Radiobiological principles: their application to γ knife therapy.
Authors: Hopewell JW, Millar WT, Lindquist C
Abstract
Gamma Knife treatments are regarded as single dose exposures, however, in reality the total dose delivered is the addition of a variable number of individual smaller doses from the variable number of iso-centres or shots, selected to cover a lesion. The dose prescription, in terms of dose and dose rate, to different points on a given physical iso-surface, will vary according to location. In radiobiological terms this treatment pattern does not represent a single exposure, but a schedule with a variable number of different sized dose fractions given at d...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Imaging diagnosis of brain metastasis.
Authors: Barajas RF, Cha S
Abstract
Hematogeneous spread of primary neoplasm can result in central nervous system (CNS) disease burden in various anatomically distinct regions; calvarial, pachymeningeal, leptomeningeal, and intraparenchymal. The choice of imaging modality is dependent on the individual clinical situation, but, largely depends on the patients overall clinical status and the information needed to make treatment decisions. Contrast-enhanced magnetic resonance (MR) imaging is the preferred imaging modality of choice; however, computed tomography (CT) is often utilized as the first-pass screeni...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Surgical treatment of solitary brain metastases.
Authors: Gates M, Alsaidi M, Kalkanis S
Abstract
Brain metastases are the most common form of brain tumors and are diagnosed in about 40% of all patients with systemic malignancies. Although the percentage of solitary brain metastases has dropped in recent estimates from about 50-30% of all patients with brain metastases, this percentage still represents a significant number of patients, and the overall incidence of brain metastases is still on the rise. Historically, brain metastases carried a grim prognosis with a median survival of only a few weeks. The utilization of whole-brain radiation therapy (WBRT...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Whole-brain radiation therapy of brain metastasis.
Authors: Sahgal A, Soliman H, Larson DA
Abstract
The purpose of this report was to review the role of whole brain radiotherapy (WBRT) in the management of brain metastases. In particular, we review the role of WBRT as a prophylactic therapy, and the role of surgery and stereotactic radiousurgery (SRS) with respect to WBRT, by discussing the relevant randomized controlled trials. WBRT is associated with toxicities and this may influence the decision to use WBRT and, therefore, we review both the acute side effects of WBRT and the more serious late side effects of neurocognitive impairment and leukoencephalo...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Advances in radiation therapy of brain metastasis.
Authors: Lo SS, Sahgal A, Ma L, Chang EL
Abstract
The traditional treatment for brain metastases is to administer whole-brain radiation therapy using two-dimensional techniques. Owing to the short survival duration of patients historically treated, most patients with brain metastases did not survive long enough to manifest neurologic/neuropsychologic complications. With improved systemic therapy, and more aggressive focal treatment options, longer survival times are now becoming observed along with late effects of cancer treatment. Recently, advances in radiation therapy for brain metastases have taken sha...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Role of chemotherapy on brain metastasis.
Authors: Lee SH
Abstract
Cytotoxic chemotherapy has been considered ineffective for brain metastasis, traditionally because of poor penetration across the blood-brain barrier. However, cytotoxic chemotherapy could be effective in some specific situation, e.g. macroscopic brain metastasis of chemosensitive disease, such as small cell lung cancer, germ cell tumor and breast cancer. Recently, tyrosine kinase inhibitors targeting epidermal growth factor receptor (EGFR) (gefitinib and erlotinib) or human epidermal growth factor receptor 2 (HER2) (lapatinib) have a promising activity to brain metastasis of lung ...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Radiosurgery for brain metastases.
Authors: Kondziolka D, Flickinger JC, Lunsford LD
Abstract
We discuss the current literature on the role of stereotactic radiosurgery in the multidisciplinary management of brain metastases and focus on the level of evidence that addresses key management questions. We reviewed the literature on the different roles of radiosurgery, radiotherapy, and resection, and in particular the 2009 Guidelines project of the Joint Section on Tumors of the AANS/CNS. Retrospective case series, matched cohort studies, and randomized trials show specific survival and local tumor control benefits after radiosurgery. Radiosur...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Stereotactic radiosurgery for patients with metastatic brain tumors: development of a consensus radiosurgery guideline recommendation.
Authors: Niranjan A, Lunsford LD, Emerick RL
Abstract
Our objective was to provide guidelines about the use of stereotactic radiosurgery in patients with imaging identified metastatic tumors of the brain. The working group consisted of physicians and medical physicists from the staff of major medical centers that provide radiosurgery. Computerized and hand searches of published literature electronic clinical databases were performed. Members of a working group reviewed published literature and clinical experience on metastatic brain tumor radiosurgery to develop a draft guideline and provide scientific fou...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Radiosurgical dose selection for brain metastasis.
Authors: Yu JB, Schulder M, Knisely J
Abstract
Dose selection for brain metastasis radiosurgery is based largely upon clinical data obtained over a half century of radiosurgical treatments for various benign and malignant conditions. It is expected that within the entire radiosurgical process, the step of dose selection will occur within a framework of accurate calibration of dose delivery and accurate and detailed imaging for planning the radiosurgical treatment. Brain metastasis radiosurgery should seek lifelong, uncomplicated control. A low radiosurgery dose that will not control the tumor will not achi...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Treatment of brain metastasis from lung cancer.
Authors: Kawabe T, Phi JH, Yamamoto M, Kim DG, Barfod BE, Urakawa Y
Abstract
Brain metastasis from lung cancer occupies a significant portion of all brain metastases. About 15-20% of patients with non-small cell lung cancer (NSCLC) develop brain metastasis during the course of the disease. The prognosis of brain metastasis is poor with median survival of less than 1 year. Whole-brain radiation therapy (WBRT) is widely used for the treatment of brain metastasis. WBRT can also be used as adjuvant treatment along with surgery and stereotactic radiosurgery (SRS).Surgery provides a rapid relief of mass effects ...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
γ knife radiosurgery of brain metastasis from breast cancer.
Authors: Padovani L, Muracciole X, Régis J
Abstract
The incidence of brain metastasis in patients with metastatic breast cancer ranges from 14 to 16%.Age, number of metastatic sites, short disease-free survival and molecular subtypes are associated with the occurrence of brain metastasis. Patients classified in the triple-negative group more frequently presented brain metastasis as the first site (26%) than those in the human epidermal growth factor receptor 2 (HER2)-positive (6%) or luminal (12%) subtypes. Whole brain radiation therapy (WBRT) is still the standard treatment for breast cancer patients wit...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Brain metastasis from renal cell carcinoma.
Authors: Kim YH, Kim JW, Chung HT, Paek SH, Kim DG, Jung HW
Abstract
Renal cell carcinoma (RCC) is one of primary cancers which metastasis to the brain frequently, although RCC accounts for only 1% of all cancer. The metastatic tumor from RCC has the propensity of intratumoral hemorrhage and relatively massive surrounding edema compared with other metastatic tumors. These characteristics make an emphasis on the surgical resection in the management of metastatic tumor. However, the surgery is not always possible due to the characteristics of tumor and patient. The outcome of conventional whole brain radioth...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Stereotactic radiosurgery of brain metastasis from melanoma.
Authors: Marchan EM, Sheehan J
Abstract
Brain metastasis represents the most common intracranial neoplasm in adult patients. Melanoma is the third most frequent cancer histology and consequently comprises a significant portion of brain metastasis patients. Unlike the more frequent lung and breast cancers, melanoma represents a particularly challenging entity because of its radioresistant nature. Stereotactic radiosurgery appears to overcome the inherent radioresistance of brain metastasis from melanoma and, thereby, affords a high rate of local tumor control. Reports from leading centers indicate a favorab...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
γ knife radiosurgery of other brain metastases.
Authors: Kondziolka D, Niranjan A, Kano H, Flickinger JC, Lunsford LD
Abstract
We evaluated the role of Gamma Knife stereotactic radiosurgery in the multidisciplinary management of brain metastases ovarian and endometrial, prostate, thyroid, sarcoma, or unknown primary cancers. From a series of over 3,000 patients who had Gamma Knife radiosurgery for brain metastases we reviewed indications and outcomes in patients with less common cancer types. All tumor types responded favorably to radiosurgery. Patients with male and female genitourinary primaries tended to develop brain metastases late in their course ...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
CyberKnife radiosurgery for brain metastases.
Authors: Wowra B, Muacevic A, Tonn JC
Abstract
Classic radiosurgery is a neurosurgical treatment concept for single-fraction irradiation of cerebral lesions not amenable to open surgery. Until recently it has been realized mainly by frame-based technologies (Gamma Knife; stereotactic linear accelerators). The CyberKnife described in 1997 is an image-guided frameless robotic technology for whole-body radiosurgery. It can be used for classic single-fraction radiosurgery and for hypofractionated treatments. The CyberKnife treatment procedure is completely non-invasive and can be repeated throughout the body i...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
