Expanded Radiosurgery Capabilities Utilizing Gamma Knife Icon™

Abstract

The indications and techniques for the treatment of intracranial lesions continue to evolve with the advent of novel technologies. The Gamma Knife Icon™ (GK Icon™) is the most recent model available from Elekta, providing a frameless solution for stereotactic radiosurgery. At our institution, 382 patients with 3,213 separate intracranial lesions have been treated with frameless stereotactic radiotherapy using the GK Icon. The wide range of diagnoses include brain metastases, meningiomas, arteriovenous malformations, acoustic neuromas, pituitary adenomas, and several other histologies. The ability to perform both frame and frameless treatments on the GK Icon has significantly increased our daily volume by almost 50% on a single machine. Although the frameless approach allows one to take advantage of the precision in radiosurgery, the intricacies regarding treatment with this frameless system are not well established. Our initial experience will help to serve as a guide to those wishing to implement this novel technology in their practice.

In phantom evaluation of targeting accuracy in MRI-based brain radiosurgery

“…The Icon includes integrated imaging systems that allow the plan to be adjusted just before treatment and to perform image verification in hypo-fractionated protocols, recently tested to treat large lesions or lesions positioned close to sensitive structures (i.e. brainstem) [36,37]. Moreover, the phantom can be used to test targeting and co-registration accuracy of brain radiosurgery procedures carried out with any radiotherapy approach.…”

Impact of Social Determinants of Health on Stereotactic Radiotherapy for Vestibular Schwannoma

“…As both region and metropolitan area are included as independent variables in multivariate analysis, population‐density as well as geographic region have an independent effect on radiotherapy selection in different parts of the United States 47 . Greater travel distances were also independently associated with GK, consistent with individuals traveling longer distances to academic centers to have GK performed whereas LINAC is more frequently utilized in readily accessible community hospitals 7,39,40 . Finally, VS patients with tumor sizes ≥4 cm had higher odds of receiving GK.…”

“…Likewise, LINAC patients had a significantly greater proportion of patients treated in nonmetropolitan areas compared to GK patients. GK utilizes a machine designed exclusively for skull base brain radiosurgery, whereas LINAC has more versatile applications in delivering radiation therapy 39,40 . As a result, smaller community‐based hospitals, which are more frequently found in nonmetropolitan areas may rely on LINAC to carry out a wider variety of procedures due to the limited need for a dedicated machine like GK, simply due to the low incidence of VS and thus fewer patients indicated for this specialized type of SRS treatment 26 .…”

Clinical validation of novel lightning dose optimizer for gamma knife radiosurgery of irregular‐shaped arteriovenous malformations and pituitary adenomas

“…Preplanning capability for the GK‐SRS using previously obtained MRI images has been available on GammaPlan and most recently the preplanning clinic workflow was reported for the prospective patients on LGK Icon. 21 , 22 However, in our current clinic workflow with LGK Perfexion, we do not use the preplanning capability. Nevertheless, for all plans generated with LDO, the planning time was remarkably shorter than with manual planning and lower dose to OARs, including normal brain.…”

“…Preplanning capability for the GK‐SRS using previously obtained MRI images has been available on GammaPlan and most recently the preplanning clinic workflow was reported for the prospective patients on LGK Icon 21,22 . However, in our current clinic workflow with LGK Perfexion, we do not use the preplanning capability.…”