Gamma Knife surgery for central neurocytomas

Abstract

Object The optimal management of central neurocytoma (CN) remnants and recurrences is still not clear. To date no large series of patients treated with Gamma Knife surgery (GKS) for CNs has been published. For that reason the authors decided to combine data from 5 different centers so that they could analyze the largest population of patients treated with GKS for CN currently available. Methods Data obtained in 42 patients who were treated for CN with GKS before July 1, 2010, were retrospectively collected and analyzed. The median prescribed dose was 13 Gy (range 11–25 Gy). The follow-up time in these patients ranged from 0.5 to 14.7 years (mean 6.1 years, median 4.9 years). Eleven patients were followed up for 5–10 years and 9 patients for more than 10 years. All patients were alive and well at the closing of the study except 1 patient, who died of injuries sustained in a traffic accident. Results Two cases of local tumor progression and 2 cases of distant tumor recurrence occurred among the patient population, yielding 5- and 10-year tumor control rates of 91% and 81%, respectively. No permanent complications occurred. The findings were in line with results reported in earlier publications. Despite the high tumor control rate, enlargement of part of or the whole ventricular system was seen in 45% of patients. Conclusions The high tumor control rate and the low complication rate following GKS indicate that GKS is the preferred treatment for CN tumor remnants or recurrences following microsurgery. However, data from longer follow-up times in more patients are needed before this conclusion can be validated. The patients need to be closely monitored and potential hydrocephalus managed despite tumor control.

Systematic Analysis of Clinical Outcomes Following Stereotactic Radiosurgery for Central Neurocytoma

“…The current systematic analysis updates the findings of Park and includes several additional case series published since then for a total of 150 patients [50515253]. To our knowledge, this study represents the largest and most current review of CN patients treated with SRS.…”

“…SRS has been demonstrated to be effective in primary management of CN, particularly in cases less amenable to surgical resection [293150]. In our study, 25 patients (16.7%) were treated with GKRS alone.…”

“…Kim et al [29] report a 20% LC failure rate for patients treated with primary SRS vs. 40% LC failure in patients treated with adjuvant SRS. Similarly, Karlsson et al [50] found primary SRS to be efficacious in control of incidental, asymptomatic CN. The report of effective primary control is consistent with our findings that mean tumor volume is directly correlated with LC failure, since smaller tumor volumes are less likely to need surgical decompression or be symptomatic.…”

“…There are only 3 reported AREs (all cases of cerebral edema) in the literature with only one becoming symptomatic (Table 1) [294150]. Only 2% of the patients reviewed experienced AREs.…”

Treatment strategies for huge central neurocytomas

“…GKRS as a primary or secondary treatment option for CNs was also demonstrated in several researches [6,9,24,25] . In our series, CNs in two patients with STR(+GKRS) recurred or progressed postoperatively and were treated with (repeated) GKRS, and no recurrence was found during the follow-up period.…”