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Zhu L, Dong S, Sun L, Xiao Y, Zhong Y, Pan M, Wang Y. Dosimetric comparison of HyperArc and InCise MLC-based CyberKnife plans in treating single and multiple brain metastases. J Appl Clin Med Phys 2024; 25:e14404. [PMID: 38803034 PMCID: PMC11302820 DOI: 10.1002/acm2.14404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/19/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to compare the dosimetric attributes of two multi-leaf collimator based techniques, HyperArc and Incise CyberKnife, in the treatment of brain metastases. MATERIAL AND METHODS 17 cases of brain metastases were selected including 6 patients of single lesion and 11 patients of multiple lesions. Treatment plans of HyperArc and CyberKnife were designed in Eclipse 15.5 and Precision 1.0, respectively, and transferred to Velocity 3.2 for comparison. RESULTS HyperArc plans provided superior Conformity Index (0.91 ± 0.06 vs. 0.77 ± 0.07, p < 0.01) with reduced dose distribution in organs at risk (Dmax, p < 0.05) and lower normal tissue exposure (V4Gy-V20Gy, p < 0.05) in contrast to CyberKnife plans, although the Gradient Indexes were similar. CyberKnife plans showed higher Homogeneity Index (1.54 ± 0.17 vs. 1.39 ± 0.09, p < 0.05) and increased D2% and D50% in the target (p < 0.05). Additionally, HyperArc plans had significantly fewer Monitor Units (MUs) and beam-on time (p < 0.01). CONCLUSION HyperArc plans demonstrated superior performance compared with MLC-based CyberKnife plans in terms of conformity and the sparing of critical organs and normal tissues, although no significant difference in GI outcomes was noted. Conversely, CyberKnife plans achieved a higher target dose and HI. The study suggests that HyperArc is more efficient and particularly suitable for treating larger lesions in brain metastases.
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Affiliation(s)
- Liying Zhu
- Radiation Oncology CenterHuashan HospitalFudan UniversityShanghaiChina
| | - Shengnan Dong
- Radiation Oncology CenterHenan Province Hospital of TCMZhengzhouChina
| | - Lei Sun
- Department of NeurosurgeryCyberKnife CenterHuashan HospitalFudan UniversityShanghaiChina
| | - Yixuan Xiao
- Radiation Oncology CenterHuashan HospitalFudan UniversityShanghaiChina
| | - Yihua Zhong
- Radiation Oncology CenterHuashan HospitalFudan UniversityShanghaiChina
| | - Mingyuan Pan
- Radiation Oncology CenterHuashan HospitalFudan UniversityShanghaiChina
| | - Yang Wang
- Radiation Oncology CenterHuashan HospitalFudan UniversityShanghaiChina
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2
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Nicol C, Pinkham MB, Lion K, Foote M, McBean A, Higgins M, Conlon E, Ownsworth T. Individuals' perceptions of health and well-being in the context of stereotactic radiosurgery for benign brain tumour: A longitudinal qualitative investigation. Neuropsychol Rehabil 2024; 34:244-267. [PMID: 36927243 DOI: 10.1080/09602011.2023.2181190] [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: 08/28/2022] [Accepted: 02/10/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Treatment-related outcomes after Gamma Knife Stereotactic Radiosurgery (GKSRS) for benign brain tumour are well-established; yet patient reported outcomes have been largely overlooked. This study explored individuals' perspectives of their health and well-being prior to and following GKSRS. METHOD Twenty adults (65% female) aged 24-71 years with benign brain tumour were recruited from a major metropolitan hospital and assessed approximately one week prior to, two weeks after, and at three months following GKSRS. They completed telephone-based interviews focusing on general health, symptoms, and well-being. Interviews were transcribed and analysed using thematic analysis. RESULTS Three major themes characterized individuals' perceptions of their health and well-being. "Understanding my Illness and Treatment" reflected individuals' efforts to make sense of their illness and symptoms to reduce ambiguity and increase sense of control. "Experiencing Gamma Knife" related to expectations of the procedure, outcomes, daily impacts, and emotional reactions. "Adjusting one's Mindset and Coping" characterised how peoples' approaches to coping with their illness were altered over time. CONCLUSIONS Coping and adjustment is highly individualistic in the context of GKSRS. Over time, most individuals were able to make sense of their illness, adjust their mindset and utilize behavioural strategies and support systems to cope with the long-term effects.
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Affiliation(s)
- Chelsea Nicol
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
- The Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Mount Gravatt, Australia
| | - Mark B Pinkham
- School of Medicine, University of Queensland, Brisbane, Australia
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Katarzyna Lion
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
- The Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Mount Gravatt, Australia
| | - Matthew Foote
- School of Medicine, University of Queensland, Brisbane, Australia
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Angela McBean
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Mary Higgins
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
| | - Elizabeth Conlon
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
- The Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Mount Gravatt, Australia
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Huang YY, Yang J, Liu YB. Planning issues on linac-based stereotactic radiotherapy. World J Clin Cases 2022; 10:12822-12836. [PMID: 36568990 PMCID: PMC9782937 DOI: 10.12998/wjcc.v10.i35.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/20/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
This work aims to summarize and evaluate the current planning progress based on the linear accelerator in stereotactic radiotherapy (SRT). The specific techniques include 3-dimensional conformal radiotherapy, dynamic conformal arc therapy, intensity-modulated radiotherapy, and volumetric-modulated arc therapy (VMAT). They are all designed to deliver higher doses to the target volume while reducing damage to normal tissues; among them, VMAT shows better prospects for application. This paper reviews and summarizes several issues on the planning of SRT to provide a reference for clinical application.
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Affiliation(s)
- Yang-Yang Huang
- School of Nuclear Science and Engineering, East China University of Technology, Nanchang 330013, Jiangxi Province, China
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, Henan Province, China
| | - Jun Yang
- Department of Radiotherapy, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Yi-Bao Liu
- School of Nuclear Science and Engineering, East China University of Technology, Nanchang 330013, Jiangxi Province, China
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Chermat R, Ziaee M, Mak DY, Refet-Mollof E, Rodier F, Wong P, Carrier JF, Kamio Y, Gervais T. Radiotherapy on-chip: microfluidics for translational radiation oncology. LAB ON A CHIP 2022; 22:2065-2079. [PMID: 35477748 DOI: 10.1039/d2lc00177b] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The clinical importance of radiotherapy in the treatment of cancer patients justifies the development and use of research tools at the fundamental, pre-clinical, and ultimately clinical levels, to investigate their toxicities and synergies with systemic agents on relevant biological samples. Although microfluidics has prompted a paradigm shift in drug discovery in the past two decades, it appears to have yet to translate to radiotherapy research. However, the materials, dimensions, design versatility and multiplexing capabilities of microfluidic devices make them well-suited to a variety of studies involving radiation physics, radiobiology and radiotherapy. This review will present the state-of-the-art applications of microfluidics in these fields and specifically highlight the perspectives offered by radiotherapy on-a-chip in the field of translational radiobiology and precision medicine. This body of knowledge can serve both the microfluidics and radiotherapy communities by identifying potential collaboration avenues to improve patient care.
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Affiliation(s)
- Rodin Chermat
- μFO Lab, Polytechnique Montréal, Montréal, QC, Canada.
- Institut du Cancer de Montréal, (ICM), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Maryam Ziaee
- μFO Lab, Polytechnique Montréal, Montréal, QC, Canada.
- Institut du Cancer de Montréal, (ICM), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - David Y Mak
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Elena Refet-Mollof
- μFO Lab, Polytechnique Montréal, Montréal, QC, Canada.
- Institut du Cancer de Montréal, (ICM), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Francis Rodier
- Institut du Cancer de Montréal, (ICM), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de radiologie, radio-oncologie et médecine nucléaire, Université de Montréal, Montreal, QC, Canada
| | - Philip Wong
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Institut du Cancer de Montréal, (ICM), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Jean-François Carrier
- Département de radiologie, radio-oncologie et médecine nucléaire, Université de Montréal, Montreal, QC, Canada
- Département de Physique, Université de Montréal, Montréal, QC, Canada
- Département de Radio-oncologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Yuji Kamio
- Département de Radio-oncologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
- Département de Pharmacologie et Physiologie, Université de Montréal, Montreal, QC, Canada
| | - Thomas Gervais
- μFO Lab, Polytechnique Montréal, Montréal, QC, Canada.
- Institut du Cancer de Montréal, (ICM), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
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Wang KL, Ren Q, Chiu S, Patel B, Meng FG, Hu W, Shukla AW. Deep brain stimulation and other surgical modalities for the management of essential tremor. Expert Rev Med Devices 2020; 17:817-833. [PMID: 33081571 DOI: 10.1080/17434440.2020.1806709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Surgical treatments are considered for essential tremor (ET) when patients do not respond to oral pharmacological therapies. These treatments mainly comprise radiofrequency (RF) thalamotomy, gamma knife radiosurgery (GKRS), deep brain stimulation (DBS), and focused ultrasound (FUS) procedures. AREAS COVERED We reviewed the strengths and weaknesses of each procedure and clinical outcomes for 7 RF studies (n = 85), 11 GKRS (n = 477), 33 DBS (n = 1061), and 13 FUS studies (n = 368). A formal comparison was not possible given the heterogeneity in studies. Improvements were about 42%-90% RF, 10%-79% GKRS, 45%-83% DBS, 42%-83% FUS at short-term follow-up (<12 months) and were about 54%-82% RF, 11%-84% GKRS, 18%-92% DBS, and 42%-80% FUS at long-term follow-up (>12 months). EXPERT OPINION We found DBS with inherent advantages of being an adjustable and reversible procedure as the most frequently employed surgical procedure for control of ET symptoms. FUS is a promising procedure but has limited applicability for unilateral control of symptoms. RF is invasive, and GKRS has unpredictable delayed effects. Each of these surgical modalities has advantages and limitations that need consideration when selecting a treatment for the ET patients.
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Affiliation(s)
- Kai-Liang Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University , Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University , Beijing, China
| | - Qianwei Ren
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University , Beijing, China
| | - Shannon Chiu
- Department of Neurology, University of Florida College of Medicine , Gainesville, FL, USA
| | - Bhavana Patel
- Department of Neurology, University of Florida College of Medicine , Gainesville, FL, USA
| | - Fan-Gang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University , Beijing, China
| | - Wei Hu
- Department of Neurology, University of Florida College of Medicine , Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, University of Florida College of Medicine , Gainesville, FL, USA
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Tse GH, Jiang FY, Radatz MWR, Sinha S, Zaki H. Skull base aneurysmal bone cyst presenting with hydrocephalus: progressive residuum obliterated by Gamma Knife stereotactic radiosurgery in a pediatric patient. J Neurosurg Pediatr 2020; 26:76-81. [PMID: 32244207 DOI: 10.3171/2020.2.peds19755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/05/2020] [Indexed: 11/06/2022]
Abstract
Aneurysmal bone cysts (ABCs) are an uncommon entity predominantly encountered in the pediatric population. The skull is rarely involved, but these cysts have been reported to arise in the skull base. Traditional treatment has been with surgery alone; however, there is a gathering body of literature that reports alternative treatments that can achieve long-term disease-free survival. However, these therapies are predominantly directed at peripheral skeletal lesions. To the authors' knowledge, this report is the first to describe long-term follow-up of the efficacy of Gamma Knife stereotactic radiosurgery for treatment of ABC residuum in the skull base that resulted in long-term patient stability and likely ABC obliteration.
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Affiliation(s)
- George H Tse
- 1Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Feng Y Jiang
- 2Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Matthias W R Radatz
- 3The National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and
| | - Saurabh Sinha
- 4Department of Paediatric Neurosurgery, Sheffield Children's Hospital, Western Bank, Sheffield, United Kingdom
| | - Hesham Zaki
- 4Department of Paediatric Neurosurgery, Sheffield Children's Hospital, Western Bank, Sheffield, United Kingdom
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Gilles M, Brun E, Sicard-Roselli C. Quantification of hydroxyl radicals and solvated electrons produced by irradiated gold nanoparticles suggests a crucial role of interfacial water. J Colloid Interface Sci 2018; 525:31-38. [DOI: 10.1016/j.jcis.2018.04.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 03/09/2018] [Accepted: 04/04/2018] [Indexed: 12/26/2022]
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Development of a Prototype Robotic System for Radiosurgery with Upper Hemispherical Workspace. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:4264356. [PMID: 29065601 PMCID: PMC5546125 DOI: 10.1155/2017/4264356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/06/2017] [Accepted: 05/30/2017] [Indexed: 11/18/2022]
Abstract
This paper introduces a specialized robotic system under development for radiosurgery using a small-sized linear accelerator. The robotic system is a 5-DOF manipulator that can be installed above a patient to make an upper hemispherical workspace centered in a target point. In order to determine the optimal lengths of the link, we consider the requirements for the workspace of a linear accelerator for radiosurgery. A more suitable kinematic structure than conventional industrial manipulators is proposed, and the kinematic analysis is also provided. A graphic simulator is implemented and used for dynamic analysis. Based on those results, a prototype manipulator and its control system are under development.
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9
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Miner RC. Image-Guided Neurosurgery. J Med Imaging Radiat Sci 2017; 48:328-335. [PMID: 31047466 DOI: 10.1016/j.jmir.2017.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 06/27/2017] [Indexed: 01/21/2023]
Abstract
Image-guided surgery provides more precise targeting, is less invasive, and has improved outcomes when compared with conventional surgical approaches. Imaging is used to plan, monitor progress, and assess results. Because no one modality offers real-time physiological and anatomical information, a wide range of imaging modalities are used at each phase of the surgery. This article will discuss how various modalities are used in image-guided neurosurgery for common brain pathologies.
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Affiliation(s)
- Robert C Miner
- Carleton University, Ottawa, Ontario, Canada; Ottawa Heart Institute, Ottawa, Ontario, Canada.
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10
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Tuleasca C, Negretti L, Faouzi M, Magaddino V, Gevaert T, von Elm E, Levivier M. Radiosurgery in the management of brain metastasis: a retrospective single-center study comparing Gamma Knife and LINAC treatment. J Neurosurg 2017; 128:352-361. [PMID: 28338441 DOI: 10.3171/2016.10.jns161480] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors present a retrospective analysis of a single-center experience with treatment of brain metastases using Gamma Knife (GK) and linear accelerator (LINAC)-based radiosurgery and compare the results. METHODS From July 2010 to July 2012, 63 patients with brain metastases were treated with radiosurgery. Among them, 28 (with 83 lesions) were treated with a GK unit and 35 (with 47 lesions) with a LINAC. The primary outcome was local progression-free survival (LPFS), evaluated on a per-lesion basis. The secondary outcome was overall survival (OS), evaluated per patient. Statistical analysis included standard tests and Cox regression with shared-frailty models to account for the within-patient correlation. RESULTS The mean follow-up period was 11.7 months (median 7.9 months, range 1.7-32 months) for GK and 18.1 months (median 17 months, range 7.5-28.7 months) for LINAC. The median number of lesions per patient was 2.5 (range 1-9) in the GK group and 1 (range 1-3) in the LINAC group (p < 0.01, 2-sample t-test). There were more radioresistant lesions (e.g., melanoma) and more lesions located in functional areas in the GK group. Additional technical reasons for choosing GK instead of LINAC were limitations of LINAC movements, especially if lesions were located in the lower posterior fossa or multiple lesions were close to highly functional areas (e.g., the brainstem), precluding optimal dosimetry with LINAC. The median marginal dose was 24 Gy with GK and 20 Gy with LINAC (p < 0.01, 2-sample t-test). For GK, the actuarial LPFS rate at 3, 6, 9, 12, and 17 months was 96.96%, 96.96%, 96.96%, 88.1%, and 81.5%, remaining stable until 32 months. For LINAC the rate at 3, 6, 12, 17, 24, and 33 months was 91.5%, 91.5%, 91.5%, 79.9%, 55.5%, and 17.1% (log-rank p = 0.03). In the Cox regression with shared-frailty model, the risk of local progression in the LINAC group was almost twice that of the GK group (HR 1.92, p > 0.05). The mean OS was 16.0 months (95% CI 11.2-20.9 months) in the GK group, compared with 20.9 months (95% CI 16.4-25.3 months) in the LINAC group. Univariate and multivariate analysis showed that a lower graded prognostic assessment (GPA) score, noncontrolled systemic status at last radiological assessment, and older age were associated with lower OS; after adjustment of these covariables by Cox regression, the OS was similar in the 2 groups. CONCLUSIONS In this retrospective study comparing GK and LINAC-based radiosurgery for brain metastases, patients with more severe disease were treated by GK, including those harboring lesions of greater number, of radioresistant type, or in highly functional areas. The risk of local progression for the LINAC group was almost twice that in the GK group, although the difference was not statistically significant. Importantly, the OS rates were similar for the 2 groups, although GK was used in patients with more complex brain metastatic disease and with no other therapeutic alternative.
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Affiliation(s)
- Constantin Tuleasca
- 1Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, and.,2Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne.,3Faculty of Biology and Medicine, University of Lausanne
| | | | - Mohamed Faouzi
- 3Faculty of Biology and Medicine, University of Lausanne.,5Institute of Social and Preventive Medicine, Lausanne University Hospital
| | - Vera Magaddino
- 6Institute of Radiation Physics, Lausanne,Switzerland; and
| | - Thierry Gevaert
- 7Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel,Belgium
| | - Erik von Elm
- 3Faculty of Biology and Medicine, University of Lausanne.,5Institute of Social and Preventive Medicine, Lausanne University Hospital
| | - Marc Levivier
- 1Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, and.,3Faculty of Biology and Medicine, University of Lausanne
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Tuleasca C, Broome M, Mosimann PJ, Schiappacasse L, Zeverino M, Dorenlot A, Champoudry J, Régis J, Levivier M. Jaw Immobilization for Gamma Knife Surgery in Patients with Mandibular Lesions: A Newly, Innovative Approach. Stereotact Funct Neurosurg 2016; 94:342-347. [DOI: 10.1159/000449065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/08/2016] [Indexed: 11/19/2022]
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Sager O, Dincoglan F, Beyzadeoglu M. Stereotactic radiosurgery of glomus jugulare tumors: current concepts, recent advances and future perspectives. CNS Oncol 2015; 4:105-14. [PMID: 25768334 DOI: 10.2217/cns.14.56] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Stereotactic radiosurgery (SRS), a very highly focused form of therapeutic irradiation, has been widely recognized as a viable treatment option in the management of intracranial pathologies including benign tumors, malign tumors, vascular malformations and functional disorders. The applications of SRS are continuously expanding thanks to the ever-increasing advances and corresponding improvements in neuroimaging, radiation treatment techniques, equipment, treatment planning and delivery systems. In the context of glomus jugulare tumors (GJT), SRS is being more increasingly used both as the upfront management modality or as a complementary or salvage treatment option. As its safety and efficacy is being evident with compiling data from studies with longer follow-up durations, SRS appears to take the lead in the management of most patients with GJT. Herein, we address current concepts, recent advances and future perspectives in SRS of GJT in light of the literature.
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Affiliation(s)
- Omer Sager
- Department of Radiation Oncology, Gulhane Military Medical Academy, Gn. Tevfik Saglam Cad. 06018, Etlik, Kecioren, Ankara, Turkey
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13
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Crimmins M, Gobin YP, Patsalides A, Knopman J. Therapeutic management of cerebral arteriovenous malformations: a review. Expert Rev Neurother 2015; 15:1433-44. [PMID: 26567441 DOI: 10.1586/14737175.2015.1079129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The therapeutic management of cerebral arteriovenous malformations has undergone significant change over the past 40 years. Embolization, radiosurgery, advanced imaging modalities, neuropsychological testing and advances in surgical technique has both significantly improved our ability to treat patients, as well as confounding the landscape as to what constitutes best medical practice. Variability in natural history provides additional challenges in that it is challenging to determine an accurate estimate of the risk of hemorrhage, morbidity and mortality. It is clear that the complexity of the treatment of these lesions demands a multidisciplinary approach. The need for a team of neurosurgeons, interventional and diagnostic neuroradiologists, neurologists, radiation oncologists and neuropsychologists will improve outcomes and aid in determining best therapy for patients.
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Affiliation(s)
- Michael Crimmins
- a Weill Cornell Medical Center - Neurosurgery , 525 East 68th Street Starr Pavilion, 10065 , NY , USA
| | - Y Pierre Gobin
- a Weill Cornell Medical Center - Neurosurgery , 525 East 68th Street Starr Pavilion, 10065 , NY , USA
| | - Athos Patsalides
- a Weill Cornell Medical Center - Neurosurgery , 525 East 68th Street Starr Pavilion, 10065 , NY , USA
| | - Jared Knopman
- a Weill Cornell Medical Center - Neurosurgery , 525 East 68th Street Starr Pavilion, 10065 , NY , USA
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14
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Montoure A, Zaidi H, Sheehy JP, Shetter AG, Spetzler R. Radiation Necrosis Secondary to Trigeminal Nerve TomoTherapy: A Cautionary Case Study. Cureus 2015; 7:e243. [PMID: 26180667 PMCID: PMC4494583 DOI: 10.7759/cureus.243] [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] [Accepted: 01/23/2015] [Indexed: 11/05/2022] Open
Abstract
New radiation delivery modalities have recently challenged Gamma Knife surgery as the historic gold standard in the treatment of trigeminal neuralgia (TN). TomoTherapy, a relative newcomer, has been approved by the U.S. FDA for various intracranial pathologies but is currently off label for the treatment of TN. A 73-year-old female presented with gait instability, intermittent headaches, and confusion. She was treated with TomoTherapy for refractory TN at an outside facility, which failed to reduce her symptoms. Magnetic resonance imaging demonstrated a lesion in the right mesial temporal lobe. A standard right anterior temporal lobectomy was performed and the final pathological report was notable for necrosis, gliosis, and edema consistent with a remote radiation injury. The patient improved postoperatively, but at her two-year follow up, she continued to have persistent bilateral TN and new onset seizures. Imaging revealed no new mass in the resection field. Stereotactic radiosurgery (SRS) is an evolving field with broadening indications, which makes it ever more important for physicians to be aware of differences between various SRS modalities. This case report highlights a cautionary example, and emphasizes the need for a more systematic evaluation of novel SRS methods before clinical application.
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Affiliation(s)
| | - Hasan Zaidi
- Department of Neurosurgery, Barrow Neurological Institute
| | - John P Sheehy
- Department of Neurosurgery, Barrow Neurological Institute
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15
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Allison RR, Patel RM, McLawhorn RA. Radiation oncology: physics advances that minimize morbidity. Future Oncol 2014; 10:2329-44. [DOI: 10.2217/fon.14.176] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
ABSTRACT Radiation therapy has become an ever more successful treatment for many cancer patients. This is due in large part from advances in physics including the expanded use of imaging protocols combined with ever more precise therapy devices such as linear and particle beam accelerators, all contributing to treatments with far fewer side effects. This paper will review current state-of-the-art physics maneuvers that minimize morbidity, such as intensity-modulated radiation therapy, volummetric arc therapy, image-guided radiation, radiosurgery and particle beam treatment. We will also highlight future physics enhancements on the horizon such as MRI during treatment and intensity-modulated hadron therapy, all with the continued goal of improved clinical outcomes.
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Affiliation(s)
- Ron R Allison
- 21st Century Oncology, Inc., 801 WH Smith Blvd, Greenville, NC 27858, USA
| | - Rajen M Patel
- 21st Century Oncology, Inc., 801 WH Smith Blvd, Greenville, NC 27858, USA
| | - Robert A McLawhorn
- 21st Century Oncology, Inc., 801 WH Smith Blvd, Greenville, NC 27858, USA
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16
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Rossmeisl JH. New treatment modalities for brain tumors in dogs and cats. Vet Clin North Am Small Anim Pract 2014; 44:1013-38. [PMID: 25441624 DOI: 10.1016/j.cvsm.2014.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Despite advancements in standard therapies, intracranial tumors remain a significant source of morbidity and mortality in veterinary and human medicine. Several newer approaches are gaining more widespread acceptance or are currently being prepared for translation from experimental to routine therapeutic use. Clinical trials in dogs with spontaneous brain tumors have contributed to the development and human translation of several novel therapeutic brain tumor approaches.
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Affiliation(s)
- John H Rossmeisl
- Neurology and Neurosurgery, Department of Small Animal Clinical Sciences, VA-MD Regional College of Veterinary Medicine, Virginia Tech, 215 Duckpond Drive, Mail Code 0442, Blacksburg, VA 24061, USA.
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17
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van der Sanden B, Appaix F, Berger F, Selek L, Issartel JP, Wion D. Translation of the ecological trap concept to glioma therapy: the cancer cell trap concept. Future Oncol 2013; 9:817-24. [PMID: 23718302 DOI: 10.2217/fon.13.30] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Viewing tumors as ecosystems offers the opportunity to consider how ecological concepts can be translated to novel therapeutic perspectives. The ecological trap concept emerged approximately half a century ago when it was observed that animals can prefer an environment of low quality for survival over other available environments of higher quality. The presence of such a trap can drive a local population to extinction. The cancer cell trap concept is the translation of the ecological trap into glioma therapy. It exploits and diverts the invasive potential of glioma cells by guiding their migration towards specific locations where a local therapy can be delivered efficiently. This illustrates how an ecological concept can change therapeutic obstacles into therapeutic tools.
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Affiliation(s)
- Boudewijn van der Sanden
- INSERM U836, Grenoble Institut des Neurosciences, Université Joseph Fourier, CHU Michallon, Grenoble, France
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18
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De Salles AA, Gorgulho AA, Pereira JL, McLaughlin N. Intracranial Stereotactic Radiosurgery. Neurosurg Clin N Am 2013; 24:491-8. [DOI: 10.1016/j.nec.2013.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Allison RR. The electromagnetic spectrum: current and future applications in oncology. Future Oncol 2013; 9:657-67. [DOI: 10.2217/fon.13.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The electromagnetic spectrum is composed of waves of various energies that interact with matter. When focused upon and directed at tumors, these energy sources can be employed as a means of lesion ablation. While the use of x-rays is widely known in this regard, a growing body of evidence shows that other members of this family can also achieve oncologic success. This article will review therapeutic application of the electromagnetic spectrum in current interventions and potential future applications.
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Affiliation(s)
- Ron R Allison
- 21st Century Oncology, 801 WH Smith Boulevard, Greenville, NC 27834, USA
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Delpon G, Porcheron D, Thillays F, Redon A, Blond S, Valéry CA, Latorzeff I, Mahé MA. [Medical devices needed for stereotactic radiosurgery and intracranial stereotactic radiotherapy]. Cancer Radiother 2012; 16 Suppl:S26-9. [PMID: 22632785 DOI: 10.1016/j.canrad.2012.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 04/25/2012] [Indexed: 11/29/2022]
Abstract
Since the previous special issue of Cancer Radiothérapie dedicated to radiosurgery in 1998, many important technological and computer developments have improved external beam radiotherapy treatment device performances. Whereas the Gamma Knife(®) was the gold standard for intracranial radiosurgery, new linear accelerator developments have led to new possibilities for the clinicians. This article describes quickly the different devices available for cranial radiosurgery or fractionated stereotactic radiotherapy.
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Affiliation(s)
- G Delpon
- Service de physique médicale, centre René-Gauducheau, institut de cancérologie de l'Ouest, boulevard Jacques-Monod, Nantes-Saint-Herblain, France.
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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.
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Affiliation(s)
- Emanuela Binello
- Department of Neurosurgery, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10129, USA
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