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Stereotactic radiosurgery

Dale Ding, Zhiyuan Xu, Han-Hsun Shih, Robert M Starke, Chun-Po Yen, Or Cohen-Inbar, Jason P Sheehan
BACKGROUND: Incompletely obliterated cerebral arteriovenous malformations (AVMs) after initial treatment with stereotactic radiosurgery (SRS) can be treated with a repeat session of SRS. However, the relative efficacy of repeat vs initial SRS is not well specified. OBJECTIVE: To retrospectively compare in matched cohorts the outcomes of repeat vs initial SRS for the treatment of matched cohorts with angioarchitecturally similar AVMs. METHODS: We studied a data set of patients with AVM treated with radiosurgery during the period spanning 1989 to 2013...
November 2016: Neurosurgery
Myreille D'Astous, Allen L Ho, Arjun Pendharkar, Clara Y H Choi, Scott G Soltys, Iris C Gibbs, Armine T Tayag, Patricia A Thompson, John R Adler, Steven D Chang
Non-vestibular cranial nerve schwannomas (NVCNS) are rare lesions, representing <10 % of cranial nerve schwannomas. The optimal treatment for NVCNS is often derived from vestibular schwannomas experience. Surgical resection has been referred to as the first line treatment for those benign tumors, but significant complication rates are reported. Stereotactic radiosurgery (SRS) has arisen as a mainstay of treatment for many benign tumors, including schwanommas. We retrospectively reviewed the outcomes of NVCNS treated by SRS to characterize tumor control, symptom relief, toxicity, and the role of hypo-fractionation of SRS dose...
October 17, 2016: Journal of Neuro-oncology
Tejinder Kataria, Deepak Gupta, Shikha Goyal, Shyam Singh Bisht, Ravi Chaudhary, Kushal Narang, Susovan Banerjee, Trinanjan Basu, Ashu Abhishek, Sasikumar Sambasivam, Nisha T Vishnu
Stereotactic body radiotherapy (SBRT) is being increasingly utilized in the treatment of prostate cancer. With the advent of high precision radiosurgery systems, it is possible to obtain dose distributions akin to High Dose Rate (HDR) brachytherapy with SBRT. However, urethral toxicity has a significant impact on the quality of life in prostate cancer patients. Contouring the male urethra on a computed tomography scan is difficult in the absence of an indwelling catheter. In this pictorial essay, we have used the magnetic resonance imaging obtained for radiotherapy planning to aid in delineation of the male urethra and have attempted to define guidelines for the same...
October 17, 2016: British Journal of Radiology
Lijun Ma, Steve E Braunstein, Philip V Theodosopoulos, Michael W McDermott, Penny K Sneed
PURPOSE: Various cochlear dose surrogates have been reported as associated with hearing outcome in studies of stereotactic radiosurgery (SRS) for vestibular schwannomas. In this study, we investigated whether an inherent functional relationship exists among these reported surrogates. METHODS AND MATERIALS: A cohort of 85 serial patient cases treated with single-fraction stereotactic radiosurgery from 1997 through 2013 at our institution was analyzed. For all the cases, the mean prescription dose was 12...
August 20, 2016: Practical Radiation Oncology
Jacob A Miller, Elizabeth E Bennett, Roy Xiao, Rupesh Kotecha, Samuel T Chao, Michael A Vogelbaum, Gene H Barnett, Lilyana Angelov, Erin S Murphy, Jennifer S Yu, Manmeet S Ahluwalia, John H Suh, Alireza M Mohammadi
BACKGROUND: The primary dose-limiting toxicity of stereotactic radiosurgery (SRS) is radiation necrosis (RN), which occurs after approximately 5% to 10% of treatments. This adverse event may worsen neurologic deficits, increase the frequency and cost of imaging, and necessitate prolonged treatment with steroids or antiangiogenic agents. Previous investigations have primarily identified lesion size and dosimetric constraints as risk factors for RN in small populations. We hypothesized that disease histology, receptor status, and mutational status are associated with RN...
September 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Ghaith Habboub, Mayur Sharma, Gene H Barnett, Alireza M Mohammadi
BACKGROUND: Minimally-invasive approaches are attractive alternative to standard craniotomy for large intracranial tumors with potentially lesser morbidity. In this report, we describe a sequential combination of two minimally-invasive surgical techniques to treat a large intracranial tumor. CLINICAL PRESENTATION: A 49year-old woman presented with a history of breast cancer and large left parietal metastasis with significant perilesional edema. This was initially managed by whole brain radiation therapy and stereotactic radiosurgery...
October 11, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Giuseppe Minniti, Mattia Falchetto Osti, Maximillian Niyazi
Stereotactic radiosurgery (SRS) delivered as either single-fraction or multi-fraction SRS (2-5 fractions) is frequently employed in patients with residual or recurrent pituitary adenoma. The most common delivery systems used for SRS include the cobalt-60 system Gamma Knife, the CyberKnife (CK) robotic radiosurgery system, or a modified conventional radiotherapy machine (linear accelerator, LINAC). Tumor control and normalization of hormone hypersecretion have been reported in 75-100 % and 25-80 % of patients, respectively...
October 11, 2016: Radiation Oncology
Ning Wen, Siming Lu, Jinkoo Kim, Yujiao Qin, Yimei Huang, Bo Zhao, Chang Liu, Indrin J Chetty
PURPOSE: The purpose of this study is to evaluate the dosimetric uncertainty associated with Gafchromic™ (EBT3) films and establish a practical and efficient film dosimetry protocol for Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT). METHOD AND MATERIALS: EBT3 films were irradiated at each of seven different dose levels between 1 and 15 Gy with open fields and standard deviations of dose maps were calculated at each color channel for evaluation...
October 4, 2016: Radiation Oncology
Zhou Huang, Bing Sun, Ge Shen, Lei Cha, Xiangying Meng, Junliang Wang, Zhenshan Zhou, Shikai Wu
The outcome of recurrent brain metastasis is dismal. This study aims to assess the clinical outcomes and toxicity of reirradiation as a salvage treatment for progressive brain metastasis in patients with advanced breast cancer. Between July 2005 and September 2014, the medical records of 56 patients with brain metastasis from breast cancer were retrospectively reviewed. Of these patients, 39 received whole-brain radiotherapy (WBRT) followed by stereotactic radiosurgery (SRS) reirradiation (Group 1), and 17 received SRS followed by WBRT reirradiation (Group 2)...
October 5, 2016: Journal of Radiation Research
Yuanli Dong, Chengrui Fu, Hui Guan, Tianyi Zhang, Zicheng Zhang, Tao Zhou, Baosheng Li
Despite advances in the fields of surgery, chemotherapy and radiotherapy, the prognosis for high-grade glioma (HGG) remains unsatisfactory. The majority of HGG patients experience disease recurrence. To date, no standard treatments have been established for recurrent HGG. Repeat surgery and chemotherapy demonstrate moderate efficacy. As recurrent lesions are usually located within the previously irradiated field, a second course of irradiation was once considered controversial, as it was considered to exhibit unsatisfactory efficacy and radiation-related toxicities...
October 2016: Oncology Letters
Joshua Chiu, Marlon Pierce, Steve E Braunstein, Philip V Theodosopoulos, Michael W McDermott, Penny K Sneed, Lijun Ma
Sharp dose fall-off is the hallmark of brain radiosurgery for the purpose of delivering high dose radiation to the target while minimizing peripheral dose to regional normal brain tissue. In this study, a technique was developed to enhance the peripheral dose gradient by magnifying the total number of beams focused toward each isocenter through pre-programmed patient head tilting. This technique was tested in clinical settings on a dedicated brain radiosurgical system (GKPFX, Gamma Knife Perfexion, Elekta Oncology) by comparing dosimetry as well as delivery efficiency for 20 radiosurgical cases previously treated with the system...
October 3, 2016: Physics in Medicine and Biology
B K Kleinschmidt-DeMasters, Kevin O Lillehei
Radiation-induced vascular "malformations", designated cavernous hemangiomas/cavernomas ("RICHs"), are seldom biopsied and are usually diagnosed based on neuroimaging features. They are an increasingly recognized complication of both CNS external beam radiation therapy and stereotactic radiosurgery. We identified 13 patients with radiation-induced vascular "malformations" in our surgical neuropathology databases searched from 2000 to 2016; 4 had received their therapy during childhood; 5 had received radiosurgery...
September 30, 2016: Journal of Neuropathology and Experimental Neurology
Feng Xu, Sida Pan, Nicholas C Bambakidis
Facial nerve schwannomas are rare, benign, nerve-sheath tumors. They can occur in any segment of the facial nerve, and often clinically and radiographically mimic the most common vestibular schwannoma when extending into the cerebellopontine angle. The optimal treatment strategy for intracranial facial nerve schwannomas remains controversial and includes observation, resection, and stereotactic radiosurgery. In this article, we review the natural history, clinical features, diagnosis and current management of facial nerve schwannomas...
September 28, 2016: World Neurosurgery
Alvin Y Chan, Diem Kieu T Tran, Amandip S Gill, Frank P K Hsu, Sumeet Vadera
Laser interstitial thermal therapy (LITT) is a minimally invasive procedure used to treat a variety of intracranial lesions. Utilization of robotic assistance with stereotactic procedures has gained attention due to potential for advantages over conventional techniques. The authors report the first case in which robot-assisted MRI-guided LITT was used to treat radiation necrosis in the posterior fossa, specifically within the cerebellar peduncle. The use of a stereotactic robot allowed the surgeon to perform LITT using a trajectory that would be extremely difficult with conventional arc-based techniques...
October 2016: Neurosurgical Focus
Robert T Buckley, Anthony C Wang, John W Miller, Edward J Novotny, Jeffrey G Ojemann
OBJECTIVE Laser ablation is a novel, minimally invasive procedure that utilizes MRI-guided thermal energy to treat epileptogenic and other brain lesions. In addition to treatment of mesial temporal lobe epilepsy, laser ablation is increasingly being used to target deep or inoperable lesions, including hypothalamic hamartoma (HH), subependymal giant cell astrocytoma (SEGA), and exophytic intrinsic hypothalamic/third ventricular tumors. The authors reviewed their early institutional experience with these patients to characterize clinical outcomes in patients undergoing this procedure...
October 2016: Neurosurgical Focus
Claudio E Tatsui, Telmo A B Belsuzarri, Marilou Oro, Laurence D Rhines, Jing Li, Amol J Ghia, Behrang Amini, Heron Espinoza, Paul D Brown, Ganesh Rao
OBJECTIVE An emerging paradigm for treating patients with epidural spinal cord compression (ESCC) caused by metastatic tumors is surgical decompression and stabilization, followed by stereotactic radiosurgery. In the setting of rapid progressive disease, interruption or delay in return to systemic treatment can lead to a negative impact in overall survival. To overcome this limitation, the authors introduce the use of spinal laser interstitial thermotherapy (sLITT) in association with percutaneous spinal stabilization to facilitate a rapid return to oncological treatment...
October 2016: Neurosurgical Focus
Mir Amaan Ali, Kate T Carroll, Robert C Rennert, Thomas Hamelin, Leon Chang, Brian P Lemkuil, Mayur Sharma, Jill S Barnholtz-Sloan, Charlotte Myers, Gene H Barnett, Kris Smith, Alireza M Mohammadi, Andrew E Sloan, Clark C Chen
OBJECTIVE Therapeutic options for brain metastases (BMs) that recur after stereotactic radiosurgery (SRS) remain limited. METHODS The authors provide the collective experience of 4 institutions where treatment of BMs that recurred after SRS was performed with stereotactic laser ablation (SLA). RESULTS Twenty-six BMs (in 23 patients) that recurred after SRS were treated with SLA (2 patients each underwent 2 SLAs for separate lesions, and a third underwent 2 serial SLAs for discrete BMs). Histological findings in the BMs treated included the following: breast (n = 6); lung (n = 6); melanoma (n = 5); colon (n = 2); ovarian (n = 1); bladder (n = 1); esophageal (n = 1); and sarcoma (n = 1)...
October 2016: Neurosurgical Focus
Anthony M Burrows, W Richard Marsh, Gregory Worrell, David A Woodrum, Bruce E Pollock, Krzysztof R Gorny, Joel P Felmlee, Robert E Watson, Timothy J Kaufmann, Steven Goerss, Jamie J Van Gompel
OBJECTIVE Hypothalamic hamartomas (HHs) are associated with gelastic seizures and the development of medically refractory epilepsy. Magnetic resonance imaging-guided laser interstitial thermal therapy (MRg-LITT) is a minimally invasive ablative treatment that may have applicability for these deep-seated lesions. Here, the authors describe 3 patients with refractory HHs who they treated with MRg-LITT. METHODS An institutional review board-approved prospective database of patients undergoing Visualase MRg-LITT was retrospectively reviewed...
October 2016: Neurosurgical Focus
Kimberly L Desmond, Hatef Mehrabian, Sofia Chavez, Arjun Sahgal, Hany Soliman, Radoslaw Rola, Greg J Stanisz
PURPOSE: The purpose of this work was to determine the predictive value of chemical exchange saturation transfer (CEST) metrics in brain metastases treated with stereotactic radiosurgery (SRS). METHODS: CEST spectra at a radiofrequency power of 0.52 µT were collected on a 3 Tesla (T) magnetic resonance imaging from 25 patients at three time points: pretreatment, 1 week, and 1 month post-treatment. Amide proton transfer-weighted images and maps of the amplitude and width of Lorentzian-shaped CEST peaks and the relaxation-compensated AREX metric were constructed at the offset frequencies of amide, amine, and relayed nuclear Overhauser effect (NOE) from aliphatic groups as well as the broad magnetization transfer effect...
September 30, 2016: Magnetic Resonance in Medicine: Official Journal of the Society of Magnetic Resonance in Medicine
Or Cohen-Inbar, Robert M Starke, Hideyuki Kano, Gregory Bowden, Paul Huang, Rafael Rodriguez-Mercado, Luis Almodovar, Inga S Grills, David Mathieu, Danilo Silva, Mahmoud Abbassy, Symeon Missios, John Y K Lee, Gene H Barnett, Douglas Kondziolka, L Dade Lunsford, Jason P Sheehan
OBJECTIVE Cerebellar arteriovenous malformations (AVMs) represent the majority of infratentorial AVMs and frequently have a hemorrhagic presentation. In this multicenter study, the authors review outcomes of cerebellar AVMs after stereotactic radiosurgery (SRS). METHODS Eight medical centers contributed data from 162 patients with cerebellar AVMs managed with SRS. Of these patients, 65% presented with hemorrhage. The median maximal nidus diameter was 2 cm. Favorable outcome was defined as AVM obliteration and no posttreatment hemorrhage or permanent radiation-induced complications (RICs)...
September 30, 2016: Journal of Neurosurgery
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