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Cho HJ, Lee JM, Park SH, Park JB, Jung NY. The Efficacy and Tolerability of Radiosurgery in Treating Benign Meningiomas: A Dose Comparison Study from a Single-Center Analysis. Life (Basel) 2024; 14:664. [PMID: 38929650 PMCID: PMC11204394 DOI: 10.3390/life14060664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
This retrospective study aimed to evaluate the impact of radiation dose on the outcomes of stereotactic radiosurgery (SRS) for benign meningiomas and determine an optimal dosing strategy for balancing tumor control and treatment-related toxicity. Clinical data of 147 patients with 164 lesions treated between 2014 and 2022 were reviewed. Primary outcomes included progression-free survival (PFS), local control rate (LCR), and radiation-induced toxicity, with secondary outcomes focusing on LCR and radiation-induced peritumoral edema (PTE) in two dose groups (≥14 Gy and <14 Gy). The results revealed a median follow-up duration of 47 months, with 1-year, 2-year, and 5-year PFS rates of 99.3%, 96.7%, and 93.8%, respectively, and an overall LCR of 95.1%. Radiation-induced toxicity was observed in 24.5% of patients, primarily presenting mild symptoms. Notably, no significant difference in LCR was found between the two dose groups (p = 0.628), while Group 2 (<14 Gy) exhibited significantly lower PTE (p = 0.039). This study concludes that SRS with a radiation dose < 14 Gy demonstrates comparable tumor control with reduced toxicity, advocating consideration of such dosing to achieve a balance between therapeutic efficacy and safety.
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Affiliation(s)
- Hyun-Jeong Cho
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea; (H.-J.C.); (J.-M.L.); (J.-B.P.)
| | - Jong-Min Lee
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea; (H.-J.C.); (J.-M.L.); (J.-B.P.)
| | - Sung-Ho Park
- Department of Neurosurgery, TrueBeam Radiosurgery Center, Ulsan University Hospital, Ulsan 44033, Republic of Korea;
| | - Jun-Bum Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea; (H.-J.C.); (J.-M.L.); (J.-B.P.)
| | - Na-Young Jung
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea; (H.-J.C.); (J.-M.L.); (J.-B.P.)
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Radiosurgical options in neuro-oncology: a review on current tenets and future opportunities. Part II: adjuvant radiobiological tools. TUMORI JOURNAL 2015; 101:57-63. [PMID: 25702646 DOI: 10.5301/tj.5000215] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 11/20/2022]
Abstract
Stereotactic radiosurgery (SRS) is currently a well-established, minimally invasive treatment for many primary and secondary tumors, especially deep-sited lesions for which traditional neurosurgical procedures were poorly satisfactory or not effective at all. The initial evolution of SRS was cautious, relying on more than 30 years of experimental and clinical work that preceded its introduction into the worldwide medical community. This path enabled a brilliant present, and the continuous pace of technological advancement holds promise for a brighter future. Part II of this review article will cover the impact of multimodal adjuvant technologies on SRS, and their input to the crucial role played by neurosurgeons, radiation oncologists and medical physicists in the management and care of fragile neuro-oncological patients.
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Yun TJ, Park CK, Kim TM, Lee SH, Kim JH, Sohn CH, Park SH, Kim IH, Choi SH. Glioblastoma treated with concurrent radiation therapy and temozolomide chemotherapy: differentiation of true progression from pseudoprogression with quantitative dynamic contrast-enhanced MR imaging. Radiology 2014; 274:830-40. [PMID: 25333475 DOI: 10.1148/radiol.14132632] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To explore the role of dynamic contrast material-enhanced magnetic resonance (MR) imaging in the differentiation of true progression from pseudoprogression in patients with glioblastoma on the basis of findings in entirely newly developed or enlarged enhancing lesions after concurrent radiation therapy and chemotherapy with temozolomide and to evaluate the diagnostic performance of the quantitative pharmacokinetic parameters obtained at dynamic contrast-enhanced MR imaging, such as the volume transfer constant (K(trans)), the extravascular extracellular space per unit volume of tissue(ve), and the blood plasma volume per unit volume of tissue(vp). MATERIALS AND METHODS This prospective study had institutional review board approval; written informed consent was obtained from all patients. Thirty-three patients with histopathologically proven glioblastoma who had undergone concurrent radiation therapy and chemotherapy with temozolomide were included. Dynamic contrast-enhanced MR imaging-derived pharmacokinetic parameters, including K(trans), ve, and vp, were calculated for newly developed or enlarged enhancing lesions. Pharmacokinetic parameters were compared between the true progression (n = 17) and pseudoprogression (n = 16) groups by using unpaired t tests and then multivariable analysis. RESULTS The mean K(trans) and ve were higher in the true progression group than in the pseudoprogression group (mean K(trans), 0.44 min(-1) ± 0.25 [standard deviation] and 0.23 min(-1) ± 0.10 for true progression and pseudoprogression groups, respectively, P = .004; and mean ve, 1.26 ± 0.78 and 0.75 ± 0.49 for true progression and pseudoprogression groups, respectively, P = .034). Multivariable analysis showed that mean K(trans) was the only independently differentiating variable (P = .004). CONCLUSION Dynamic contrast-enhanced MR imaging-derived pharmacokinetic parameters, including K(trans) and ve, in the entire newly developed or enlarged enhancing lesion may be useful objective diagnostic tools in the differentiation of true progression from pseudoprogression in patients with glioblastoma who have undergone concurrent radiation therapy and chemotherapy with temozolomide.
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Affiliation(s)
- Tae Jin Yun
- From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (T.J.Y., J.H.K., C.H.S., S.H.C.); Department of Radiology (T.J.Y., J.H.K., C.H.S., S.H.C.), Department of Neurosurgery (C.K.P.), Department of Internal Medicine, Cancer Research Institute (T.M.K., S.H.L.), Department of Pathology (S.H.P.), and Department of Radiation Oncology, Cancer Research Institute (I.H.K.), Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Republic of Korea; Center for Nanoparticle Research, Institute for Basic Science, Seoul, Republic of Korea (S.H.C.); and School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea (S.H.C.)
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Shirai K, Mizui T, Suzuki Y, Okamoto M, Hanamura K, Yoshida Y, Hino M, Noda SE, Al-jahdari WS, Chakravarti A, Shirao T, Nakano T. X Irradiation Changes Dendritic Spine Morphology and Density through Reduction of Cytoskeletal Proteins in Mature Neurons. Radiat Res 2013; 179:630-6. [DOI: 10.1667/rr3098.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Apuzzo MLJ, Pagán VM, Faccio R, Liu CY. A Bosphorus submarine passage and the reinvention of neurosurgery. World Neurosurg 2012. [PMID: 23177761 DOI: 10.1016/j.wneu.2012.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
One of the major themes characterizing the emergence of modern neurosurgery has been the concept of technology transfer and the application of a broad spectrum of revolutionary elements of technology from both physical and biological science. These transference applications are now apparent in modern neurosurgery as it is practiced on all continents of the globe. More than 3 decades ago, these ideas that now have come to fruition were in states of formulation. This article describes and further documents one such fertile cauldron of ideas and practical realities--the United States Navy Nuclear Submarine Service and its role and affect on the life and professional career of an academic neurosurgeon who was active in areas of progress as modernity was established for the early 21st century.
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Affiliation(s)
- Michael L J Apuzzo
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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Rauch PJ, Park HS, Knisely JPS, Chiang VL, Vortmeyer AO. Delayed radiation-induced vasculitic leukoencephalopathy. Int J Radiat Oncol Biol Phys 2011; 83:369-75. [PMID: 22024206 DOI: 10.1016/j.ijrobp.2011.06.1982] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 06/21/2011] [Accepted: 06/24/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE Recently, single-fraction, high-dosed focused radiation therapy such as that administered by Gamma Knife radiosurgery has been used increasingly for the treatment of metastatic brain cancer. Radiation therapy to the brain can cause delayed leukoencephalopathy, which carries its own significant morbidity and mortality. While radiosurgery-induced leukoencephalopathy is known to be clinically different from that following fractionated radiation, pathological differences are not well characterized. In this study, we aimed to integrate novel radiographic and histopathologic observations to gain a conceptual understanding of radiosurgery-induced leukoencephalopathy. METHODS AND MATERIALS We examined resected tissues of 10 patients treated at Yale New Haven Hospital between January 1, 2009, and June 30, 2010, for brain metastases that had been previously treated with Gamma Knife radiosurgery, who subsequently required surgical management of a symptomatic regrowing lesion. None of the patients showed pathological evidence of tumor recurrence. Clinical and magnetic resonance imaging data for each of the 10 patients were then studied retrospectively. RESULTS We provide evidence to show that radiosurgery-induced leukoencephalopathy may present as an advancing process that extends beyond the original high-dose radiation field. Neuropathologic examination of the resected tissue revealed traditionally known leukoencephalopathic changes including demyelination, coagulation necrosis, and vascular sclerosis. Unexpectedly, small and medium-sized vessels revealed transmural T-cell infiltration indicative of active vasculitis. CONCLUSIONS We propose that the presence of a vasculitic component in association with radiation-induced leukoencephalopathy may facilitate the progressive nature of the condition. It may also explain the resemblance of delayed leukoencephalopathy with recurring tumor on virtually all imaging modalities used for posttreatment follow-up.
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Affiliation(s)
- Philipp J Rauch
- Departments of Pathology and Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Bisdas S, Naegele T, Ritz R, Dimostheni A, Pfannenberg C, Reimold M, Koh TS, Ernemann U. Distinguishing recurrent high-grade gliomas from radiation injury: a pilot study using dynamic contrast-enhanced MR imaging. Acad Radiol 2011; 18:575-83. [PMID: 21419671 DOI: 10.1016/j.acra.2011.01.018] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The accurate delineation of tumor recurrence and its differentiation from radiation injury in the follow-up of adjuvantly treated high-grade gliomas presents a significant problem in neuro-oncology. The aim of this study was to investigate whether hemodynamic parameters derived from dynamic contrast-enhanced (DCE) T1-weighted magnetic resonance imaging (MRI) can be used to distinguish recurrent gliomas from radiation necrosis. MATERIALS AND METHODS Eighteen patients who were being treated for glial neoplasms underwent prospectively conventional and DCE-MRI using a 3T scanner. The pharmacokinetic modelling was based on a two-compartment model that allows for the calculation of K(trans) (transfer constant between intra- and extravascular, extracellular space), v(e) (extravascular, extracellular space), k(ep) (transfer constant from the extracellular, extravascular space into the plasma), and iAUC (initial area under the signal intensity-time curve). Regions of interest (ROIs) were drawn around the entire recurrence-suspected contrast-enhanced region. A definitive diagnosis was established at subsequent surgical resection or clinicoradiologic follow-up. The hemodynamic parameters in the contralateral normal white matter, the radiation injury sites, and the tumor recurrent lesions were compared using nonparametric tests. RESULTS The K(trans), v(e), k(ep), and iAUC values in the normal white matter were significantly different than those in the radiation necrosis and recurrent gliomas (0.01, <P < .0001). The only significantly different hemodynamic parameter between the recurrent tumor lesions and the radiation-induced necrotic sites were K(trans) and iAUC, which were significantly higher in the recurrent glioma group than in the radiation necrosis group (P ≤ .0184). A K(trans) cutoff value higher than 0.19 showed 100% sensitivity and 83% specificity for detecting the recurrent gliomas, whereas an iAUC cutoff value higher than 15.35 had 71% sensitivity and 71% specificity. The v(e) and k(ep) values in recurrent tumors were not significantly higher than those in radiation-induced necrotic lesions. CONCLUSIONS These findings suggest that DCE-MRI may be used to distinguish between recurrent gliomas and radiation injury and thus, assist in follow-up patient management strategy.
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Cai R, Barnett GH, Novak E, Chao ST, Suh JH. Principal risk of peritumoral edema after stereotactic radiosurgery for intracranial meningioma is tumor-brain contact interface area. Neurosurgery 2010; 66:513-22. [PMID: 20173546 DOI: 10.1227/01.neu.0000365366.53337.88] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) of meningiomas is associated with posttreatment peritumoral edema (PTE). The purpose of this study was to evaluate the prevalence and risk factors of post-SRS PTE for intracranial meningiomas. METHODS A total of 163 patients with 182 meningiomas treated with SRS were retrospectively reviewed. Tumors were divided into 4 pre-SRS groups according to whether they had undergone previous surgery and whether they had preexisting PTE. Several risk factors were investigated by univariate and multivariate analysis in all tumors, tumors without previous surgery, tumors without preexisting PTE, and preexisting PTE. RESULTS Of 182 tumors, 45 (24.7%) developed post-SRS PTE. Compared with tumors without preexisting PTE, the odds of developing post-SRS PTE in tumors with preexisting PTE were 6.0 times higher in all tumors, and 6.9 times higher in tumors without previous surgery. A 1-cm2 increase in tumor-brain contact interface area increased the odds of developing post-SRS PTE by 17% in all tumors, 16% in tumors without previous surgery, and 26% in tumors without preexisting PTE. Of 118 tumors without previous surgery, 13 had preexisting PTE, the existence of which had a significant relationship to both tumor-brain contact interface area and tumor volume. CONCLUSION Post-SRS PTE is common in patients with meningioma. Tumor-brain contact interface area and preexisting PTE were the most significant risk factors for post-SRS PTE. Tumor volume and tumor-brain contact interface area were significant risk factors for the development of preexisting PTE.
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Affiliation(s)
- Rongsheng Cai
- Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Neurological Institute, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Kang TW, Kim ST, Byun HS, Jeon P, Kim K, Kim H, Lee JII. Morphological and functional MRI, MRS, perfusion and diffusion changes after radiosurgery of brain metastasis. Eur J Radiol 2009; 72:370-80. [DOI: 10.1016/j.ejrad.2008.08.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 08/11/2008] [Accepted: 08/11/2008] [Indexed: 10/21/2022]
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Barajas RF, Chang JS, Segal MR, Parsa AT, McDermott MW, Berger MS, Cha S. Differentiation of recurrent glioblastoma multiforme from radiation necrosis after external beam radiation therapy with dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. Radiology 2009; 253:486-96. [PMID: 19789240 DOI: 10.1148/radiol.2532090007] [Citation(s) in RCA: 296] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate whether cerebral blood volume (CBV), peak height (PH), and percentage of signal intensity recovery (PSR) measurements derived from the results of T2-weighted dynamic susceptibility-weighted contrast material-enhanced (DSC) magnetic resonance (MR) imaging performed after external beam radiation therapy (EBRT) can be used to distinguish recurrent glioblastoma multiforme (GBM) from radiation necrosis. MATERIALS AND METHODS Fifty-seven patients were enrolled in this HIPAA-compliant institutional review board-approved retrospective study after they received a diagnosis of GBM, underwent EBRT, and were examined with DSC MR imaging, which revealed progressive contrast enhancement within the radiation field. A definitive diagnosis was established at subsequent surgical resection or clinicoradiologic follow-up. Regions of interest were retrospectively drawn around the entire contrast-enhanced region. This created T2-weighted signal intensity-time curves that produced three cerebral hemodynamic MR imaging measurements: CBV, PH, and PSR. Welch t tests were used to compare measurements between groups. RESULTS Mean, maximum, and minimum relative PH and relative CBV were significantly higher (P < .01) in patients with recurrent GBM than in patients with radiation necrosis. Mean, maximum, and minimum relative PSR values were significantly lower (P < .05) in patients with recurrent GBM than in patients with radiation necrosis. CONCLUSION These findings suggest that DSC perfusion MR imaging may be used to differentiate recurrent GBM from EBRT-induced radiation necrosis.
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Affiliation(s)
- Ramon F Barajas
- Department of Radiology, Neuroradiology Section, University of California, San Francisco, CA 94143, USA
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Delayed toxicity from gamma knife radiosurgery to lesions in and adjacent to the brainstem. J Clin Neurosci 2009; 16:1139-47. [PMID: 19576781 DOI: 10.1016/j.jocn.2009.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 03/05/2009] [Accepted: 03/05/2009] [Indexed: 11/20/2022]
Abstract
The aims of this study were to assess the incidence of, and risk factors for, delayed toxicity following gamma knife stereotactic radiosurgery (GKRS) to lesions in and adjacent to the brainstem. We retrospectively evaluated the delayed toxicity of GKRS following the treatment of 114 lesions in and adjacent to the brainstem in 107 patients. The median tumor volume was 6.2 cm(3) and the median dose to the tumor margin was 16Gy. The mean follow-up was 40 months. Thirteen patients (12%) demonstrated clinical evidence of delayed toxicity, with a median latency to the development of toxicity of 6 months. The actuarial incidence of toxicity at 1 year and 5 years was 10.2% and 13.8%. Larger tumor volume (p=0.02) and larger treatment volume (p=0.04) were associated with an increased incidence of delayed toxicity. Large lesions adjacent to the brainstem have a higher than previously suspected rate of delayed toxicity.
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Effects of gamma knife irradiation on the expression of NMDA receptor subunits in rat forebrain. Neurosci Lett 2008; 439:250-5. [DOI: 10.1016/j.neulet.2008.05.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2007] [Revised: 03/17/2008] [Accepted: 05/05/2008] [Indexed: 11/22/2022]
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Elder JB, Hoh DJ, Oh BC, Heller AC, Liu CY, Apuzzo ML. THE FUTURE OF CEREBRAL SURGERY. Neurosurgery 2008; 62:1555-79; discussion 1579-82. [DOI: 10.1227/01.neu.0000333820.33143.0d] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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