Fractionated Gamma Knife radiosurgery for skull base meningiomas: a single-institution experience
Autor: | Hamid Borghei-Razavi, Lilyana Angelov, Varun R. Kshettry, Krishna C Joshi, Jason K. Hsieh, Alankrita Raghavan, Samuel T. Chao, John H. Suh, Gennady Neyman, Alireza M. Mohammadi, Pablo F. Recinos, Baha'eddin A. Muhsen, G.H. Barnett |
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Rok vydání: | 2019 |
Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Gamma knife radiosurgery Brain Edema Radiosurgery Skull Base Neoplasms Asymptomatic Patient Positioning 030218 nuclear medicine & medical imaging Meningioma 03 medical and health sciences 0302 clinical medicine Edema Meningeal Neoplasms medicine Humans Prospective cohort study Aged Retrospective Studies business.industry Cranial nerves General Medicine Middle Aged medicine.disease Combined Modality Therapy Tumor Burden Skull medicine.anatomical_structure Female Surgery Dose Fractionation Radiation Neurology (clinical) Radiology Cranial Irradiation medicine.symptom business Craniotomy 030217 neurology & neurosurgery Follow-Up Studies |
Zdroj: | Neurosurgical Focus. 46:E8 |
ISSN: | 1092-0684 |
Popis: | OBJECTIVEGamma Knife radiosurgery (GKRS) has been successfully used for the treatment of intracranial meningiomas given its steep dose gradients and high-dose conformality. However, treatment of skull base meningiomas (SBMs) may pose significant risk to adjacent radiation-sensitive structures such as the cranial nerves. Fractionated GKRS (fGKRS) may decrease this risk, but until recently it has not been practical with traditional pin-based systems. This study reports the authors’ experience in treating SBMs with fGKRS, using a relocatable, noninvasive immobilization system.METHODSThe authors performed a retrospective review of all patients who underwent fGKRS for SBMs between 2013 and 2018 delivered using the Extend relocatable frame system or the Icon system. Patient demographics, pre- and post-GKRS tumor characteristics, perilesional edema, prior treatment details, and clinical symptoms were evaluated. Volumetric analysis of pre-GKRS, post-GKRS, and subsequent follow-up visits was performed.RESULTSTwenty-five patients met inclusion criteria. Nineteen patients were treated with the Icon system, and 6 patients were treated with the Extend system. The mean pre-fGKRS tumor volume was 7.62 cm3 (range 4.57–13.07 cm3). The median margin dose was 25 Gy delivered in 4 (8%) or 5 (92%) fractions. The median follow-up time was 12.4 months (range 4.7–17.4 months). Two patients (9%) experienced new-onset cranial neuropathy at the first follow-up. The mean postoperative tumor volume reduction was 15.9% with 6 patients (27%) experiencing improvement of cranial neuropathy at the first follow-up. Median first follow-up scans were obtained at 3.4 months (range 2.8–4.3 months). Three patients (12%) developed asymptomatic, mild perilesional edema by the first follow-up, which remained stable subsequently.CONCLUSIONSfGKRS with relocatable, noninvasive immobilization systems is well tolerated in patients with SBMs and demonstrated satisfactory tumor control as well as limited radiation toxicity. Future prospective studies with long-term follow-up and comparison to single-session GKRS or fractionated stereotactic radiotherapy are necessary to validate these findings and determine the efficacy of this approach in the management of SBMs. |
Databáze: | OpenAIRE |
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