Gamma Knife evolving instrumentation

Ganz, Jeremy C.

doi:10.1016/bs.pbr.2021.10.025

Cited by 3 publications

(4 citation statements)

References 30 publications

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“…When compared to RT, SRS and GK groups of patients show an apparent increase in the number of collateral minor adverse effects with major complications limited to few cases [65-67]. New technological advances in SRS and GK techniques have been introduced during the years with promising results [68].…”

Section: Discussionmentioning

confidence: 99%

Cervicomedullary Gliomas in Pediatric Age: A Systematic Review of the Literature and Tertiary Care Center Experience

et al. 2022

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Introduction. CMG are usually low-grade tumors often found in pediatric age. Histological findings, treatments and classification have been much the same for 40 years, although histological and molecular classifications have largely been developed for other pediatric CNS tumors. The management and treatment of pediatric CMG is still conducted by many authors according to their anatomical location and characteristics, independently from histology. Methods. We conducted a literature review in PubMed (Medline) to identify relevant contributions about pediatric CMG published until December 31st, 2021. We also analyzed a series of 10 patients with CMG treated from 2006 to 2021 at IRCCS Istituto Nazionale dei Tumori. The aim of the present review is to see whether and how the diagnosis, treatment and classification of cervicomedullary gliomas (CMG) in children have developed over time, especially in the context of molecular advancements, and to analyze our single center experience in the last 15 years. Results. Thirty articles have been included in the review. Articles have been divided in two historical periods (1981-2000 and 2001-2021) and data from different series were analyzed to see how much the management and treatment of pediatric CMG have changed during years. Analysis of our series of 10 patients affected by CMG was also performed to compare it with the literature. Discussion. Management and classification of CMG in children has not dramatically changed during years. However, new insight from molecular diagnostics and target therapies and development of radiological, neurophysiological and radiotherapy techniques have updated treatment modalities in the last 20 years. Treatment modalities and their innovations have been reviewed and discussed. Further studies are needed to standardize and customize treatment protocols for these tumors.

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Section: Discussionmentioning

confidence: 99%

Cervicomedullary Gliomas in Pediatric Age: A Systematic Review of the Literature and Tertiary Care Center Experience

et al. 2022

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“…It still maintains a high level of accuracy while improving patient comfort. Another major advantage of the Icon™ system is its top-notch internal motion management and cross-repositioning system, which achieves submillimeter precision in treatment ( 19 , 20 ). We describe a case of recurrent orbital anaplastic meningioma that received radiotherapy with tomotherapy (TOMO) to the recurrent lesion area and the high-risk area within the orbit for nearly 5 weeks.…”

Section: Introductionmentioning

confidence: 99%

Combined helical tomotherapy and Gamma Knife stereotactic radiosurgery for high-grade recurrent orbital meningioma: a case report

Zhang,

Wu,

et al. 2023

Front. Oncol.

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Orbital meningioma is a rare type of orbital tumor with high invasiveness and recurrence rates, making it extremely challenging to treat. Due to the special location of the disease, surgery often cannot completely remove the tumor, requiring postoperative radiation therapy. Here, we report a case of an elderly male patient with right-sided proptosis, visual impairment, and diplopia. Imaging diagnosis revealed a space-occupying lesion in the extraconal space of the right orbit. Pathological and immunohistochemical examination of the resected tumor confirmed it as a grade 3 anaplastic meningioma. Two months after surgery, the patient complained of right eye swelling and a magnetic resonance imaging (MRI) scan showed a recurrence of the tumor. The patient received helical tomotherapy (TOMO) in the postoperative tumor bed and high-risk areas within the orbit with a total dose of 48Gy. However, there was no significant improvement in the patient’s right eye swelling, and the size of the recurrent lesion showed no significant change on imaging. Gamma knife multifractionated stereotactic radiosurgery (MF-SRS) was then given to the recurrent lesion with 50% prescription dose 13.5Gy/3f, once every other day. An imaging diagnosis performed 45 days later showed that the tumor had disappeared completely. The patient’s vision remained unchanged, but diplopia was significantly relieved after MF-SRS. We propose a new hybrid treatment model for recurrent orbital meningioma, where conventional radiation therapy ensures local control of high-risk areas around the postoperative cavity, and MF-SRS maximizes the radiation dose to recurrent lesion areas while protecting surrounding tissues and organs.

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“…It allows use of a thermoplastic mask with an infrared high-definition motion management system (HDMM) for non-invasive immobilization. 12 The ICON's integral cone beam CT (CBCT) defines stereotactic coordinates independent from the frame. 3,13 Submillimeter frameless positioning accuracy is achieved by a combination of CBCT imaging, automatic coregistration, online adaptive planning, and monitoring of intrafraction movements with the HDMM.…”

Section: Introductionmentioning

confidence: 99%

“…10,18 Fractionation or distributed schedules, 21 linac SRS, 17 or frame placement, may ultimately be required. 12,[17][18] Whether anxiolytics or sedation should be used to improve mask tolerability is under debate. In semistructured interviews of patients receiving GK via frameless fixation, many reported taking lorazepam to help relax.…”

mentioning

confidence: 99%

Tolerability and Stability of Mask Fixation in Gamma Knife Stereotactic Radiosurgery: Predictors of Treatment Interruptions

Yang¹,

Bowden

Patel

et al. 2022

MRAJ

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Background. Frameless fixation with a thermoplastic mask is an alternative to traditional frame-based immobilization for Gamma-Knife stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT). However, interruptions during beam-on time can significantly prolong treatment delivery, impacting patient experience and unit workflow. Aim. We investigated clinical and technical predictors of treatment interruptions, and the phases of treatment during which interruptions are most likely to occur. Methods. Patients undergoing frameless Gamma Knife SRS or FSRT in 2020 were retrospectively reviewed. Clinical parameters were extracted from electronic medical records. Dosimetric and treatment interruption data were obtained from Gamma Knife treatment reports. Univariate and multivariate analyses analyzed technical and clinical predictors of treatment interruptions. Results. Our cohort included 84 patients receiving 141 fractions encompassing 255 lesions. 49/84 (58.3%) were female, 79/84 (94.0%) had brain metastases, 49/84 (58.3%) were taking dexamethasone and 30/84 (35.7%) used analgesics. 89/106 (84.0%) courses were single fractions. Mean planned beam-on time was 37.1 minutes (range 7.1-118.8 min) versus a total bed time of 64.9 minutes (range 15-252min) per fraction. 64.5% (91/141) of fractions were interrupted at least once; 12/141 fractions were paused 20 times or more, with a maximum 54 pauses. The mean number of pauses per quartile decreased the further the patient proceeded in beam-on time, and patients receiving first lifetime cranial radiation paused more often than during subsequent fractions. At least one pause occurred in 100% of fractions with a planned beam-on time exceeding 60 minutes. Planned beam-on time, number of gating events and high-definition motion management alarms significantly correlated with total number of pauses on multivariate analysis (all p<0.0001); these three factors, along with prep time and number of operator-initiated pauses, predicted total time on the Gamma Knife couch (all p<0.0001). Clinical factors, medication use, and prior SRS/FSRT were not predictive of pauses. Conclusions. Planned beam-on time, number of gating events and high-definition motion management alarms significantly predicted likelihood of interruptions during frameless Gamma Knife SRS/FSRT. These factors should be considered in selection of immobilization method, especially if exceeding 60 minutes.

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Gamma Knife evolving instrumentation

Cited by 3 publications

References 30 publications

Cervicomedullary Gliomas in Pediatric Age: A Systematic Review of the Literature and Tertiary Care Center Experience

Cervicomedullary Gliomas in Pediatric Age: A Systematic Review of the Literature and Tertiary Care Center Experience

Combined helical tomotherapy and Gamma Knife stereotactic radiosurgery for high-grade recurrent orbital meningioma: a case report

Tolerability and Stability of Mask Fixation in Gamma Knife Stereotactic Radiosurgery: Predictors of Treatment Interruptions

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