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Ehret F, Kohlhase N, Eftimova D, Hofmann T, Fürweger C, Haidenberger A, Kufeld M, Muacevic A, Santacroce A. Self-Shielding Gyroscopic Radiosurgery: A Prospective Experience and Analysis of the First 100 Patients. Cureus 2024; 16:e56035. [PMID: 38606262 PMCID: PMC11008698 DOI: 10.7759/cureus.56035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/13/2024] Open
Abstract
Background Stereotactic radiosurgery is a well-established treatment option for the management of various benign and malignant brain tumors. It can be delivered with several treatment platforms, usually requiring shielded radiation vaults to meet regulatory safety requirements. Recent technical advances have led to the first self-shielding platform enabling the delivery of gyroscopic radiosurgery (GRS). Given the limited number of GRS treatment platforms, the novelty of its characteristics, and the lack of available data, we report our prospective experience with the first 100 patients treated with GRS. Materials and methods Patients undergoing GRS for the treatment of intracranial tumors were enrolled in this prospective study. Patient and treatment characteristics, including patient satisfaction, were collected and analyzed. Results A total of 100 patients with 155 tumors were treated. The most commonly treated tumors comprised brain metastases (BM) (49%), vestibular schwannomas (31%), and meningiomas (14%). The median prescription dose for malignant and benign tumors was 20 and 13 Gy, respectively. The median prescription isodose line was 56%. Gross tumor volumes were small, with a median of 0.37 cc for BM and 0.92 cc for the other entities. The median total treatment time was 40 minutes. Dosimetric performance indices showed median values of 1.20 (conformity index), 1.24 (new conformity index), 1.74 (homogeneity index), and 3.13 (gradient index). Volumetric assessment of the treated tumors showed an overall decrease in size at the first available follow-up. Most patients were satisfied with the treatment experience. Conclusion Our first prospective experience of the use of GRS is favorable. Analyses of the dosimetric performance, treatment times, volumetric assessment, and patient satisfaction demonstrate its suitability for stereotactic treatments of intracranial tumors. Further prospective clinical and dosimetric analyses for GRS are pending.
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Affiliation(s)
- Felix Ehret
- Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, DEU
- Charité - Universitätsmedizin Berlin, German Cancer Consortium (DKTK) partner site Berlin, and German Cancer Research Center (DKFZ) Heidelberg, Berlin, DEU
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Nadja Kohlhase
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Dochka Eftimova
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Theresa Hofmann
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Christoph Fürweger
- Medical Physics, European Radiosurgery Center Munich, Munich, DEU
- Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, Cologne, DEU
| | | | - Markus Kufeld
- Radiosurgery, European Radiosurgery Center Munich, Munich, DEU
| | | | - Antonio Santacroce
- Radiosurgery, European Radiosurgery Center Munich, Munich, DEU
- Medicine, Faculty of Health, Witten/Herdecke University, Witten, DEU
- Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Hamm, DEU
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Ehret F, Kaul D, Kufeld M, Endt CV, Budach V, Senger C, Fürweger C, Haidenberger A, Muacevic A. Robotic stereotactic body radiotherapy for the management of adrenal gland metastases: a bi-institutional analysis. J Cancer Res Clin Oncol 2023; 149:1095-1101. [PMID: 35290521 PMCID: PMC9984319 DOI: 10.1007/s00432-022-03943-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Adrenal gland metastases (AGMs) are a common manifestation of metastatic tumor spread, especially in non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). In patients with a limited systemic tumor burden, effective treatments for AGMs are needed. Due to varying fractionation schemes and limited reports, short-course treatment results for stereotactic body radiotherapy (SBRT) for AGMs are lacking. This work analyzes the outcomes of short-course SBRT for AGMs. METHODS Patients who underwent robotic SBRT for AGMs with one to five fractions were eligible for analysis. RESULTS In total, data from 55 patients with 72 AGMs from two institutions were analyzed. Most AGMs originated from renal cell carcinoma (38%) and NSCLC (35%). The median follow-up was 16.4 months. The median prescription dose and isodose line were 24 Gy and 70%, respectively. Most patients (85%) received SBRT with just one fraction. The median biologically effective dose assuming an α/β ratio of 10 (BED10) was 80.4 Gy. The local control and progression-free survival after 1 and 2 years were 92.9%, 67.8%, and 46.2%, as well as 24.3%, respectively. Thirteen patients (24%) suffered from grade 1 or 2 toxicities. The BED10 showed a significant impact on LC (p < 0.01). Treatments with a BED10 equal to or above the median were associated with a better LC (p < 0.01). CONCLUSION Robotic SBRT is an efficient and safe treatment modality for AGM. Treatment-associated side effects are sporadic and manageable. Results suggest short-course SBRT to be a preferable and time-saving treatment option for the management of AGMs if an adequate BED10 can be safely applied.
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Affiliation(s)
- Felix Ehret
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany. .,Department of Radiation Oncology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany. .,European Radiosurgery Center, 81377, Munich, Germany.
| | - David Kaul
- Department of Radiation Oncology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany.,Charité CyberKnife Center, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Berlin, 69120, Heidelberg, Germany
| | - Markus Kufeld
- European Radiosurgery Center, 81377, Munich, Germany
| | - Clara Vom Endt
- Department of Radiation Oncology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany.,Charité CyberKnife Center, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
| | - Carolin Senger
- Department of Radiation Oncology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany.,Charité CyberKnife Center, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
| | - Christoph Fürweger
- European Radiosurgery Center, 81377, Munich, Germany.,Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, 50937, Cologne, Germany
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Ehret F, Hofmann T, Fürweger C, Kufeld M, Staehler M, Muacevic A, Haidenberger A. Single-fraction prostate-specific membrane antigen positron emission tomography- and multiparametric magnetic resonance imaging-guided stereotactic body radiotherapy for prostate cancer local recurrences. BJU Int 2023; 131:101-108. [PMID: 36114771 DOI: 10.1111/bju.15894] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To analyse the efficacy and safety of focal prostate-specific membrane antigen positron emission tomography (PSMA-PET)- and multiparametric magnetic resonance imaging (mpMRI)-guided single-fraction stereotactic body radiotherapy (SBRT) for the treatment of prostate cancer (PCa) local recurrences. PATIENTS AND METHODS Patients with PSMA-PET-positive PCa local recurrences treated with single-fraction SBRT between 2016 and 2020 were included. Identification for subsequent recurrences or metastatic spread based on increasing prostate-specific antigen (PSA) levels were evaluated using PSMA-PET imaging. RESULTS A total of 64 patients were identified. Patients received various treatments before SBRT (31 patients with radical prostatectomy [RP], 18 external beam radiotherapy [EBRT] with RP, five EBRT, and the remaining 10 other combinations). The median follow-up was 21.6 months. The median PSA level before SBRT was 1.47 ng/mL. All patients received a single-fraction treatment with a median prescription dose and isodose line of 21 Gy and 65%, respectively. At the time of SBRT, six patients (9%) received an androgen deprivation therapy (ADT). PSA levels decreased after SBRT (P = 0.03) and three local recurrences were detected during the follow-up. The progression-free survival after 1-, 2-, and 3-years was 85.3%, 65.9%, and 51.2%, respectively. Six patients (9%) started ADT after SBRT due to disease progression. The rates of newly started ADT after 1-, 2-, and 3-years were 1.8%, 7.3%, and 22.7%, respectively. Grade 1 or 2 toxicities occurred in six patients (9%); no high-grade toxicity was observed. CONCLUSION While the available data for SBRT in the PCa local recurrence setting describe outcomes for fractionated irradiations, the findings of this first analysis of single-fraction, PSMA-PET- and mpMRI-guided focal SBRT are encouraging. Such treatment appears to be a safe, efficient, and time-saving therapy even in intensively pretreated patients. Recurrence-directed treatments can delay the use of ADT and could avoid prostate bed irradiation in selected patients.
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Affiliation(s)
- Felix Ehret
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany.,European Radiosurgery Center Munich, Munich, Germany
| | | | - Christoph Fürweger
- European Radiosurgery Center Munich, Munich, Germany.,Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Markus Kufeld
- European Radiosurgery Center Munich, Munich, Germany
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany
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4
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Loebel F, Pontoriero A, Kluge A, Iatì G, Acker G, Kufeld M, Cacciola A, Pergolizzi S, Vinci S, Lillo S, Xu R, Stromberger C, Budach V, Vajkoczy P, Senger C, Conti A. Image-guided robotic radiosurgery for the treatment of arteriovenous malformations. PLoS One 2022; 17:e0266744. [PMID: 36137082 PMCID: PMC9499208 DOI: 10.1371/journal.pone.0266744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 03/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background Cerebral arteriovenous malformations (AVMs) are challenging lesions, often requiring multimodal interventions; however, data on the efficacy of stereotactic radiosurgery for cerebral AVMs are limited. This study aimed to evaluate the clinical and radiographic results following robotic radiosurgery, alone or in combination with endovascular treatment, and to investigate factors associated with obliteration and complications in patients with AVM. Methods We retrospectively analyzed the clinical and imaging characteristics of 123 patients with AVMs of all Spetzler-Martin grades treated at two institutions by robotic radiosurgery in single-fraction doses (CyberKnife). Embolization was performed before radiosurgery in a subset of patients to attempt to downgrade the lesions. Factors associated with AVM obliteration and complications (toxicity) were identified via univariate and multivariate analyses. Results The median follow-up time was 48.1 months (range, 3.6–123 months). Five patients were lost to follow-up. The obliteration rate in the 59 patients with a follow-up period exceeding four years was 72.8%. Complete obliteration and partial remission were achieved in 67 (56.8%) and 31 (26.3%) cases, respectively, whereas no change was observed in 20 cases (17.8%). Embolization was performed in 54/123 cases (43.9%). Complete and partial obliteration were achieved in 29 (55.7%) and 14 (26.9%) embolized patients, respectively. In the multivariate analysis, the factors associated with obliteration were age (p = .018) and the Spetzler-Martin grade (p = .041). Treatment-induced toxicity (radiation necrosis and/or edema) was observed in 15 cases (12.7%), rebleeding occurred in three cases (2.5%), and the rate of mortality associated with rebleeding was 1.7%. Conclusions CyberKnife radiosurgery is a valid approach for treating AVMs of all Spetzler-Martin-grades, with satisfactory obliteration rates, low toxicity, and a relatively rare incidence of rebleeding.
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Affiliation(s)
- Franziska Loebel
- Department of Neurosurgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
- Department of Radiation Oncology, Charité Universitaetsmedizin Berlin, Berlin, Germany
- * E-mail:
| | | | - Anne Kluge
- Department of Radiation Oncology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Giuseppe Iatì
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | - Gueliz Acker
- Department of Neurosurgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
- Department of Radiation Oncology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Markus Kufeld
- Department of Radiation Oncology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Alberto Cacciola
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | | | - Sergio Vinci
- Department of Neuroradiology, University of Messina, Messina, Italy
| | - Sara Lillo
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | - Ran Xu
- Department of Neurosurgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Carmen Stromberger
- Department of Radiation Oncology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Carolin Senger
- Department of Radiation Oncology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Alfredo Conti
- Department of Neurosurgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
- Department of Neurosurgery, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS ISNB-Istituto delle Scienze Neurologiche Bologna, Bologna, Italy
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Lim W, Acker G, Hardt J, Kufeld M, Kluge A, Brenner W, Conti A, Budach V, Vajkoczy P, Senger C, Prasad V. Dynamic 18F-FET PET/CT to differentiate recurrent primary brain tumor and brain metastases from radiation necrosis after single-session robotic radiosurgery. Cancer Treat Res Commun 2022; 32:100583. [PMID: 35688103 DOI: 10.1016/j.ctarc.2022.100583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Cyberknife robotic radiosurgery (RRS) provides single-session high-dose radiotherapy of brain tumors with a steep dose gradient and precise real-time image-guided motion correction. Although RRS appears to cause more radiation necrosis (RN), the radiometabolic changes after RRS have not been fully clarified. 18F-FET-PET/CT is used to differentiate recurrent tumor (RT) from RN after radiosurgery when MRI findings are indecisive. We explored the usefulness of dynamic parameters derived from 18F-FET PET in differentiating RT from RN after Cyberknife treatment in a single-center study population. METHODS We retrospectively identified brain tumor patients with static and dynamic 18F-FET-PET/CT for suspected RN after Cyberknife. Static (tumor-to-background ratio) and dynamic PET parameters (time-activity curve, time-to-peak) were quantified. Analyses were performed for all lesions taken together (TOTAL) and for brain metastases only (METS). Diagnostic accuracy of PET parameters (using mean tumor-to-background ratio >1.95 and time-to-peak of 20 min for RT as cut-offs) and their respective improvement of diagnostic probability were analyzed. RESULTS Fourteen patients with 28 brain tumors were included in quantitative analysis. Time-activity curves alone provided the highest sensitivities (TOTAL: 95%, METS: 100%) at the cost of specificity (TOTAL: 50%, METS: 57%). Combined mean tumor-to-background ratio and time-activity curve had the highest specificities (TOTAL: 63%, METS: 71%) and led to the highest increase in diagnosis probability of up to 16% p. - versus 5% p. when only static parameters were used. CONCLUSIONS This preliminary study shows that combined dynamic and static 18F-FET PET/CT parameters can be used in differentiating RT from RN after RRS.
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Affiliation(s)
- Winna Lim
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - 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, Berlin 10117, Germany; Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany; BIH Academy, Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Juliane Hardt
- Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Center for Research and Training for Health in the Human-Animal-Environment Interface, University of Veterinary Medicine (Foundation) Hannover (TiHo), Buenteweg 2, Hanover 30559, Germany; Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Medical Information Management, Faculty of Information and Communication, University of Applied Sciences Hannover, Germany
| | - Markus Kufeld
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany; European Radiosurgery Center Munich, Max Lebsche-Platz 31, Munich 81377, 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, Berlin 13353, Germany
| | - Anne Kluge
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, 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, Berlin 13353, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - Alfredo Conti
- Department of Biomedical Science and Neuromotor Sciences DIBINEM, Alma Mater Studiorum - Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Via Altura 3, 40139 29 Bologna (BO), Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna (BO) 40139, Italy
| | - Volker Budach
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, 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, Berlin 13353, 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, Berlin 10117, Germany; Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - Carolin Senger
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, 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, Berlin 13353, Germany
| | - Vikas Prasad
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany; Department of Nuclear Medicine, University Hospital of Ulm, Ulm 89070, Germany.
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Ehret F, Kaul D, Mose L, Budach V, Vajkoczy P, Fürweger C, Haidenberger A, Muacevic A, Mehrhof F, Kufeld M. Intracranial Hemorrhage in Patients with Anticoagulant Therapy Undergoing Stereotactic Radiosurgery for Brain Metastases: A Bi-Institutional Analysis. Cancers (Basel) 2022; 14:cancers14030465. [PMID: 35158734 PMCID: PMC8833468 DOI: 10.3390/cancers14030465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Stereotactic radiosurgery (SRS) is a well-established treatment modality for brain metastases (BM). Given the manifold implications of metastatic cancer on the body, affected patients have an increased risk of comorbidities, such as atrial fibrillation (AF) and venous thromboembolism (VTE), which includes pulmonary embolism (PE) and deep-vein thrombosis (DVT). These may require therapeutic anticoagulant therapy (ACT). Limited data are available on the risk of intracranial hemorrhage (ICH) after SRS for patients with BM who are receiving ACT. This bi-institutional analysis aimed to describe the bleeding risk for this patient subgroup. Methods: Patients with ACT at the time of single-fraction SRS for BM from two institutions were eligible for analysis. The cumulative incidence of ICH with death as a competing event was assessed during follow-up with magnetic resonance imaging or computed tomography. Results: Forty-one patients with 97 BM were included in the analyses. The median follow-up was 8.2 months (range: 1.7–77.5 months). The median and mean BM volumes were 0.47 and 1.19 cubic centimeters, respectively. The most common reasons for ACT were PE (41%), AF (34%), and DVT (7%). The ACT was mostly performed utilizing phenprocoumon (37%), novel oral anticoagulants (32%), or low-molecular-weight heparin (20%). Nine BM from a group of five patients with ICH after SRS were identified: none of them caused neurological or any other deficits. The 6-, 12-, and 18-month cumulative bleeding incidences per metastasis were 2.1%, 12.4%, and 12.4%, respectively. The metastases with previous bleeding events and those originating from malignant melanomas were found to more frequently demonstrate ICH after SRS (p = 0.02, p = 0.01). No surgical or medical intervention was necessary for ICH management, and no observed death was associated with an ICH. Conclusion: Patients receiving an ACT and single-fraction SRS for small- to medium-sized BM did not seem to have a clinically relevant risk of ICH. Previous bleeding and metastases originating from a malignant melanoma may favor bleeding events after SRS. Further studies are needed to validate our reported findings.
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Affiliation(s)
- Felix Ehret
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, 13353 Berlin, Germany; (D.K.); (V.B.); (F.M.)
- European Radiosurgery Center, 81377 Munich, Germany; (L.M.); (C.F.); (A.H.); (A.M.); (M.K.)
- Correspondence:
| | - David Kaul
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, 13353 Berlin, Germany; (D.K.); (V.B.); (F.M.)
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité CyberKnife Center, 13353 Berlin, Germany;
| | - Lucas Mose
- European Radiosurgery Center, 81377 Munich, Germany; (L.M.); (C.F.); (A.H.); (A.M.); (M.K.)
| | - Volker Budach
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, 13353 Berlin, Germany; (D.K.); (V.B.); (F.M.)
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité CyberKnife Center, 13353 Berlin, Germany;
| | - Peter Vajkoczy
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité CyberKnife Center, 13353 Berlin, Germany;
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, 10117 Berlin, Germany
| | - Christoph Fürweger
- European Radiosurgery Center, 81377 Munich, Germany; (L.M.); (C.F.); (A.H.); (A.M.); (M.K.)
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany
| | - Alfred Haidenberger
- European Radiosurgery Center, 81377 Munich, Germany; (L.M.); (C.F.); (A.H.); (A.M.); (M.K.)
| | - Alexander Muacevic
- European Radiosurgery Center, 81377 Munich, Germany; (L.M.); (C.F.); (A.H.); (A.M.); (M.K.)
| | - Felix Mehrhof
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, 13353 Berlin, Germany; (D.K.); (V.B.); (F.M.)
| | - Markus Kufeld
- European Radiosurgery Center, 81377 Munich, Germany; (L.M.); (C.F.); (A.H.); (A.M.); (M.K.)
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7
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Kord M, Kluge A, Kufeld M, Kalinauskaite G, Loebel F, Stromberger C, Budach V, Gebauer B, Acker G, Senger C. Risks and Benefits of Fiducial Marker Placement in Tumor Lesions for Robotic Radiosurgery: Technical Outcomes of 357 Implantations. Cancers (Basel) 2021; 13:cancers13194838. [PMID: 34638321 PMCID: PMC8508340 DOI: 10.3390/cancers13194838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/29/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Robotic radiosurgery (RRS) allows for the accurate treatment of primary tumors or metastases with high single doses. However, organ motion during or between fractions can lead to imprecise irradiation. We sought to evaluate the risks and advantages of fiducial marker (FM) implantation regarding clinical complications, marker migration, and motion amplitude. Complications were most common in Synchrony®-tracked lesions affected by respiratory motion, particularly lung lesions. Pneumothoraces and pulmonary bleeding were the most common complications. An increased complication rate was associated with concomitant biopsy sampling and FM implantation. Most FM migration observed in this study occurred after CT-guided placements and clinical FM insertions. The largest motion amplitudes were observed in hepatic and lower lung lobe lesions. This study highlights the benefits of marker implantation, especially in lesions with a large motion amplitude, including hepatic lesions and lesions of the lower lobe of the lung located >100.0 mm from the spine. Abstract Fiducial markers (FM) inserted into tumors increase the precision of irradiation during robotic radiosurgery (RRS). This retrospective study evaluated the clinical complications, marker migration, and motion amplitude of FM implantations by analyzing 288 cancer patients (58% men; 63.1 ± 13.0 years) who underwent 357 FM implantations prior to RRS with CyberKnife, between 2011 and 2019. Complications were classified according to the Society of Interventional Radiology (SIR) guidelines. The radial motion amplitude was calculated for tumors that moved with respiration. A total of 725 gold FM was inserted. SIR-rated complications occurred in 17.9% of all procedures. Most complications (32.0%, 62/194 implantations) were observed in Synchrony®-tracked lesions affected by respiratory motion, particularly in pulmonary lesions (46.9% 52/111 implantations). Concurrent biopsy sampling was associated with a higher complication rate (p = 0.001). FM migration occurred in 3.6% after CT-guided and clinical FM implantations. The largest motion amplitudes were observed in hepatic (20.5 ± 11.0 mm) and lower lung lobe (15.4 ± 10.5 mm) lesions. This study increases the awareness of the risks of FM placement, especially in thoracic lesions affected by respiratory motion. Considering the maximum motion amplitude, FM placement remains essential in hepatic and lower lung lobe lesions located >100.0 mm from the spine.
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Affiliation(s)
- 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; (M.K.); (A.K.); (G.K.); (C.S.); (V.B.)
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (G.A.)
| | - 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; (M.K.); (A.K.); (G.K.); (C.S.); (V.B.)
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (G.A.)
| | - Markus Kufeld
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (G.A.)
| | - Goda Kalinauskaite
- 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; (M.K.); (A.K.); (G.K.); (C.S.); (V.B.)
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (G.A.)
| | - Franziska Loebel
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (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; (M.K.); (A.K.); (G.K.); (C.S.); (V.B.)
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (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; (M.K.); (A.K.); (G.K.); (C.S.); (V.B.)
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (G.A.)
| | - Bernhard Gebauer
- Department of Radiology, 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; (M.K.); (F.L.); (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
| | - 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; (M.K.); (A.K.); (G.K.); (C.S.); (V.B.)
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (G.A.)
- Correspondence: ; Tel.: +49-30-450-557221
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8
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Ehret F, Mose L, Kufeld M, Fürweger C, Windisch P, Haidenberger A, Schichor C, Tonn JC, Muacevic A. Image-Guided Robotic Radiosurgery for the Treatment of Same Site Spinal Metastasis Recurrences. Front Oncol 2021; 11:642314. [PMID: 34123794 PMCID: PMC8193921 DOI: 10.3389/fonc.2021.642314] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/15/2020] [Accepted: 03/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background Due to recent medical advancements, patients suffering from metastatic spinal disease have a prolonged life expectancy than several decades ago, and some will eventually experience relapses. Data for the retreatment of spinal metastasis recurrences occurring at the very same macroscopic spot as the initially treated lesion are limited. Previous studies mainly included recurrences in the boundary areas as well as other macroscopic parts of the initially affected vertebrae. This study exclusively analyzes the efficacy and safety of spinal reirradiation for recurrences on the same site utilizing single-session robotic radiosurgery. Materials and Methods Patients between 2005 and 2020 who received radiotherapy for a spinal metastasis suffering from a local recurrence were eligible for analysis. Only patients undergoing a single-session reirradiation were included. All recurrences must have been occurred in the same location as the initial lesion. This was defined as a macroscopic recurrence on computed tomography occurring at the same site as the initial spinal metastasis. All other lesions, including those in the boundary areas or other parts of the initially affected vertebrae, were excluded. Results Fifty-three patients with fifty-three lesions were retreated for spinal metastases. The median dose and number of fractions for the initial radiotherapy were 36 Gy and 15, respectively. Eleven patients were initially treated with stereotactic body radiotherapy. Retreatment was performed with a median dose of 18 Gy prescribed to a median isodose of 70%. The local control was 77% after a median follow-up of 22.2 months. Patients experiencing a second recurrence received a lower dose (p = 0.04), mostly below 18 Gy, and had a worse coverage (p = 0.01) than those showing local tumor control. 51% of patients experienced an improvement in pain control after treatment delivery. Besides, four vertebral compression fractures (7% of patients) but no other adverse events higher than grade 2 were observed. Conclusion Single-session robotic radiosurgery appears to be a safe, time-saving, and effective treatment modality for spinal metastasis recurrences occurring in the same initial location if a considerable dose and coverage can be applied. Treatment results are comparable to reirradiated metastases in the boundary areas.
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Affiliation(s)
- Felix Ehret
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany.,European Cyberknife Center, Munich, Germany
| | - Lucas Mose
- European Cyberknife Center, Munich, Germany
| | | | - Christoph Fürweger
- European Cyberknife Center, Munich, Germany.,Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Paul Windisch
- European Cyberknife Center, Munich, Germany.,Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Christian Schichor
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
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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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Ehret F, Kufeld M, Fürweger C, Haidenberger A, Windisch P, Senger C, Kord M, Träger M, Kaul D, Schichor C, Tonn JC, Muacevic A. Image-Guided Robotic Radiosurgery for the Management of Spinal Ependymomas. Front Oncol 2021; 11:654251. [PMID: 33996577 PMCID: PMC8117154 DOI: 10.3389/fonc.2021.654251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/15/2021] [Accepted: 03/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background Ependymomas are rare neoplasms of the central nervous system (CNS), usually localized intracranially and most commonly diagnosed in children. Spinal ependymomas are more frequent in young adults. They are either primary lesions or manifest as disseminated seeding of cranial tumors. Data on the management of spinal ependymoma lesions remain scarce, especially concerning stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). The purpose of this study is to report the treatment outcomes of two institutions using robotic radiosurgery (RRS) for the treatment of spinal ependymomas. Materials and Methods All patients with a histopathologically confirmed diagnosis of an ependymoma WHO grade II or III who were treated with RRS for one or more spinal lesions were included in this analysis. Results Twelve patients underwent RRS for the treatment of 32 spinal ependymoma lesions between 2005 and 2020. Two patients were below the age of 18 when treated, whereas nine patients (75%) suffered from a primary spinal ependymoma. The median dose was 15 Gy prescribed to a median isodose of 70%, with 27 lesions (84%) receiving a single-session treatment. The local control (LC) after a median follow-up of 56.7 months was 84%. LC rates at 1, 3, and 5 years were 92, 85, and 77%, respectively. The Kaplan-Meier estimated overall survival after 1, 3, and 5 years were 75, 75, and 64%, respectively. Five patients died, all of them suffering from an anaplastic ependymoma, with widespread CNS tumor progression being the reason for death in four patients. The majority of patients (58%) showed a stable neurological status at the last available follow-up. Overall, the treatment was well tolerated. Conclusion RRS appears to be a safe and efficient treatment modality for managing primary and secondary spinal ependymal tumors in patients with multiple lesions and local recurrences.
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Affiliation(s)
- Felix Ehret
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany.,European Cyberknife Center, Munich, Germany
| | | | - Christoph Fürweger
- European Cyberknife Center, Munich, Germany.,Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | | | - Paul Windisch
- European Cyberknife Center, Munich, Germany.,Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Carolin Senger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité CyberKnife Center, Berlin, Germany
| | - Melina Kord
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany
| | - Malte Träger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany
| | - David Kaul
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Schichor
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
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Ehret F, Kufeld M, Fürweger C, Haidenberger A, Windisch P, Fichte S, Lehrke R, Senger C, Kaul D, Rueß D, Ruge M, Schichor C, Tonn JC, Stalla G, Muacevic A. Robotic Radiosurgery for Persistent Postoperative Acromegaly in Patients with Cavernous Sinus-Invading Pituitary Adenomas-A Multicenter Experience. Cancers (Basel) 2021; 13:cancers13030537. [PMID: 33572555 PMCID: PMC7866786 DOI: 10.3390/cancers13030537] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/17/2020] [Revised: 01/12/2021] [Accepted: 01/28/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Growth hormone-secreting tumors of the pituitary gland which infiltrate surrounding tissue structures may not be fully resectable. This causes many patients to suffer from acromegaly after an unsuccessful surgery. To limit the considerable morbidity and mortality of such patients, effective and safe treatment options are needed. Fractionated radiotherapy and growth hormone-lowering medication are possible treatment options. Robotic radiosurgery (RRS) may be a suitable treatment modality as well. However, only sparse and heterogeneous data are available. This first retrospective multicenter study investigated the efficacy and safety of RRS for this patient group. Outcomes provide evidence that RRS may achieve biochemical disease control or remission in most of the patients. The hormone levels are decreasing after treatment, whereas favorable risk and safety profiles of RRS were shown. No new tumor growth was observed throughout the available follow-up. These findings may guide future care for this challenging patient population. Abstract Background: The rates of incomplete surgical resection for pituitary macroadenomas with cavernous sinus invasion are high. In growth hormone-producing adenomas, there is a considerable risk for persistent acromegaly. Thus, effective treatment options are needed to limit patient morbidity and mortality. This multicenter study assesses the efficacy and safety of robotic radiosurgery (RRS) for patients with cavernous sinus-invading adenomas with persistent acromegaly. Methods: Patients who underwent RRS with CyberKnife for postoperative acromegaly were eligible. Results: Fifty patients were included. At a median follow-up of 57 months, the local control was 100%. The pretreatment insulin-like growth factor 1 (IGF-1) levels and indexes were 381 ng/mL and 1.49, respectively. The median dose and prescription isodose were 18 Gy and 70%, respectively. Six months after RRS, and at the last follow-up, the IGF-1 levels and indexes were 277 ng/mL and 1.14, as well as 196 ng/mL and 0.83, respectively (p = 0.0001 and p = 0.0002). The IGF-1 index was a predictor for biochemical remission (p = 0.04). Nine patients achieved biochemical remission and 24 patients showed biochemical disease control. Three patients developed a new hypopituitarism. Conclusions: RRS is an effective treatment for this challenging patient population. IGF-1 levels are decreasing after treatment and most patients experience biochemical disease control or remission.
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Affiliation(s)
- Felix Ehret
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (C.S.); (D.K.)
- European Cyberknife Center, 81377 Munich, Germany; (M.K.); (C.F.); (A.H.); (P.W.); (A.M.)
- Correspondence:
| | - Markus Kufeld
- European Cyberknife Center, 81377 Munich, Germany; (M.K.); (C.F.); (A.H.); (P.W.); (A.M.)
| | - Christoph Fürweger
- European Cyberknife Center, 81377 Munich, Germany; (M.K.); (C.F.); (A.H.); (P.W.); (A.M.)
| | - Alfred Haidenberger
- European Cyberknife Center, 81377 Munich, Germany; (M.K.); (C.F.); (A.H.); (P.W.); (A.M.)
| | - Paul Windisch
- European Cyberknife Center, 81377 Munich, Germany; (M.K.); (C.F.); (A.H.); (P.W.); (A.M.)
- Department of Radiation Oncology, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
| | - Susanne Fichte
- CyberKnife Center Mitteldeutschland, 99089 Erfurt, Germany;
| | | | - Carolin Senger
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (C.S.); (D.K.)
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité CyberKnife Center, 13353 Berlin, Germany
| | - David Kaul
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (C.S.); (D.K.)
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Daniel Rueß
- Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany; (D.R.); (M.R.)
| | - Maximilian Ruge
- Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany; (D.R.); (M.R.)
| | - Christian Schichor
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany; (C.S.); (J.-C.T.)
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany; (C.S.); (J.-C.T.)
| | - Günter Stalla
- Medicover Neuroendocrinology, 81667 Munich, Germany;
- Department of Medicine IV, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Alexander Muacevic
- European Cyberknife Center, 81377 Munich, Germany; (M.K.); (C.F.); (A.H.); (P.W.); (A.M.)
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Ehret F, Senger C, Kufeld M, Fürweger C, Kord M, Haidenberger A, Windisch P, Rueß D, Kaul D, Ruge M, Schichor C, Tonn JC, Muacevic A. Image-Guided Robotic Radiosurgery for the Management of Intramedullary Spinal Cord Metastases-A Multicenter Experience. Cancers (Basel) 2021; 13:cancers13020297. [PMID: 33467434 PMCID: PMC7829974 DOI: 10.3390/cancers13020297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/16/2020] [Revised: 01/03/2021] [Accepted: 01/13/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Due to recent medical advancements, patients suffering from metastatic cancer have a prolonged life expectancy compared to several decades ago. Thus, the number of patients who experience metastasis to the spinal cord is increasing. Intramedullary metastases bear a dismal prognosis and cause considerable morbidity. Limited data are available on the treatment of such lesions. As surgery may be the mainstay of treatment for resectable and localized metastatic spread, previous case reports and series suggest radiosurgery to be a treatment alternative. This first multicenter study analyzes the efficacy of robotic radiosurgery (RRS) for the management of intramedullary metastases. Outcomes provide evidence that RRS is a safe, time-saving and effective treatment modality, especially for patients with unresectable lesions. Most patients die from systemic disease progression, while the majority of treated lesions remain controlled until death. Most symptoms improve or stay stable after treatment. These findings may guide further palliative care of affected patients. Abstract Background: Intramedullary metastases are rare and bear a dismal prognosis. Limited data are available on the treatment of such lesions. As surgery may be the mainstay of treatment for patients with resectable and localized metastatic spread, previous case reports and case series suggest radiosurgery to be another viable treatment modality. This multicenter study analyzes the efficacy and safety of robotic radiosurgery (RRS) for intramedullary metastases. Methods: Patients who received RRS for the treatment of at least one intramedullary metastasis were included. Results: Thirty-three patients with 46 intramedullary metastases were treated with a median dose of 16 Gy prescribed to a median isodose of 70%. The local control was 79% after a median follow-up of 8.5 months. The median overall survival (OS) was 11.7 months, with a 12- and 24-month OS of 47 and 31%. The 12-month progression-free survival was 42% and at 24 months 25%. In addition, 57% of patients showed either an improved or stable neurological function after treatment delivery. Systemic disease progression was the main cause of death. No significant treatment-related toxicities were observed. Conclusions: RRS appears to be a safe, time-saving and effective treatment modality for intramedullary metastases, especially for patients with unresectable lesions and high burden of disease.
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Affiliation(s)
- Felix Ehret
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (C.S.); (M.K.); (D.K.)
- European Cyberknife Center, 81377 Munich, Germany; (M.K.); (C.F.); (A.H.); (P.W.); (A.M.)
- Correspondence:
| | - Carolin Senger
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (C.S.); (M.K.); (D.K.)
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité CyberKnife Center, 13353 Berlin, Germany
| | - Markus Kufeld
- European Cyberknife Center, 81377 Munich, Germany; (M.K.); (C.F.); (A.H.); (P.W.); (A.M.)
| | - Christoph Fürweger
- European Cyberknife Center, 81377 Munich, Germany; (M.K.); (C.F.); (A.H.); (P.W.); (A.M.)
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany; (D.R.); (M.R.)
| | - Melina Kord
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (C.S.); (M.K.); (D.K.)
| | - Alfred Haidenberger
- European Cyberknife Center, 81377 Munich, Germany; (M.K.); (C.F.); (A.H.); (P.W.); (A.M.)
| | - Paul Windisch
- European Cyberknife Center, 81377 Munich, Germany; (M.K.); (C.F.); (A.H.); (P.W.); (A.M.)
- Department of Radiation Oncology, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
| | - Daniel Rueß
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany; (D.R.); (M.R.)
| | - David Kaul
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (C.S.); (M.K.); (D.K.)
| | - Maximilian Ruge
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany; (D.R.); (M.R.)
| | - Christian Schichor
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany; (C.S.); (J.-C.T.)
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany; (C.S.); (J.-C.T.)
| | - Alexander Muacevic
- European Cyberknife Center, 81377 Munich, Germany; (M.K.); (C.F.); (A.H.); (P.W.); (A.M.)
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13
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Conti A, Senger C, Acker G, Kluge A, Pontoriero A, Cacciola A, Pergolizzi S, Germanò A, Badakhshi H, Kufeld M, Meinert F, Nguyen P, Loebel F, Vajkoczy P, Budach V, Kaul D. Correction to: Normofractionated stereotactic radiotherapy versus CyberKnife-based hypofractionation in skull base meningioma: a German and Italian pooled cohort analysis. Radiat Oncol 2020; 15:279. [PMID: 33317569 PMCID: PMC7734707 DOI: 10.1186/s13014-020-01707-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Alfredo Conti
- Department of Neurosurgery, University of Bologna, Bologna, Italy.,Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Carolin Senger
- CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Güliz Acker
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), 10178, Berlin, Germany
| | - Anne Kluge
- CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Alberto Cacciola
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | | | - Antonino Germanò
- Department of Neurosurgery, University of Bologna, Bologna, Italy
| | - Harun Badakhshi
- Ernst Von Bergmann Medical Center, Department of Radiation Oncology, Potsdam, Germany
| | - Markus Kufeld
- CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Meinert
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Phuong Nguyen
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Loebel
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Budach
- CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany.
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14
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Kalinauskaite G, Senger C, Kluge A, Furth C, Kufeld M, Tinhofer I, Budach V, Beck M, Hochreiter A, Grün A, Stromberger C. 68Ga-PSMA-PET/CT-based radiosurgery and stereotactic body radiotherapy for oligometastatic prostate cancer. PLoS One 2020; 15:e0240892. [PMID: 33085712 PMCID: PMC7577453 DOI: 10.1371/journal.pone.0240892] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023] Open
Abstract
Background Androgen deprivation therapy (ADT) remains the standard therapy for patients with oligometastatic prostate cancer (OMPC). Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT)-based stereotactic body radiotherapy (SBRT) is emerging as an alternative option to postpone starting ADT and its associated side effects including the development of drug resistance. The aim of this study was to determine progression free-survival (PFS) and treatment failure free-survival (TFFS) after PSMA-PET/CT-based SBRT in OMPC patients. The efficacy and safety of single fraction radiosurgery (SFRS) and ADT delay were investigated. Methods Patients with ≤5 metastases from OMPC, with/without ADT treated with PSMA-PET/CT-based SBRT were retrospectively analyzed. PFS and TFFS were primary endpoints. Secondary endpoints were local control (LC), overall survival (OS) and ADT-free survival (ADTFS). Results Fifty patients with a total of 75 metastases detected by PSMA-PET/CT were analyzed. At the time of SBRT, 70% of patients were castration-sensitive. Overall, 80% of metastases were treated with SFRS (median dose 20 Gy, range: 16–25). After median follow-up of 34 months (range: 5–70) median PFS and TFFS were 12 months (range: 2–63) and 14 months (range: 2–70), respectively. Thirty-two (64%) patients had repeat oligometastatic disease. Twenty-four (48%) patients with progression underwent second SBRT course. Two-year LC after SFRS was 96%. Grade 1 and 2 toxicity occurred in 3 (6%) and 1 (2%) patients, respectively. ADTFS and OS rates at 2-years were 60.5% and 100%, respectively. In multivariate analysis, TFFS significantly improved in patients with time to first metastasis (TTM) >36 months (p = 0.01) and PSA before SBRT ≤1 ng/ml (p = 0.03). Conclusion For patients with OMPC, SBRT might be used as an alternative to ADT. This way, the start/escalation of palliative ADT and its side effects can be deferred. Metastases treated with PSMA-PET/CT-based SFRS reached excellent LC with minimal toxicity. Low PSA levels and longer TTM predict elongated TFFS.
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Affiliation(s)
- Goda Kalinauskaite
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology and Radiotherapy, Berlin, Germany
- Charité CyberKnife Center, Departments of Radiation Oncology and Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Carolin Senger
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology and Radiotherapy, Berlin, Germany
- Charité CyberKnife Center, Departments of Radiation Oncology and Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anne Kluge
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology and Radiotherapy, Berlin, Germany
- Charité CyberKnife Center, Departments of Radiation Oncology and Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Furth
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Berlin, Germany
| | - Markus Kufeld
- Charité CyberKnife Center, Departments of Radiation Oncology and Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ingeborg Tinhofer
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology and Radiotherapy, Berlin, Germany
- The Translational Radiooncology and Radiobiology Research Laboratory, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Budach
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology and Radiotherapy, Berlin, Germany
- Charité CyberKnife Center, Departments of Radiation Oncology and Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Beck
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology and Radiotherapy, Berlin, Germany
- Charité CyberKnife Center, Departments of Radiation Oncology and Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexandra Hochreiter
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology and Radiotherapy, Berlin, Germany
| | - Arne Grün
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology and Radiotherapy, Berlin, Germany
- Charité CyberKnife Center, Departments of Radiation Oncology and Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carmen Stromberger
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology and Radiotherapy, Berlin, Germany
- Charité CyberKnife Center, Departments of Radiation Oncology and Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
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15
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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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16
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Ehret F, Kufeld M, Fürweger C, Haidenberger A, Schichor C, Lehrke R, Fichte S, Senger C, Bleif M, Rueß D, Ruge M, Tonn JC, Muacevic A, Hempel JM. Image-guided robotic radiosurgery for glomus jugulare tumors-Multicenter experience and review of the literature. Head Neck 2020; 43:35-47. [PMID: 32851752 DOI: 10.1002/hed.26439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/14/2020] [Accepted: 08/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Glomus jugulare tumors (GJTs) are challenging to treat due to their vascularization and location. This analysis evaluates the effectiveness and safety of image-guided robotic radiosurgery (RRS) for GJTs in a multicenter study and reviews the existing radiosurgical literature. METHODS We analyzed outcome data from 101 patients to evaluate local control (LC), changes in pretreatment deficits, and toxicity. Moreover, radiosurgical studies for GJTs have been reviewed. RESULTS After a median follow-up of 35 months, the overall LC was 99%. Eighty-eight patients were treated with a single dose, 13 received up to 5 fractions. The median tumor volume was 5.6 cc; the median treatment dose for single-session treatments is 16 Gy, and for multisession treatments is 21 Gy. Fifty-six percentage of patients experienced symptom improvement or recovered entirely. CONCLUSIONS RRS is an effective primary and secondary treatment option for GJTs. The available literature suggests that radiosurgery is a treatment option for most GJTs.
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Affiliation(s)
| | | | - Christoph Fürweger
- European Cyberknife Center, Munich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | | | - Christian Schichor
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Campus Grosshadern, Munich, Germany
| | | | | | - Carolin Senger
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Bleif
- Radiochirurgicum/CyberKnife Südwest, Göppingen, Germany
| | - Daniel Rueß
- Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Maximilian Ruge
- Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Campus Grosshadern, Munich, Germany
| | | | - John-Martin Hempel
- Department of Otorhinolaryngology and Head and Neck Surgery, Ludwig-Maximilians-University Munich, Campus Grosshadern, Munich, Germany
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17
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Windisch P, Weber P, Fürweger C, Ehret F, Kufeld M, Zwahlen D, Muacevic A. Implementation of model explainability for a basic brain tumor detection using convolutional neural networks on MRI slices. Neuroradiology 2020; 62:1515-1518. [PMID: 32500277 DOI: 10.1007/s00234-020-02465-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE While neural networks gain popularity in medical research, attempts to make the decisions of a model explainable are often only made towards the end of the development process once a high predictive accuracy has been achieved. METHODS In order to assess the advantages of implementing features to increase explainability early in the development process, we trained a neural network to differentiate between MRI slices containing either a vestibular schwannoma, a glioblastoma, or no tumor. RESULTS Making the decisions of a network more explainable helped to identify potential bias and choose appropriate training data. CONCLUSION Model explainability should be considered in early stages of training a neural network for medical purposes as it may save time in the long run and will ultimately help physicians integrate the network's predictions into a clinical decision.
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Affiliation(s)
- Paul Windisch
- European CyberKnife Center, Munich, Germany. .,Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland.
| | | | - Christoph Fürweger
- European CyberKnife Center, Munich, Germany.,Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | | | - Daniel Zwahlen
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
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18
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Conti A, Acker G, Pontoriero A, Hardt J, Kluge A, Cacciola A, Iatì G, Kufeld M, Budach V, Vajkoczy P, Beltramo G, Pergolizzi S, Bergantin A, Loebel F, Parisi S, Senger C, Romanelli P. Factors affecting outcome in frameless non-isocentric stereotactic radiosurgery for trigeminal neuralgia: a multicentric cohort study. Radiat Oncol 2020; 15:115. [PMID: 32443978 PMCID: PMC7243318 DOI: 10.1186/s13014-020-01535-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/13/2020] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is an effective treatment for trigeminal neuralgia (TN). Nevertheless, a proportion of patients will experience recurrence and treatment-related sensory disturbances. In order to evaluate the predictors of efficacy and safety of image-guided non-isocentric radiosurgery, we analyzed the impact of trigeminal nerve volume and the nerve dose/volume relationship, together with relevant clinical characteristics. METHODS Two-hundred and ninety-six procedures were performed on 262 patients at three centers. In 17 patients the TN was secondary to multiple sclerosis (MS). Trigeminal pain and sensory disturbances were classified according to the Barrow Neurological Institute (BNI) scale. Pain-free-intervals were investigated using Kaplan Meier analyses. Univariate and multivariate Cox regression analyses were performed to identify predictors. RESULTS The median follow-up period was 38 months, median maximal dose 72.4 Gy, median target nerve volume 25 mm3, and median prescription dose 60 Gy. Pain control rate (BNI I-III) at 6, 12, 24, 36, 48, and 60 months were 96.8, 90.9, 84.2, 81.4, 74.2, and 71.2%, respectively. Overall, 18% of patients developed sensory disturbances. Patients with volume ≥ 30 mm3 were more likely to maintain pain relief (p = 0.031), and low integral dose (< 1.4 mJ) tended to be associated with more pain recurrence than intermediate (1.4-2.7 mJ) or high integral dose (> 2.7 mJ; low vs. intermediate: log-rank test, χ2 = 5.02, p = 0.019; low vs. high: log-rank test, χ2 = 6.026, p = 0.014). MS, integral dose, and mean dose were the factors associated with pain recurrence, while re-irradiation and MS were predictors for sensory disturbance in the multivariate analysis. CONCLUSIONS The dose to nerve volume ratio is predictive of pain recurrence in TN, and re-irradiation has a major impact on the development of sensory disturbances after non-isocentric SRS. Interestingly, the integral dose may differ significantly in treatments using apparently similar dose and volume constraints.
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Affiliation(s)
- 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, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany. .,Unit of Neurosurgery, IRCCS ISNB Istituto delle Scienze Neurologiche di Bologna; Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - 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.,Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, Berlin, 10178, Germany
| | | | - Juliane Hardt
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin AND Berlin Institute of Health , Berlin, Germany.,Clinical Research Unit (CRU), Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Fakultät III, Dep. Information & Communication, Medical Information Management, Hochschule Hannover - University of Applied Sciences and Arts, Expo Plaza 12, 30539, Hannover, Germany
| | - Anne Kluge
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Alberto Cacciola
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | - Giuseppe Iatì
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | - Markus Kufeld
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Volker Budach
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, 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, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, 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, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Silvana Parisi
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | - Carolin Senger
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Ehret F, Kufeld M, Fürweger C, Haidenberger A, Schichor C, Tonn JC, Muacevic A, Hempel JM. Single-session image-guided robotic radiosurgery and quality of life for glomus jugulare tumors. Head Neck 2020; 42:2421-2430. [PMID: 32394483 DOI: 10.1002/hed.26231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/03/2020] [Accepted: 04/22/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Limited data are available on the efficacy and impact on the quality of life (Qol) of single-session image-guided robotic radiosurgery (RRS) for glomus jugulare tumors (GJTs). This study investigates the role of RRS in the management of GJTs and reviews the RRS literature. METHODS We analyzed 53 GJT patients treated with RRS to evaluate the safety, local control, clinical outcome, and Qol assessed by the SF12v2. RESULTS The local control was 98% at a median follow-up of 38 months. The median tumor volume was 4.3 cc and tumors were treated with a median dose of 16.5 Gy. At the last follow-up, 35 patients had recovered from their symptoms or experienced symptom improvement. Qol analyses showed no significant decline while bodily pain significantly decreased. CONCLUSIONS RRS is a safe and efficient tool for the treatment of GJTs. Qol of patients after treatment is stable and tends to improve over time.
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Affiliation(s)
| | | | - Christoph Fürweger
- European Cyberknife Center, Munich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | | | - Christian Schichor
- Department of Neurosurgery, Campus Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Campus Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - John-Martin Hempel
- Department of Otorhinolaryngology and Head and Neck Surgery, Campus Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
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20
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Windisch PY, Tonn JC, Fürweger C, Wowra B, Kufeld M, Schichor C, Muacevic A. Clinical Results After Single-fraction Radiosurgery for 1,002 Vestibular Schwannomas. Cureus 2019; 11:e6390. [PMID: 31938667 PMCID: PMC6957120 DOI: 10.7759/cureus.6390] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Indexed: 11/21/2022] Open
Abstract
Background Herein, we report clinical results for patients treated with stereotactic radiosurgery (SRS) for vestibular schwannomas (VS) over a period of 10 years. Methods Clinical data and imaging follow-up were stored in a database of 1,378 patients, with 1,384 VS treated consecutively between 2005 and 2018 and analyzed retrospectively. A total of 996 patients with 1,002 tumors with at least one year of follow-up were included for analysis. Results Median follow-up was 3·6 years (1-12·5 years). The three, five, and 10-year Kaplan-Meier estimated local tumor control was 96·6%, 92·3%, and 90·8%, respectively. The median hearing loss of the affected ear as compared to its healthy counterpart was 17 dB at treatment start and increased to 23 and 29 dB at one and five years. Six patients (0·6%) developed symptomatic hydrocephalus and underwent the placement of a ventriculoperitoneal shunt. In 30 patients (3·0%), trigeminal sensory dysfunction developed, five patients (0·5%) had a mild transient weakness, and nine patients (0·9%) had a permanent facial weakness (House-Brackmann Grade > II) after SRS. Conclusion Single fraction SRS proves to be highly effective and shows low treatment-related toxicity for VS. SRS should be considered a primary treatment option for small and middle-sized VS.
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Affiliation(s)
| | | | | | - Berndt Wowra
- Oncology, European CyberKnife Center, Munich, DEU
| | - Markus Kufeld
- Radiation Oncology, European CyberKnife Center, Munich, DEU
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Kufeld M, Escobar H, Marg A, Pasemann D, Budach V, Spuler S. Localized irradiation of mouse legs using an image-guided robotic linear accelerator. Ann Transl Med 2017; 5:156. [PMID: 28480192 DOI: 10.21037/atm.2017.03.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To investigate the potential of human satellite cells in muscle regeneration small animal models are useful to evaluate muscle regeneration. To suppress the inherent regeneration ability of the tibialis muscle of mice before transplantation of human muscle fibers, a localized irradiation of the mouse leg should be conducted. We analyzed the feasibility of an image-guided robotic irradiation procedure, a routine treatment method in radiation oncology, for the focal irradiation of mouse legs. METHODS After conducting a planning computed tomography (CT) scan of one mouse in its customized mold a three-dimensional dose plan was calculated using a dedicated planning workstation. 18 Gy have been applied to the right anterior tibial muscle of 4 healthy and 12 mice with immune defect in general anesthesia using an image-guided robotic linear accelerator (LINAC). The mice were fixed in a customized acrylic mold with attached fiducial markers for image guided tracking. RESULTS All 16 mice could be irradiated as prevised without signs of acute radiation toxicity or anesthesiological side effects. The animals survived until scarification after 8, 21 and 49 days as planned. The procedure was straight forward and the irradiation process took 5 minutes to apply the dose of 18 Gy. CONCLUSIONS Localized irradiation of mice legs using a robotic LINAC could be conducted as planned. It is a feasible procedure without recognizable side effects. Image guidance offers precise dose delivery and preserves adjacent body parts and tissues.
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Affiliation(s)
- Markus Kufeld
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Helena Escobar
- Max Delbrück Center for Molecular Medicine, Mobile DNA group, Berlin, Germany
| | - Andreas Marg
- Muscle Research Unit, Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Diana Pasemann
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simone Spuler
- Muscle Research Unit, Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Berlin, Germany
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Kaul D, Angelidis A, Budach V, Ghadjar P, Kufeld M, Badakhshi H. Prognostic indices in stereotactic radiotherapy of brain metastases of non-small cell lung cancer. Radiat Oncol 2015; 10:244. [PMID: 26611493 PMCID: PMC4661968 DOI: 10.1186/s13014-015-0550-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our purpose was to analyze the long-term clinical outcome and to identify prognostic factors after Linac-based stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) on patients with brain metastases (BM) from non-small cell lung cancer (NSCLC). MATERIALS AND METHODS We performed a retrospective analysis of survival on 90 patients who underwent SRS or FSRT of intracranial NSCLC metastases between 04/2004 and 05/2014 that had not undergone prior surgery or whole brain radiotherapy (WBRT) for BM. Follow-up data was analyzed until May 2015. Potential prognostic factors were examined in univariable and multivariable analyses. The Golden Grading System (GGS), the disease-specific graded prognostic assessment (DS-GPA), the RADES II prognostic index as well as the NSCLC-specific index proposed by Rades et al. in 2013 (NSCLC-RADES) were calculated and their predictive values were tested in univariable analysis. RESULTS The median follow-up time of the surviving patients was 14 months. The overall survival (OS) rate was 51 % after 6 months and 29.9 % after 12 months. Statistically significant factors of better OS after univariable analysis were lower International Union Against Cancer (UICC) stage at first diagnosis, histology of adenocarcinoma, prior surgery of the primary tumor and lower total BM volume. After multivariable analysis adenocarcinoma histology remained a significant factor; higher Karnofsky Performance Score (KPS) and the presence of extracranial metastases (ECM) were also significant. The RADES II and the NSCLC-RADES indices were significant predictors of OS. However, the NSCLC-RADES failed to differentiate between intermediate- and low-risk patients. The DS-GPA and GGS were not statistically significant predictors of survival in univariable analysis. CONCLUSION The ideal prognostic index has not been defined yet. We believe that more specific indices will be developed in the future. Our results indicate that the histologic subtype of NSCLC could add to the prognostic value of specialized future indices. The RADES II index had the highest predictive value in the examined patient cohort.
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Affiliation(s)
- David Kaul
- Department of Radiation Oncology, Charité School of Medicine and University Hospital, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Alexander Angelidis
- Department of Radiation Oncology, Charité School of Medicine and University Hospital, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Volker Budach
- Department of Radiation Oncology, Charité School of Medicine and University Hospital, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité School of Medicine and University Hospital, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Markus Kufeld
- Charité CyberKnife Center, Charité School of Medicine and University Hospital, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Harun Badakhshi
- Department of Radiation Oncology, Charité School of Medicine and University Hospital, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Kaul D, Badakhshi H, Gevaert T, Pasemann D, Budach V, Tuleasca C, Gruen A, Prasad V, Levivier M, Kufeld M. Dosimetric comparison of different treatment modalities for stereotactic radiosurgery of meningioma. Acta Neurochir (Wien) 2015; 157:559-63; discussion 563-4. [PMID: 25413163 DOI: 10.1007/s00701-014-2272-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/31/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this study was to compare the three most prominent systems for stereotactic radiosurgery in terms of dosimetric characteristics: the Cyberknife system, the Gamma Knife Perfexion and the Novalis system. METHODS Ten patients treated for recurrent grade I meningioma after surgery using the Cyberknife system were identified; the Cyberknife contours were exported and comparative treatment plans were generated for the Novalis system and Gamma Knife Perfexion. Dosimetric values were compared with respect to coverage, conformity index (CI), gradient index (GI) and beam-on time (BOT). RESULTS All three systems showed comparable results in terms of coverage. The Gamma Knife and the Cyberknife system showed significantly higher levels of conformity than the Novalis system (Cyberknife vs Novalis, p = 0.002; Gamma Knife vs Novalis, p = 0.002). The Gamma Knife showed significantly steeper gradients compared with the Novalis and the Cyberknife system (Gamma Knife vs Novalis, p = 0.014; Gamma Knife vs Cyberknife, p = 0.002) and significantly longer beam-on times than the other two systems (BOT = 66 ± 21.3 min, Gamma Knife vs Novalis, p = 0.002; Gamma Knife vs Cyberknife, p = 0.002). CONCLUSIONS The multiple focal entry systems (Gamma Knife and Cyberknife) achieve higher conformity than the Novalis system. The Gamma Knife delivers the steepest dose gradient of all examined systems. However, the Gamma Knife is known to require long beam-on times, and despite worse dose gradients, LINAC-based systems (Novalis and Cyberknife) offer image verification at the time of treatment delivery.
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Affiliation(s)
- David Kaul
- Department of Radiation Oncology, Charité School of Medicine and University Hospital, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany,
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Kaul D, Badakhshi H, Gevaert T, Pasemann D, Budach V, Tuleasca C, Gruen A, Prasad V, Levivier M, Kufeld M. Erratum to: dosimetric comparison of different treatment modalities for stereotactic radiosurgery of meningioma. Acta Neurochir (Wien) 2015; 157:565. [PMID: 25530173 DOI: 10.1007/s00701-014-2315-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David Kaul
- Department of Radiation Oncology, Charité School of Medicine and University Hospital, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany,
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25
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Heufelder J, Gollrad J, Hager A, Kufeld M, Pasemann D, Rehak M, Joussen AM. Vergleich perkutaner strahlentherapeutischer Verfahren in der Therapie der altersbedingten Maukaldegeneration. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Marg A, Escobar H, Gloy S, Kufeld M, Zacher J, Spuler A, Birchmeier C, Izsvák Z, Spuler S. Human satellite cells have regenerative capacity and are genetically manipulable. J Clin Invest 2014; 124:4257-65. [PMID: 25157816 DOI: 10.1172/jci63992] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/10/2014] [Indexed: 12/15/2022] Open
Abstract
Muscle satellite cells promote regeneration and could potentially improve gene delivery for treating muscular dystrophies. Human satellite cells are scarce; therefore, clinical investigation has been limited. We obtained muscle fiber fragments from skeletal muscle biopsy specimens from adult donors aged 20 to 80 years. Fiber fragments were manually dissected, cultured, and evaluated for expression of myogenesis regulator PAX7. PAX7+ satellite cells were activated and proliferated efficiently in culture. Independent of donor age, as few as 2 to 4 PAX7+ satellite cells gave rise to several thousand myoblasts. Transplantation of human muscle fiber fragments into irradiated muscle of immunodeficient mice resulted in robust engraftment, muscle regeneration, and proper homing of human PAX7+ satellite cells to the stem cell niche. Further, we determined that subjecting the human muscle fiber fragments to hypothermic treatment successfully enriches the cultures for PAX7+ cells and improves the efficacy of the transplantation and muscle regeneration. Finally, we successfully altered gene expression in cultured human PAX7+ satellite cells with Sleeping Beauty transposon-mediated nonviral gene transfer, highlighting the potential of this system for use in gene therapy. Together, these results demonstrate the ability to culture and manipulate a rare population of human tissue-specific stem cells and suggest that these PAX7+ satellite cells have potential to restore gene function in muscular dystrophies.
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Picht T, Schilt S, Frey D, Vajkoczy P, Kufeld M. Integration of navigated brain stimulation data into radiosurgical planning: potential benefits and dangers. Acta Neurochir (Wien) 2014; 156:1125-33. [PMID: 24744010 DOI: 10.1007/s00701-014-2079-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 03/25/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Radiosurgical treatment of brain lesions near motor or language eloquent areas requires careful planning to achieve the optimal balance between effective dose prescription and preservation of function. Navigated brain stimulation (NBS) is the only non-invasive modality that allows the identification of functionally essential areas by electrical stimulation or inhibition of cortical neurons analogous to the gold-standard of intraoperative electrical mapping. OBJECTIVE To evaluate the feasibility of NBS data integration into the radiosurgical environment, and to analyze the influence of NBS data on the radiosurgical treatment planning for lesions near or within motor or language eloquent areas of the brain. METHODS Eleven consecutive patients with brain lesions in presumed motor or language eloquent locations eligible for radiosurgical treatment were mapped with NBS. The radiosurgical team prospectively analyzed the data transfer and classified the influence of the functional NBS information on the radiosurgical treatment planning using a standardized questionnaire. RESULTS The semi-automatized data transfer to the radiosurgical planning workstation was flawless in all cases. The NBS data influenced the radiosurgical treatment planning procedure as follows: improved risk-benefit balancing in all cases, target contouring in 0 %, dose plan modification in 81.9 %, reduction of radiation dosage in 72.7 % and treatment indication in 63.7 % of the cases. CONCLUSIONS NBS data integration into radiosurgical treatment planning is feasible. By mapping the spatial relationship between the lesion and functionally essential areas, NBS has the potential to improve radiosurgical planning safety for eloquently located lesions.
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Affiliation(s)
- Thomas Picht
- Department of Neurosurgery, Charité University Hospital, Augustenburger Platz 1, 13353, Berlin, Germany,
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Heim S, Coras R, Ganslandt O, Kufeld M, Blümcke I, Paulus W, Hasselblatt M. Papillary tumor of the pineal region with anaplastic small cell component. J Neurooncol 2013; 115:127-30. [PMID: 23817812 DOI: 10.1007/s11060-013-1202-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
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Marnitz S, Köhler C, Budach V, Neumann O, Kluge A, Wlodarczyk W, Jahn U, Gebauer B, Kufeld M. Brachytherapy-emulating robotic radiosurgery in patients with cervical carcinoma. Radiat Oncol 2013; 8:109. [PMID: 23638755 PMCID: PMC3695857 DOI: 10.1186/1748-717x-8-109] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 04/16/2013] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the technique, dosimetry, dose-volume-histograms (DVHs) and acute toxicity for CyberKnife® boost irradiation instead of intra-cervical brachytherapy in patients with cervical cancer. METHODS AND MATERIALS Eleven who were not suitable for brachytherapy with FIGO stage IIB-IIIB cervical cancer underwent primary chemoradiation. After fiducial implantation, T2 contrast-enhanced planning MRI and CT scans at 2-mm slice thickness were collected in the treatment position. The clinical target volume was defined as cervix + macroscopic residual tumour on MRI. Five fractions of 6 Gy each were prescribed to the target volume with a covering single dose 6 Gy. DVH parameters were evaluated for the target and organs at risk. Acute toxicity was documented once a week. RESULTS DmeanPTV ranged from 33.6-40 Gy, median 36.7 Gy with a coverage of the PTV calculated to 100% of the prescribed dose ranging from 93.0-99.3% (median 97.7%). For the PTV the median CN was 0.78 (range, 0.66 to 0.87) and the median CI was 1.28 (range 1.15 to 1.52). Gastrointestinal (GI) and genitourinary (GU) toxicity was mild. There was no grade 3 or higher GI and GU toxicity. After 6 months of follow up, there were no local recurrences. For the complete treatment, a median EQD2 to 1 cc and 2 cc of the bladder wall was 98.8 Gy and 87.1 Gy, respectively. Median EQD2 to 1 cc and 2 cc of the rectal wall was 72.3 Gy and 64 Gy, respectively, correlating with a risk < 10% for Grade 2-4 late toxicity. CONCLUSIONS CyberKnife robotic radiosurgery in patients with cervical cancer provides excellent target coverage with steep dose gradients toward normal tissues and safe DVH parameters for bladder, rectum and sigmoid. Acute toxicity was mild. Longer follow-up is needed to evaluate the oncological equality.
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Abstract
Purpose of this study is to analyze local control, clinical symptoms and toxicity after image-guided radiosurgery of spinal meningiomas and schwannomas. Standard treatment of benign spinal lesions is microsurgical resection. While a few publications have reported about radiosurgery for benign spinal lesions, this is the first study analyzing the outcome of robotic radiosurgery for benign spinal tumors, treated exclusively with a non-invasive, fiducial free, single-fraction setup. Thirty-six patients with spinal meningiomas or schwannomas were treated, utilizing a robotic radiosurgery system (CyberKnife®, Accuray Inc. Sunnyvale CA), and were followed prospectively. Medical history, histology, clinical symptoms and radiographic outcome were recorded. Thirty-nine spinal lesions were treated because of tumor recurrence, remnants after microsurgery, multiple lesions, or rejection of open surgery. Median age was 45 years (range 18–80 years). Median target volume was 3.4 cm3 (range 0.2–43.4 cm3). Histology revealed 28 schwannomas and 11 meningiomas (WHO grade I). All spinal levels were affected. Median prescription dose was 14 Gray (95% C.I. 13.4–14 Gy) to the 70% isodose. After a median follow-up of 18 months (range 6–50 months) no local tumor progression was detected. 20 lesions (51%) remained stable, 19 tumors (49%) decreased in size. One patient with schwannomatosis was treated repeatedly for three new tumor locations. Pain was the initial symptom in 16 of 25 schwannoma patients, and in 3 of 11 patients with meningiomas. Pain levels decreased in 8/19 patients. All but one patient with motor deficits remained clinically stable. No myelopathic signs where found. Single-session radiosurgery for benign spinal tumors in selected patients has proven to inhibit tumor progression within the observed period without signs of early toxicity. Radiosurgery offers an additional treatment option, if microsurgery is not feasible in cases of tumor recurrence, post-resection remnants, multiple lesions, or medical comorbidity.
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Affiliation(s)
- M Kufeld
- European Cyberknife Center Munich Grosshadern, Max-Lebsche-Platz 31, 81377 Munich, Germany.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- A Klingenstein
- Department of Ophthalmology, Ludwig-Maximilians-University, Klinikum der Universitat Munchen, Munich, Germany.
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Fürweger C, Drexler C, Kufeld M, Muacevic A, Wowra B, Schlaefer A. In Reply to Ma et al. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2010.09.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nikolajek K, Kufeld M, Muacevic A, Wowra B, Niyazi M, Ganswindt U. Spinal radiosurgery--efficacy and safety after prior conventional radiotherapy. Radiat Oncol 2011; 6:173. [PMID: 22177519 PMCID: PMC3264666 DOI: 10.1186/1748-717x-6-173] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 12/16/2011] [Indexed: 12/25/2022] Open
Abstract
Background Conventional external beam radiotherapy is a standard procedure for treatment of spinal metastases. In case of progression spinal cord tolerance limits further radiotherapy in pre-irradiated areas. Spinal stereotactic radiotherapy is a non-invasive option to re-treat pre-irradiated patients. Nevertheless, spinal radiosurgery results in relevant dose deposition within the myelon with potential toxicity. Aim of the study was to retrospectively analyse the efficacy and feasibility for salvage radiosurgery of spinal metastases. Methods During a period of 4 years (2005-2009) 70 lesions in 54 patients were treated in 60 radiosurgery sessions and retrospectively analysed. Clinical (pain, sensory and motor deficit) and radiological (CT/MRI) follow-up data were collected prospectively after radiosurgery. Pain - as main symptom - was classified by the Visual Analogue Scale (VAS) score. Every patient received single session radiosurgery after having been treated first-line with conventionally fractionated radiotherapy. Kaplan-Meier method and life tables were used to analyse freedom from local failure and overall survival. Results At a median follow-up of 14.5 months the actuarial rates of freedom from local failure at 6/12/18 months were 93%, 88% and 85%, respectively. The median radiosurgery dose was 1 × 18 Gy (range 10-28 Gy) to the median 70% isodose. The VAS score of patients with pain (median 6) dropped significantly (median 4, p = 0.002). In 6 out of 7 patients worse sensory or motor deficit after SRS was caused by local or distant failures (diagnosed by CT/MRI). One patient with metastatic renal cell carcinoma developed a progressive complete paraparesis one year after the last treatment at lumbar level L3. Due to multiple surgery and radiosurgery treatments at the lumbar region and further local progression, the exact reason remained unclear. Apart from that, no CTC grade III or higher toxicity has been observed. Conclusions By applying spinal radiosurgery relevant radiation doses can be limited to small parts of the myelon. This prevents myelopathic side effects and makes it an effective and safe treatment option for well-suited patients. Especially for previously irradiated patients with local failure or pain salvage SRS represents a valuable treatment option with high local control rates, low toxicity and significant pain reduction.
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Affiliation(s)
- Katharina Nikolajek
- Department of Radiation Oncology, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistr, 15, 81377 München, Germany
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Nikolajek K, Kufeld M, Muacevic A, Wowra B, Niyazi M, Ganswindt U. 1001 poster SPINAL RADIOSURGERY – EFFICACY AND SAFETY AFTER PRIOR CONVENTIONAL RADIOTHERAPY. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71123-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fürweger C, Drexler CG, Kufeld M, Wowra B. Feasibility of fiducial-free prone-position treatments with CyberKnife for lower lumbar/sacral spine lesions. Cureus 2011. [DOI: 10.7759/cureus.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Fürweger C, Drexler C, Kufeld M, Muacevic A, Wowra B. Advances in fiducial-free image-guidance for spinal radiosurgery with CyberKnife--a phantom study. J Appl Clin Med Phys 2010; 12:3446. [PMID: 21587167 PMCID: PMC5718658 DOI: 10.1120/jacmp.v12i2.3446] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 10/22/2010] [Accepted: 11/04/2010] [Indexed: 11/23/2022] Open
Abstract
The image‐guided CyberKnife radiosurgery system is capable of tracking spinal targets without fiducial implants. Recently, a new version of this fiducial‐free image guidance modality (“enhanced Xsight spine tracking”) has been introduced. We assessed the accuracy of this novel technique versus its precursor in a comparative phantom study. The CyberKnife consists of a 6 MV linac on a six‐axis robot and a stereoscopic kV image guidance system. An anthropomorphic head‐and‐neck phantom with a cervical spine section was mounted on the linac nozzle. The robotic manipulator was used to precisely move the phantom to defined positions in the CyberKnife workspace. Multiple stereoscopic images were acquired at different translational and rotational positions. The enhanced Xsight spine tracking readouts were recorded and compared to the nominal phantom position. These tests were repeated with the original Xsight spine tracking version to analyze potential differences. Enhanced Xsight spine tracking correctly reported translational offsets with an RMS error of less than 0.4 mm. Yaw and roll rotations were detected with an accuracy of 0.2°, 0.25°. Pitch offsets were slightly underestimated, with up to 0.3° for an offset of ± 2°. Nominal X (left‐right) translational offsets were partially misinterpreted as roll (0.2° at a 10 mm offset). Apart from this, no correlation between rotational and translational directions was found. In comparison, the original Xsight spine tracking showed identical results for translations, but larger systematic and statistical errors for rotations. Enhanced Xsight spine tracking measurably improves precision in fiducial‐free spinal radiosurgery with the CyberKnife. PACS number: 87.53.Ly
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Staehler M, Fürweger C, Kufeld M, Karl A, Roosen A, Stief C, Muacevic A. Cyberknife radiosurgery of a renal pelvis tumor to avoid renal dialysis. Cureus 2010. [DOI: 10.7759/cureus.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Fürweger C, Drexler C, Kufeld M, Muacevic A, Wowra B, Schlaefer A. Patient Motion and Targeting Accuracy in Robotic Spinal Radiosurgery: 260 Single-Fraction Fiducial-Free Cases. Int J Radiat Oncol Biol Phys 2010; 78:937-45. [DOI: 10.1016/j.ijrobp.2009.11.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 10/19/2009] [Accepted: 11/23/2009] [Indexed: 11/24/2022]
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Stintzing S, Hoffmann RT, Heinemann V, Kufeld M, Rentsch M, Muacevic A. Radiosurgery of liver tumors: value of robotic radiosurgical device to treat liver tumors. Ann Surg Oncol 2010; 17:2877-83. [PMID: 20574773 DOI: 10.1245/s10434-010-1187-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Indexed: 12/23/2022]
Abstract
BACKGROUND The treatment of isolated liver metastases has become a rapidly developing field with many new, technically advanced methods. Here we present the therapeutic efficacy of a robotic radiosurgery for local control of liver metastases from solid tumors. METHODS Patients with tumorous lesions to the liver, not qualifying for surgery, were treated with single-session radiosurgery (24 Gy) that used robotic image-guided real-time tumor tracking. All detectable lesions had to be irradiated. In a prospective analysis, follow-up was performed by magnetic resonance imaging scanning 2 months after the treatment, and subsequently at 3-month intervals to evaluate local control. For inclusion into the radiosurgery treatment protocol, tumor volumes had to be <90 ml. RESULTS Thirty-six patients (median age, 65 years) with a total of 54 target lesions were evaluated. Single lesions were treated in 23 patients and multiple targets in 13 patients. Metastases originated from colon cancer (n = 19), ovarian cancer (n = 3), pancreatic cancer (n = 2), breast cancer (n = 2), and others (n = 6). Four lesions were of primary liver origin (hepatocellular carcinoma and cholangiocellular carcinoma). Median tumor volume was 18 ml (range, 2.2-90 ml). The median follow-up was 21.3 months. The disease of 25 patients (69.4%) showed complete or partial local response, 6 patients (16.7%) had stable lesions, and 5 patients (14%) experienced local recurrence. Grade 2-4 adverse events due to radiation treatment were not observed. CONCLUSIONS Robotic radiosurgery with image-guided real-time tumor tracking of liver neoplasm is a new and promising approach for patients with disease that is not eligible for surgical resection and might enhance the possibilities of multidisciplinary oncological treatment concepts.
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Affiliation(s)
- Sebastian Stintzing
- Department of Hematology and Oncology, University Hospital Grosshadern, LMU Munich, Munich, Germany.
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Stintzing S, Hoffmann R, Heinemann V, Kufeld M, Muacevic A. Frameless single-session robotic radiosurgery of liver metastases in colorectal cancer patients. Eur J Cancer 2010; 46:1026-32. [DOI: 10.1016/j.ejca.2010.01.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 12/23/2009] [Accepted: 01/14/2010] [Indexed: 12/20/2022]
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Stintzing S, Hoffmann RT, Heinemann V, Kufeld M, Muacevic A. Robotic radiosurgery of liver metastases of solid tumors. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15049 Background: The number of patients (pts) suffering from isolated liver metastases is growing. Although surgical excision is the treatment of choice many pts do not qualify for surgery. So local ablative techniques like radiofrequency ablation, laser induced thermal ablation therapy, brachytherapy and different external beam radiation therapies have been employed. We here report the therapeutic efficacy of a robotic radiosurgery device for local control of liver metastases of solid tumors. Methods: Patients with liver metastases not qualifying for surgery were treated with single session radiosurgery (24 Gy) using robotic image-guided real-time tumor tracking. In a prospective analysis, follow-up was done by MRI scanning at two months after the treatment, and subsequently at 3-month intervals to evaluate local control. For inclusion into the radiosurgery treatment protocol, tumor volumes had to be smaller than 80cc. Results: 27 pts (median age 62 years) with a total of 43 target lesions were evaluated. 17 pts were treated with single, 10 pts with multiple targets. Metastases (n=27) originated from: colon (12), rectum (2), pancreas (2), lung (1), bladder (2), malignant melanoma (1), stomach (1), cholangiocellular carcinoma (2), breast (1), ovary (1), appendix (1) and endometrium (1). Median tumor volume was 21cc (range 2.2–79.3). Median KPS was 100% (range 80–100). The median follow up was 12 months. 23 pts (85%) reached local control of the disease, 4 pts (15%) had local recurrence. Grade 2–4 adverse events due to cyberknife treatment were not observed. Conclusions: Robotic radiosurgery with image-guided real-time tumor tracking of liver metastases is a new and promising treatment approach for pts not eligible for surgical resection and might enhance the possibilities of multidisciplinary oncological treatment concepts. No significant financial relationships to disclose.
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Affiliation(s)
- S. Stintzing
- University of Munich - Klinikum Grosshadern, Munich, Germany; University of Munich - Klinikum Grosshdern, Munich, Germany; European Cyberknife Center, Munich, Germany
| | - R. T. Hoffmann
- University of Munich - Klinikum Grosshadern, Munich, Germany; University of Munich - Klinikum Grosshdern, Munich, Germany; European Cyberknife Center, Munich, Germany
| | - V. Heinemann
- University of Munich - Klinikum Grosshadern, Munich, Germany; University of Munich - Klinikum Grosshdern, Munich, Germany; European Cyberknife Center, Munich, Germany
| | - M. Kufeld
- University of Munich - Klinikum Grosshadern, Munich, Germany; University of Munich - Klinikum Grosshdern, Munich, Germany; European Cyberknife Center, Munich, Germany
| | - A. Muacevic
- University of Munich - Klinikum Grosshadern, Munich, Germany; University of Munich - Klinikum Grosshdern, Munich, Germany; European Cyberknife Center, Munich, Germany
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Kufeld M, Junker K, Sudhoff H, Dazert S. [Collision tumor of a hypopharyngeal adenoidcystic carcinoma and a laryngeal squamous cell carcinoma]. Laryngorhinootologie 2004; 83:51-4. [PMID: 14740306 DOI: 10.1055/s-2004-814109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Malignancies in head and neck cancer are mainly squamous cell carcinomas. Adenoid cystic carcinomas are rare lesions of this site. Laryngeal adenoid cystic carcinoma is estimated to occur in 0.1 - 0.7 % of all laryngeal carcinomas. Adenoid cystic carcinomas are rarely located in the hypopharynx. To our knowledge there is no case report of adenoid cystic carcinoma of the hypopharynx as part of a collision tumor of the larynx. CASE REPORT A 47-year-old male patient was diagnosed with an adenoid cystic carcinoma of the hypopharynx and a squamous cell carcinoma of the larynx. Because of local extension of both tumors laryngectomy and partial pharyngotomy with bilateral neck dissection was performed followed by radiation therapy. Clinical aspects as well as histomorphological and immunohistochemical criteria of both tumor entities are discussed. DISCUSSION AND CONCLUSIONS Immunohistochemical characteristics showed two different carcinoma entities in the larynx and hypopharynx. Only by complete histological investigation of a carcinoma those rare cases of a collision tumor can be detected. Both tumor entities need to be considered for therapy strategy and oncological follow-up planning.
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Affiliation(s)
- M Kufeld
- Klinik für Hals-, Nasen- und Ohrenkrankheiten, Kopf- und Halschirurgie der Ruhr-Universität Bochum, Germany
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Kufeld M, Claus B, Campi A, Lanksch WR, Benndorf G. Three-dimensional rotational myelography. AJNR Am J Neuroradiol 2003; 24:1290-3. [PMID: 12917114 PMCID: PMC7973654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Three-dimensional (3D) rotational radiography, initially developed to visualize intracranial aneurysms, is applied to the cervical spine after conventional myelography. We call this process 3D rotational myelography. 3D reconstruction and then postprocessing allows imaging in multiple planes. Spinal or nerve root sheath alterations caused by bony or soft tissue can be visualized and differentiated by using this technique.
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Affiliation(s)
- Markus Kufeld
- Department of Neurosurgery, Humboldt University Charité, Berlin, Germany
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