Management of adverse radiation effects after radiosurgery.
Authors: Monaco EA, Niranjan A, Kano H, Flickinger JC, Kondziolka D, Lunsford LD
Abstract
Stereotactic radiosurgery (SRS) is a well-established tool in the armamentarium for the treatment of metastatic tumors to the brain. Although SRS has proven to be highly effective in the management of brain metastases, it is not without risk. Despite selective targeting of lesions and the sharp dose fall-off associated with radiosurgical treatments, adverse radiation effects (AREs) can and do occur, albeit at a low rate, just as has been reported after conventional fractionated radiation therapy. One of the most vexin...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Radiosurgery after craniotomy.
Authors: Mathieu D
Abstract
Adjuvant irradiation of the resection cavity after craniotomy is a newer application of stereotactic radiosurgery. This technique has been proposed to avoid long-term neurotoxicity of whole-brain radiation therapy, and seems to afford comparable local control rates in the multiple published retrospective series so far. Currently, many questions remain to be answered to define the optimal patients who are candidate for tumor bed radiosurgery. The optimal timing after craniotomy, the volume of tissue to include in the treatment isodose and the radiation dose required to provide lo...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Combined role of whole-brain radiation therapy and radiosurgery for the treatment of brain metastasis.
Authors: Den RB, Andrews DW
Abstract
While the optimal treatment of brain metastases remains controversial, there is a clear role for radiotherapy in the management of this disease. Herein, we discuss, based upon the prospective randomized trials, the interplay of surgical resection, whole-brain radiation therapy and stereotactic radiosurgery. Specific treatment recommendations depend on various clinical parameters and patient preference. Consistently, multiple trials of whole-brain radiation therapy have demonstrated improved local control, decreased progression elsewhere in the brain, but no overall surv...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Modern radiosurgery equipment for treating brain metastases.
Authors: Chung HT, Kim DG
Abstract
Radiosurgery plays an important role in the management of brain metastases, which are the most common indication for such treatment in many centers. Because brain metastases are well enhanced on magnetic resonance images and show clear margins from the surrounding normal brain, they are suitable for radiosurgery. The dedicated radiosurgery machines used for treating brain metastases have different characteristics from the conventional external beam radiotherapy machines, although the same gamma rays are used in both methods. In a radiosurgery procedure, highly concentrate...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Stereotactic radiosurgery for large brain metastases.
Authors: Han JH, Kim DG, Kim CY, Chung HT, Jung HW
Abstract
Surgical resection still remains the mainstay of treatments for large brain metastases if feasible. Recently, stereotactic radiosurgery (SRS) using low-dose, 11- to 12-Gy marginal prescription dose, was tried to document the benefit for patients with large brain metastases when it was used as a primary or salvage treatment. Many large brain metastases responded promptly and showed favorable outcome after SRS. More than half of the patients recovered from their neurological deficits within 1 month after SRS. However, not negligible portion of patie...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
How many metastases can be treated with radiosurgery?
We describe postradiosurgical treatment outcomes of our consecutive series of 1,676 patients (654 females and 1,022 males, mean age 63 years, range 19-92 years) who underwent Gamma Knife radiosurgery (GKRS) for brain metastases, focusing particularly on GKRS for multiple lesions. The most common primary cancer was lung (1,057; 63.1%), followed by alimentary tract (198; 11.8%), breast (180; 10.7%), uro-genital (113; 6.7%) and others (128; 7.6%). Mean and median lesion numbers were 7 and 3, respectively, range 1-85. The overall median survival times were 9.0 months in females and 5.9 in males after GKRS (p < 0.0001). The ...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Management of recurrent brain metastasis after radiosurgery.
In this report, we review current diagnostic challenges regarding local recurrence after SRS and the development of new brain metastases after SRS. Potential therapeutic strategies and the patients for who each is recommended are discussed, including repeat SRS, surgical resection, WBRT, fractionated stereotactic radiosurgery, chemotherapy, and supportive care.
PMID: 22236688 [PubMed - indexed for MEDLINE] (Source: Progress in Neurological Surgery)
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Future perspectives on brain metastasis management.
Authors: Monaco EA, Parry PV, Grandhi R, Niranjan A, Kano H, Lunsford LD
Abstract
Brain metastases are the most common intracranial tumors encountered by physicians. Historically, the mainstays of therapy were limited to surgery and whole brain radiation. Surgery is typically reserved for safely accessible and symptomatic tumors in patients well enough to tolerate a procedure. Whole-brain radiation therapy has proven to have limited efficacy and concerns have arisen regarding its toxicity. Advances in the treatment of systemic cancers have yielded improved long-term survival and quality of life for patient...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Management of brain metastases. Forward.
Authors: Kim DG
PMID: 22334943 [PubMed - indexed for MEDLINE] (Source: Progress in Neurological Surgery)
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Stereotactic radiosurgery (SRS) and the management of metastatic brain cancer. Introduction.
Authors: Lunsford LD
PMID: 22334944 [PubMed - indexed for MEDLINE] (Source: Progress in Neurological Surgery)
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
A brief history of arteriovenous malformation radiosurgery.
Authors: Niranjan A, Lunsford LD
Abstract
Stereotactic radiosurgery was first described by Leksell in Stockholm, Sweden in 1951. In 1967, Leksell introduced the 'Gamma Knife' for clinical use in carefully selected patients. A major role for radiosurgery further emerged in 1972 after its application for brain arteriovenous malformations. Radiosurgery was initially used for high risk or deep seated AVMs that were unsuitable for resection or embolization. Several additional pioneers contributed towards its continued development. Stereotactic radiosurgery is now considered as an important option for patients w...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Natural history of cerebral arteriovenous malformations and the risk of hemorrhage after radiosurgery.
Authors: Yen CP, Schlesinger D, Sheehan JP
Abstract
The annual hemorrhage rate of intracranial arteriovenous malformations (AVMs) varies from 2 to 4%. In a patient with decades of life ahead, the cumulative risk of hemorrhage is significant. AVMs exhibiting characteristics such as deep venous drainage, venous stenosis, associated aneurysms and feeders from perforators are associated with an elevated risk of hemorrhage. We reviewed 1,400 AVM patients who underwent Gamma Knife surgery (GKS) at the University of Virginia between 1989 and 2009. The dose selection was based on the size and location of the nidus...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
The technical evolution of gamma knife radiosurgery for arteriovenous malformations.
Authors: Lunsford LD, Niranjan A, Kano H, Kondziolka D
Abstract
Gamma Knife stereotactic radiosurgery was first applied for the treatment of an intracranial arteriovenous malformation (AVM) in 1968. Using biplane angiography to target a small-volume, deep-seated lesion, photons were cross-fired on the pathological shunt. The AVM was obliterated within 3 years. This began a cautious introduction of Gamma Knife radiosurgery in the 1970s. As the Gamma Knife technology spread to sites in Europe, South America and the USA in the 1980s, AVM radiosurgery became a primary indication. During the early years the usu...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Targeting and conformality in arteriovenous malformation radiosurgery.
In this report we examine theoretical and practical issues of target delineation and creation of conformal AVM treatment plans, and comment on the concepts of gradient and homogeneity.
PMID: 23258507 [PubMed - indexed for MEDLINE] (Source: Progress in Neurological Surgery)
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Dose selection in stereotactic radiosurgery.
This article reviews the principles and data guiding dose selection for AVM radiosurgery.
PMID: 23258508 [PubMed - indexed for MEDLINE] (Source: Progress in Neurological Surgery)
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
