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Senger C, Kluge A, Kord M, Zimmermann Z, Conti A, Kufeld M, Kreimeier A, Loebel F, Stromberger C, Budach V, Vajkoczy P, Acker G. Effectiveness and Safety of Robotic Radiosurgery for Optic Nerve Sheath Meningiomas: A Single Institution Series. Cancers (Basel) 2021; 13:cancers13092165. [PMID: 33946405 PMCID: PMC8125730 DOI: 10.3390/cancers13092165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/31/2022] Open
Abstract
Simple Summary Optic nerve sheath meningiomas (ONSM) are a rare subtype of meningioma. Only four retrospective studies with 3–21 patients have been published on the treatment of ONSM by radiosurgery. This study represents the largest published series on robotic radiosurgery to date, treating 25 patients with 27 ONSM lesions. Furthermore, hypofractionated radiosurgical treatment proves to be a safe alternative to surgery and fractionated stereotactic radiation with an overall local tumor control rate of 96.0% and stable or improved visual acuity in 90.0% and 10.0% of patients, respectively. We believe that our study makes a significant contribution to the literature, as our results indicate that robotic radiosurgery is a safe and effective treatment for the management of ONSM and offers a potential treatment option that would improve patient care and clinical outcomes. Abstract The role of robotic radiosurgery (RRS) in the treatment of optic nerve sheath meningiomas (ONSM) remains controversial and it is only performed in specialized institutions due to tight dose constraints. We evaluated the effectiveness and safety of RRS in the management of ONSM. Twenty-five patients with 27 ONSM lesions who underwent RRS using the Cyberknife (CK) system were retrospectively analyzed (median age, 47.9 years; 84.0% women). Multisession RRS was used with 4–5 fractions with a cumulative dose of 20.0–25.0 Gy in 84.0% of patients and a single fraction at a dose of 14.0–15.0 Gy in 16% of patients. Prior to RRS, seven (28%) patients experienced blindness on the lesion side. In those patients with preserved vision prior to radiosurgery, the visual acuity remained the same in 90.0% and improved in 10.0% of the patients. Overall local tumor control was 96.0% (mean follow-up period; 37.4 ± 27.2 months). Neither patient age, previous surgery, or the period from the initial diagnosis to RRS showed a dependency on visual acuity before or after radiosurgery. RRS is a safe and effective treatment for the management of ONSM. Hypofractionation of radiosurgery in patients with preserved vision before CK treatment results in stable or improved vision.
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Affiliation(s)
- Carolin Senger
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
- Correspondence: ; Tel.: +49-30-450-557221
| | - Anne Kluge
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Melina Kord
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Zoe Zimmermann
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Alfredo Conti
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
- Alma Mater Studiorum-Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Via Altura 3, 40139 Bologna (BO), Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna (BO), Italy
| | - Markus Kufeld
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Anita Kreimeier
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Franziska Loebel
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Carmen Stromberger
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Volker Budach
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Peter Vajkoczy
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Gueliz Acker
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health at Charité Universitätsmedizin Berlin, BIH Acadamy, Clinician Scientist Program, Charitéplatz 1, 10117 Berlin, Germany
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Acker G, Hashemi SM, Fuellhase J, Kluge A, Conti A, Kufeld M, Kreimeier A, Loebel F, Kord M, Sladek D, Stromberger C, Budach V, Vajkoczy P, Senger C. Efficacy and safety of CyberKnife radiosurgery in elderly patients with brain metastases: a retrospective clinical evaluation. Radiat Oncol 2020; 15:225. [PMID: 32993672 PMCID: PMC7523070 DOI: 10.1186/s13014-020-01655-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022] Open
Abstract
Background Stereotactic radiosurgery (SRS) has been increasingly applied for up to 10 brain metastases instead of whole brain radiation therapy (WBRT) to achieve local tumor control while reducing neurotoxicity. Furthermore, brain-metastasis incidence is rising due to the increasing survival of patients with cancer. Our aim was to analyze the efficacy and safety of CyberKnife (CK) radiosurgery for elderly patients. Methods We retrospectively identified all patients with brain metastases ≥ 65 years old treated with CK-SRS at our institution since 2011 and analyzed data of primary diseases, multimodality treatments, and local therapy effect based on imaging follow-up and treatment safety. Kaplan–Meier analysis for local progression-free interval and overall survival were performed. Results We identified 97 patients (233 lesions) fulfilling the criteria at the first CK-SRS. The mean age was 73.2 ± 5.8 (range: 65.0–87.0) years. Overall, 13.4% of the patients were > 80 years old. The three most frequent primary cancers were lung (40.2%), kidney (22.7%), and malignant melanoma (15.5%). In 38.5% (47/122 treatments) multiple brain metastases were treated with the CK-SRS, with up to eight lesions in one session. The median planning target volume (PTV) was 1.05 (range: 0.01–19.80) cm3. A single fraction was applied in 92.3% of the lesions with a median prescription dose of 19 (range: 12–21) Gy. The estimated overall survivals at 3-, 6-, and 12 months after SRS were 79, 55, and 23%, respectively. The estimated local tumor progression-free intervals at 6-, 12-, 24-, 36-, and 72 months after SRS were 99.2, 89.0, 67.2, 64.6, and 64.6%, respectively. Older age and female sex were predictive factors of local progression. The Karnofsky performance score remained stable in 97.9% of the patients; only one patient developed a neurological deficit after SRS of a cerebellar lesion (ataxia, CTCAE Grade 2). Conclusions SRS is a safe and efficient option for the treatment of elderly patients with brain metastases with good local control rates without the side effects of WBRT. Older age and female sex seem to be predictive factors of local progression. Prospective studies are warranted to clarify the role of SRS treatment for elderly patients.
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Affiliation(s)
- Gueliz Acker
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany. .,Charité CyberKnife Center, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Seyed-Morteza Hashemi
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Josch Fuellhase
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Anne Kluge
- Charité CyberKnife Center, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Alfredo Conti
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Charité CyberKnife Center, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Neurosurgery, Biomedical and Neuromotor sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Markus Kufeld
- Charité CyberKnife Center, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anita Kreimeier
- Charité CyberKnife Center, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Franziska Loebel
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Charité CyberKnife Center, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Melina Kord
- Charité CyberKnife Center, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Diana Sladek
- Charité CyberKnife Center, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Carmen Stromberger
- Charité CyberKnife Center, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Volker Budach
- Charité CyberKnife Center, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Charité CyberKnife Center, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Carolin Senger
- Charité CyberKnife Center, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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Conti A, Acker G, Kluge A, Loebel F, Kreimeier A, Budach V, Vajkoczy P, Ghetti I, Germano' AF, Senger C. Decision Making in Patients With Metastatic Spine. The Role of Minimally Invasive Treatment Modalities. Front Oncol 2019; 9:915. [PMID: 31608228 PMCID: PMC6761912 DOI: 10.3389/fonc.2019.00915] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/03/2019] [Indexed: 12/18/2022] Open
Abstract
Spine metastases affect more than 70% of terminal cancer patients that eventually suffer from severe pain and neurological symptoms. Nevertheless, in the overwhelming majority of the cases, a spinal metastasis represents just one location of a diffuse systemic disease. Therefore, the best practice for treatment of spinal metastases depends on many different aspects of an oncological disease, including the assessment of neurological status, pain, location, and dissemination of the disease as well as the ability to predict the risk of disease progression with neurological worsening, benefits and risks associated to treatment and, eventually, expected survival. To address this need for a framework and algorithm that takes all aspects of care into consideration, we reviewed available evidence on the multidisciplinary management of spinal metastases. According to the latest evidence, the use of stereotactic radiosurgery (SRS) or stereotactic body radiotherapy (SBRT) for spinal metastatic disease is rapidly increasing. Indeed, aggressive surgical resection may provide the best results in terms of local control, but carries a significant rate of post-surgical morbidity whose incidence and severity appears to be correlated to the extent of resection. The multidisciplinary management represents, according to current evidence, the best option for the treatment of spinal metastases. Noteworthy, according to the recent literature evidence, cases that once required radical surgical resection followed by low-dose conventional radiotherapy, can now be more effectively treated by minimally invasive spinal surgery (MISS) followed by spine SRS with decreased morbidity, improved local control, and more durable pain control. This combination allows also extending this standard of care to patients that would be too sick for an aggressive surgical treatment.
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Affiliation(s)
- Alfredo Conti
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Güliz Acker
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Charité CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anne Kluge
- Charité CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Franziska Loebel
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Charité CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anita Kreimeier
- Charité CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Volker Budach
- Charité CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Charité CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ilaria Ghetti
- Department of Neurosurgery, University of Messina, Messina, Italy
| | | | - Carolin Senger
- Charité CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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