six patients had no initial symptoms. After therapy, one patient indicated improvement of the present visual deficit and two patients no change. Out of the two patients with persistent diplopia, two reported improvement after therapy and three no change. No progression of symptoms was noted in any of the cases. Fourteen out of sixteen treated lesions were stable or regressive following CyberKnife radiosurgery (87%). As no serious adverse effects were reported in this series, CyberKnife therapy was shown to be of great value for local management of orbital metastases.
Collapse
Affiliation(s)
- A Klingenstein
- Department of Ophthalmology, Ludwig-Maximilians-University, Klinikum der Universitat Munchen, Munich, Germany.
| | | | | | | | | | | |
Collapse
|
33
|
Abstract
PURPOSE OF REVIEW This review provides information and an update on stereotactic radiosurgery (SRS) equipment, with a focus on intracranial lesions and brain neoplasms. RECENT FINDINGS Gamma Knife radiosurgery represents the gold standard for intracranial radiosurgery, using a dedicated equipment, and has recently evolved with a newly designed technology, Leksell Gamma Knife Perfexion. Linear accelerator-based radiosurgery is more recent, and originally based on existing systems, either adapted or dedicated to radiosurgery. Equipment incorporating specific technologies, such as the robotic CyberKnife system, has been developed. Novel concepts in radiation therapy delivery techniques, such as intensity-modulated radiotherapy, were also developed; their integration with computed tomography imaging and helical delivery has led to the TomoTherapy system. Recent data on the management of intracranial tumors with radiosurgery illustrate the trend toward a larger use and acceptance of this therapeutic modality. SUMMARY SRS has become an important alternative treatment for a variety of lesions. Each radiosurgery system has its advantages and limitations. The 'perfect' and ubiquitous system does not exist. The choice of a radiosurgery system may vary with the strategy and needs of specific radiosurgery programs. No center can afford to acquire every technology, and strategic choices have to be made. Institutions with large neurosurgery and radiation oncology programs usually have more than one system, allowing optimization of the management of patients with a choice of open neurosurgery, radiosurgery, and radiotherapy. Given its minimally invasive nature and increasing clinical acceptance, SRS will continue to progress and offer new advances as a therapeutic tool in neurosurgery and radiotherapy.
Collapse
|
34
|
Historical Development of Stereotactic Ablative Radiotherapy. STEREOTACTIC BODY RADIATION THERAPY 2012. [DOI: 10.1007/174_2012_540] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
35
|
Sahgal A, Bilsky M, Chang EL, Ma L, Yamada Y, Rhines LD, Létourneau D, Foote M, Yu E, Larson DA, Fehlings MG. Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient. J Neurosurg Spine 2010; 14:151-66. [PMID: 21184635 DOI: 10.3171/2010.9.spine091005] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Stereotactic body radiotherapy (SBRT) for spinal metastases is an emerging therapeutic option aimed at delivering high biologically effective doses to metastases while sparing the adjacent normal tissues. This technique has emerged following advances in radiation delivery that include sophisticated radiation treatment planning software, body immobilization devices, and capabilities of detecting and correcting patient positional deviations with image-guided radiotherapy. There are limited clinical data specifically supporting the role of SBRT as a superior alternative to conventional radiation in the postoperative patient. The focus of this review was to examine the evidence pertaining to spine SBRT in the treatment of spinal metastases and to provide a comprehensive analysis of published patterns of failure, with emphasis on the postoperative patient.
Collapse
Affiliation(s)
- Arjun Sahgal
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, Ontario M5G2M9, Canada.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Coatrieux JL, Velut J, Dillenseger JL, Toumoulin C. De l’imagerie médicale à la thérapie guidée par l’image. Med Sci (Paris) 2010; 26:1103-9. [DOI: 10.1051/medsci/201026121103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
37
|
Khrizman P, Small W, Dawson L, Benson AB. The Use of Stereotactic Body Radiation Therapy in Gastrointestinal Malignancies in Locally Advanced and Metastatic Settings. Clin Colorectal Cancer 2010; 9:136-43. [DOI: 10.3816/ccc.2010.n.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
38
|
Haigron P, Dillenseger JL, Luo L, Coatrieux JL. Image-guided therapy: evolution and breakthrough. ACTA ACUST UNITED AC 2010; 29:100-4. [PMID: 20176527 DOI: 10.1109/memb.2009.935459] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Beyond the advances made in computer-assisted interventions and robotic systems, the demand for more efficient and safer therapies remains challenging. Thus, if it is possible to improve the instrument tracking, steering, and target localization, to miniaturize the sensors and actuators, and to conduct preoperatively planned minimally invasive therapies, we still need new resources to achieve permanent destruction of abnormal tissues or suppression of pathological processes. Most of the physics-based (or energy-based) therapeutic principles at our disposal have been established a long time ago, but their actions on basic cellular and molecular mechanisms are not yet fully understood. They all have a wide spectrum of clinical targets in terms of organs and pathologies, modes of application (external, interstitial, intraluminal, etc.) with advantages and side-effect drawbacks, proven indications, and contraindications. Some of them may still face controversies regarding their outcomes. This short article, mainly focused on tumor destruction, briefly reviews in its first part some of these techniques and sketches the next generation under investigation. The former include radio frequency (RF), high-intensity focused ultrasound (HiFU), microwaves, and cryotherapy, of which all are temperature based. Laser-based approaches [e.g., photodynamic therapy (PDT) at large] are also discussed. Radiotherapy and its variants (hadrontherapy, brachytherapy, Gamma Knife, and CyberKnife) remain, of course, as the reference technique in cancer treatment. The next breakthroughs are examined in the second part of the article. They are based on the close association between imaging agents, drugs, and some stimulation techniques. The ongoing research efforts in that direction show that, if they are still far from clinical applications, strong expectations are made. From the point of view of interventional planning and image guidance, all of them share a lot of concerns.
Collapse
Affiliation(s)
- Pascal Haigron
- INSERM, U642, and LTSI, Université de Rennes 1, Rennes, F-35000, France
| | | | | | | |
Collapse
|
39
|
Equivalence in dose fall-off for isocentric and nonisocentric intracranial treatment modalities and its impact on dose fractionation schemes. Int J Radiat Oncol Biol Phys 2010; 76:943-8. [PMID: 20159366 DOI: 10.1016/j.ijrobp.2009.07.1721] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 06/29/2009] [Accepted: 07/04/2009] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate whether dose fall-off characteristics would be significantly different among intracranial radiosurgery modalities and the influence of these characteristics on fractionation schemes in terms of normal tissue sparing. METHODS AND MATERIALS An analytic model was developed to measure dose fall-off characteristics near the target independent of treatment modalities. Variations in the peripheral dose fall-off characteristics were then examined and compared for intracranial tumors treated with Gamma Knife, Cyberknife, or Novalis LINAC-based system. Equivalent uniform biologic effective dose (EUBED) for the normal brain tissue was calculated. Functional dependence of the normal brain EUBED on varying numbers of fractions (1 to 30) was studied for the three modalities. RESULTS The derived model fitted remarkably well for all the cases (R(2) > 0.99). No statistically significant differences in the dose fall-off relationships were found between the three modalities. Based on the extent of variations in the dose fall-off curves, normal brain EUBED was found to decrease with increasing number of fractions for the targets, with alpha/beta ranging from 10 to 20. This decrease was most pronounced for hypofractionated treatments with fewer than 10 fractions. Additionally, EUBED was found to increase slightly with increasing number of fractions for targets with alpha/beta ranging from 2 to 5. CONCLUSION Nearly identical dose fall-off characteristics were found for the Gamma Knife, Cyberknife, and Novalis systems. Based on EUBED calculations, normal brain sparing was found to favor hypofractionated treatments for fast-growing tumors with alpha/beta ranging from 10 to 20 and single fraction treatment for abnormal tissues with low alpha/beta values such as alpha/beta = 2.
Collapse
|
40
|
Larocque MP, Syme A, Yahya A, Wachowicz K, Allalunis-Turner J, Fallone BG. Monitoring T2 and ADC at 9.4 T following fractionated external beam radiation therapy in a mouse model. Phys Med Biol 2010; 55:1381-93. [DOI: 10.1088/0031-9155/55/5/008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
41
|
Chang UK, Youn SM, Park SQ, Rhee CH. Clinical results of cyberknife(r) radiosurgery for spinal metastases. J Korean Neurosurg Soc 2009; 46:538-44. [PMID: 20062569 DOI: 10.3340/jkns.2009.46.6.538] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 07/14/2009] [Accepted: 11/01/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Primary treatment of spinal metastasis has been external beam radiotherapy. Recent advance of technology enables radiosurgery to be extended to extracranial lesions. The purpose of this study was to determine the clinical effectiveness and safety of stereotactic radiosurgery using Cyberknife in spinal metastasis. METHODS From June, 2002 to December, 2007, 129 patients with 167 spinal metastases were treated with Cyberknife. Most of the patients (94%) presented with pain and nine patients suffered from motor deficits. Twelve patients were asymptomatic. Fifty-three patients (32%) had previous radiation therapy. Using Cyberknife, 16-39 Gy in 1-5 fractions were delivered to spinal metastatic lesions. Radiation dose was not different regarding the tumor pathology or tumor volume. RESULTS After six months follow-up, patient evaluation was possible in 108 lesions. Among them, significant pain relief was seen in 98 lesions (91%). Radiological data were obtained in 83 lesions. The mass size was decreased or stable in 75 lesions and increased in eight lesions. Radiological control failure cases were hepatocellular carcinoma (5 cases), lung cancer (1 case), breast cancer (1 case) and renal cell carcinoma (1 case). Treatment-related radiation injury was not detected. CONCLUSION Cyberknife radiosurgery is clinically effective and safe for spinal metastases. It is true even in previously irradiated patients. Compared to conventional radiation therapy, Cyberknife shows higher pain control rate and its treatment process is more convenient for patients. Thus, it can be regarded as a primary treatment modality for spinal metastases.
Collapse
Affiliation(s)
- Ung-Kyu Chang
- Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Korea
| | | | | | | |
Collapse
|
42
|
Abstract
SUMMARYSurgical robotics is a growing discipline, continuously expanding with an influx of new ideas and research. However, it is important that the development of new devices take account of past mistakes and successes. A structured approach is necessary, as with proliferation of such research, there is a danger that these lessons will be obscured, resulting in the repetition of mistakes and wasted effort and energy. There are several research paths for surgical robotics, each with different risks and opportunities and different methodologies to reach a profitable outcome. The main emphasis of this paper is on a methodology for ‘applied research’ in surgical robotics. The methodology sets out a hierarchy of criteria consisting of three tiers, with the most important being the bottom tier and the least being the top tier. It is argued that a robotic system must adhere to these criteria in order to achieve acceptability. Recent commercial systems are reviewed against these criteria, and are found to conform up to at least the bottom and intermediate tiers, the most important first two tiers, and thus gain some acceptability. However, the lack of conformity to the criteria in the top tier, and the inability to conclusively prove increased clinical benefit, is shown to be hampering their potential in gaining wide establishment.
Collapse
|
43
|
Birkfellner W, Stock M, Figl M, Gendrin C, Hummel J, Dong S, Kettenbach J, Georg D, Bergmann H. Stochastic rank correlation: a robust merit function for 2D/3D registration of image data obtained at different energies. Med Phys 2009; 36:3420-8. [PMID: 19746775 DOI: 10.1118/1.3157111] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In this article, the authors evaluate a merit function for 2D/3D registration called stochastic rank correlation (SRC). SRC is characterized by the fact that differences in image intensity do not influence the registration result; it therefore combines the numerical advantages of cross correlation (CC)-type merit functions with the flexibility of mutual-information-type merit functions. The basic idea is that registration is achieved on a random subset of the image, which allows for an efficient computation of Spearman's rank correlation coefficient. This measure is, by nature, invariant to monotonic intensity transforms in the images under comparison, which renders it an ideal solution for intramodal images acquired at different energy levels as encountered in intrafractional kV imaging in image-guided radiotherapy. Initial evaluation was undertaken using a 2D/3D registration reference image dataset of a cadaver spine. Even with no radiometric calibration, SRC shows a significant improvement in robustness and stability compared to CC. Pattern intensity, another merit function that was evaluated for comparison, gave rather poor results due to its limited convergence range. The time required for SRC with 5% image content compares well to the other merit functions; increasing the image content does not significantly influence the algorithm accuracy. The authors conclude that SRC is a promising measure for 2D/3D registration in IGRT and image-guided therapy in general.
Collapse
Affiliation(s)
- Wolfgang Birkfellner
- Center for Biomedical Engineering and Physics, Medical University Vienna, Waehringer Guertel 18-20 AKH 4L, A-1090 Vienna, Austria.
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Dawood O, Mahadevan A, Goodman KA. Stereotactic body radiation therapy for liver metastases. Eur J Cancer 2009; 45:2947-59. [PMID: 19773153 DOI: 10.1016/j.ejca.2009.08.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 08/19/2009] [Indexed: 12/17/2022]
Abstract
Although resection is the standard of care for liver metastasis, 80-90% of patients are not resectable at diagnosis. Advances in combination chemotherapy, particularly with targeted agents, have increased tumour response and survival in patients with unresectable metastatic colorectal cancer, but these techniques have limitations and may be associated with high recurrence rates. Some autopsy series have shown that as many as 40% of patients with metastatic colorectal cancer have disease confined to the liver; aggressive local therapy may improve overall survival in such patients. Local control of liver metastases can also ease hepatic capsular pain to improve quality of life. Stereotactic body radiation therapy (SBRT) offers an alternative, non-invasive approach to the treatment of liver metastasis through precisely targeted delivery of radiation to the tumours while minimising normal tissue toxicity. Early applications of SBRT to liver metastases have been promising with the reports of 2-year local control rates of 71-86% and other studies reporting 18-month local control rates of 71-93%. While these data establish the safety of SBRT for liver metastases, more rigorous phase II clinical studies are needed to fully evaluate long-term efficacy and toxicity results. In the interim, this review stresses that SBRT of liver must be performed cautiously given the challenges of organ motion and the low toxicity tolerance of the surrounding hepatic parenchyma.
Collapse
Affiliation(s)
- Omar Dawood
- Accuray Incorporated, Sunnyvale, CA, United States
| | | | | |
Collapse
|
45
|
Lunsford LD. Stereotactic Radiosurgery with the CyberKnife for Pituitary Adenomas. J Korean Neurosurg Soc 2009; 45:405. [PMID: 19609430 DOI: 10.3340/jkns.2009.45.6.405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
46
|
Ernst F, Schlaefer A, Dieterich S, Schweikard A. A Fast Lane Approach to LMS prediction of respiratory motion signals. Biomed Signal Process Control 2008. [DOI: 10.1016/j.bspc.2008.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
47
|
Matsuo T, Yanai H, Sugiu K, Tominaga S, Kimata Y. Orbital exenteration after transarterial embolization in a patient with Wyburn-Mason syndrome: pathological findings. Jpn J Ophthalmol 2008; 52:308-313. [PMID: 18773270 DOI: 10.1007/s10384-008-0563-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2007] [Accepted: 04/23/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND We present the pathological findings at orbital exenteration in a patient with Wyburn-Mason syndrome who underwent transarterial embolization. CASE A 31-year-old man with a 10-year history of gradual exacerbation of left exophthalmos and left cheek swelling was found to have facial and orbital arteriovenous malformations on the left side. There was no vascular malformation in the brain. The feeding arteries derived from the left internal maxillary artery, facial artery, and ophthalmic artery. He underwent several courses of transarterial embolization of the feeding arteries from the left internal maxillary artery and then from the facial artery, resulting in no reduction of the arteriovenous malformation. He finally elected to undergo ophthalmic artery embolization in the expectation of a reduction and with the understanding that he would lose sight in his left eye. Two years later, he requested lid-sparing orbital exenteration and reconstruction with cutaneous flap transfer and prosthesis for cosmetic reasons. OBSERVATIONS Pathologically, orbital vascular channels of varying sizes were filled with embolizing glue and had degenerating vascular wall cells surrounded by inflammatory cell infiltration. The central retinal artery in the optic nerve was also filled with the embolizing glue, and the retina lost the ganglion cell layer and inner nuclear layer but maintained the outer nuclear layer and outer segments. CONCLUSIONS Marked anastomoses and hence incomplete embolization among the feeding arteries of facial and orbital vascular malformations in Wyburn-Mason syndrome do not respond well to attempts at feeding vessel embolization, which result in unsuccessful closure of the malformation.
Collapse
Affiliation(s)
- Toshihiko Matsuo
- Department of Ophthalmology, Okayama University Graduate School of Medicine Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Hiroyuki Yanai
- Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kenji Sugiu
- Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Susumu Tominaga
- Otolaryngology/Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihiro Kimata
- Plastic/Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
48
|
Sheehan JP, Jagannathan J. Review of spinal radiosurgery: a minimally invasive approach for the treatment of spinal and paraspinal metastases. Neurosurg Focus 2008; 25:E18. [DOI: 10.3171/foc/2008/25/8/e18] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Intracranial radiosurgery has been proved effective for the treatment of brain metastasis. The treatment of paraspinal and spinal metastasis with spinal radiosurgery represents a natural extension of the principles of intracranial radiosurgery. However, spinal radiosurgery is a far more complicated process than intracranial radiosurgery. Larger treatment volumes, numerous organs at risk, and the inability to utilize rigid, frame-based immobilization all contribute to the substantially more complex process of spinal radiosurgery.
Beyond the convenience of a shorter duration of treatment for the patient, spinal radiosurgery affords a greater biological equivalent dose to a metastatic lesion than conventional radiotherapy fractionation schemes. This appears to translate into a high rate of tumor control and fast pain relief for patients. The minimally invasive nature of this approach is consistent with trends in open spinal surgery and helps to maintain or improve a patient's quality of life. Spinal radiosurgery has expanded the neurosurgical treatment armamentarium for patients with spinal and paraspinal metastasis.
Collapse
|
49
|
Tarricone R, Aguzzi G, Musi F, Fariselli L, Casasco A. Cost-effectiveness analysis for trigeminal neuralgia: Cyberknife vs microvascular decompression. Neuropsychiatr Dis Treat 2008; 4:647-52. [PMID: 18830392 PMCID: PMC2526367 DOI: 10.2147/ndt.s2827] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/AIMS We present the preliminary results of a cost-effectiveness analysis of cyberknife radiosurgery (CKR) versus microvascular decompression (MVD) for patients with medically unresponsive trigeminal neuralgia. METHODS Direct healthcare costs from hospital's perspective attributable to CKR and MVD were collected. Pain level caused by trigeminal neuralgia was measured through the Barrow Neurological Institute pain intensity scoring criteria, at admission and after an average of 6 months follow-up. RESULTS 20 patients for both arms were enrolled, for a total of 40 patients. The two procedures resulted equally effective at 6 month follow-up, with different resources consumption: CKR reducing hospital costs by an average of 34% per patient. The robustness of these results was confirmed in appropriate sensitivity analyses. CONCLUSION CKR resulted to be a cost-saving alternative compared with the surgical intervention.
Collapse
Affiliation(s)
- Rosanna Tarricone
- Economic Evaluation Area, CERGAS Centre for Research on Healthcare Management-Bocconi University Milan, Italy
| | | | | | | | | |
Collapse
|
50
|
Sawant A, Venkat R, Srivastava V, Carlson D, Povzner S, Cattell H, Keall P. Management of three-dimensional intrafraction motion through real-time DMLC tracking. Med Phys 2008; 35:2050-61. [PMID: 18561681 PMCID: PMC2809733 DOI: 10.1118/1.2905355] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 02/18/2008] [Accepted: 03/15/2008] [Indexed: 12/25/2022] Open
Abstract
Tumor tracking using a dynamic multileaf collimator (DMLC) represents a promising approach for intrafraction motion management in thoracic and abdominal cancer radiotherapy. In this work, we develop, empirically demonstrate, and characterize a novel 3D tracking algorithm for real-time, conformal, intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT)-based radiation delivery to targets moving in three dimensions. The algorithm obtains real-time information of target location from an independent position monitoring system and dynamically calculates MLC leaf positions to account for changes in target position. Initial studies were performed to evaluate the geometric accuracy of DMLC tracking of 3D target motion. In addition, dosimetric studies were performed on a clinical linac to evaluate the impact of real-time DMLC tracking for conformal, step-and-shoot (S-IMRT), dynamic (D-IMRT), and VMAT deliveries to a moving target. The efficiency of conformal and IMRT delivery in the presence of tracking was determined. Results show that submillimeter geometric accuracy in all three dimensions is achievable with DMLC tracking. Significant dosimetric improvements were observed in the presence of tracking for conformal and IMRT deliveries to moving targets. A gamma index evaluation with a 3%-3 mm criterion showed that deliveries without DMLC tracking exhibit between 1.7 (S-IMRT) and 4.8 (D-IMRT) times more dose points that fail the evaluation compared to corresponding deliveries with tracking. The efficiency of IMRT delivery, as measured in the lab, was observed to be significantly lower in case of tracking target motion perpendicular to MLC leaf travel compared to motion parallel to leaf travel. Nevertheless, these early results indicate that accurate, real-time DMLC tracking of 3D tumor motion is feasible and can potentially result in significant geometric and dosimetric advantages leading to more effective management of intrafraction motion.
Collapse
Affiliation(s)
- Amit Sawant
- Department of Radiation Oncology, Stanford University, Stanford, California 94305, USA.
| | | | | | | | | | | | | |
Collapse
|