Minimized Doses for Linear Accelerator Radiosurgery of Brainstem Metastasis

Valéry, Charles-Ambroise; Boskos, Christos; Boisserie, G.; Lamproglou, Ioannis; Cornu, Philippe; Mazeron, Jean‐Jacques; Simon, Jean‐Marc

doi:10.1016/j.ijrobp.2010.02.028

Cited by 38 publications

(41 citation statements)

References 27 publications

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“…Valery et al 32) tried to limit peripheral isodose to 13 Gy and to improve conformal dosimetry, reported a local control rate of 90.0%, a mean survival time of 10.0 months. There are possible explanations for the good local control rate compared with hemispherical locations usually treated with higher doses.…”

Section: Resultsmentioning

confidence: 99%

“…There are possible explanations for the good local control rate compared with hemispherical locations usually treated with higher doses. Targeting or defining an intraparenchymal target is more accurate in this area; high-density brainstem white fibers surrounding the lesion may constitute a barrier against cell spread; and a combination of both may come into play 32) . Lorenzoni et al 22) reported that the only patient with tumor recurrence was treated initially with a marginal dose of 18 Gy; the lesion was retreated 8 months later with a marginal dose of 20 Gy.…”

Section: Resultsmentioning

confidence: 99%

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Gamma Knife Radiosurgery for Brainstem Metastasis

Yoo

Park

Kwon

et al. 2011

J Korean Neurosurg Soc

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small case series for the management of brainstem metastases using Gamma Knife Radiosurgery (GKRS) 12,16,18,22,26,35) . The present study assessed outcomes following our use of GKRS for the management of brainstem metastasis, and we investigated the effect of treatment on tumor size and survival time. MATERIALS AND METHODS Patient characteristicsFrom November 1992 to June 2010, a total of 32 patients underwent GKRS for local control of brainstem metastasis at our institute. The clinical characteristics of the 32 patients are summarized in Table 1. The study population consisted of 23 men and 9 women, with a mean age of 56.1 years (range, 39-73). The primary malignancy was lung cancer in 21 patients, breast cancer in 3, renal cell cancer in 2, prostate cancer in 2, and hepatocellular carcinoma, colorectal cancer in 1, gastric cancer in 1, and melanoma in 1. Fourteen patients had score of more than 70 on the Karnofsky performance status (KPS), and 18 had scores of less than 70. Lesions were located in the pons in 23 patients, the midbrain in 6 and the medulla oblongata in 3 patients. Fifteen patients presented with brainstem signs which INTRODUCTIONMetastasis to the brain is a frequent complication of malignant tumors of the lung, breast, kidney, and of malignant melanoma 2) . Metastatic brain lesions are estimated to eventually develop in 15 to 40% of patients with cancer 31) , and autopsy studies show brain metastases in 24% of cancer patients. However, brainstem metastases are uncommon, and account for only 3 to 5% of all brain metastases 8,17,30) . Brainstem metastases are generally not treated surgically due to the risk of causing neurological damage. Whole brain radiation therapy (WBRT) and stereotactic radiosurgery have been reported to provide benefits in brain metastases patients 3,4,9,10,14,19,29) . However, the benefits of such treatment in brainstem metastasis patients remain unclear.Since the first report of Huang et al. series 15) , there were some Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaObjective : Brainstem metastases are rarely operable and generally unresponsive to conventional radiation therapy or chemotherapy. Recently, Gamma Knife Radiosurgery (GKRS) was used as feasible treatment option for brainstem metastasis. The present study evaluated our experience of brainstem metastasis which was treated with GKRS. Methods : Between November 1992 and June 2010, 32 patients (23 men and 9 women, mean age 56.1 years, range 39-73) were treated with GKRS for brainstem metastases. There were metastatic lesions in pons in 23, the midbrain in 6, and the medulla oblongata in 3 patients, respectively. The primary tumor site was lung in 21, breast in 3, kidney in 2 and other locations in 6 patients. The mean tumor volume was 1,517 mm 3 (range, 9-6,000), and the mean marginal dose was 15.9 Gy (range, 6-23). Magnetic Resonance Imaging (MRI) was obtained every 2-3 months following GKRS. Follow-up MRI was possible in 24 patients at a mean follow-up durat...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Gamma Knife Radiosurgery for Brainstem Metastasis

Yoo

Park

Kwon

et al. 2011

J Korean Neurosurg Soc

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“…14,22 Besides, Valery et al have showed that reduced doses can achieve the same local control in brainstem lesions. 17 In their study, using linac radiosurgery, median radiosurgical dose was 13.4 Gy (BED: 103.2 for α/β=2), median survival was 10 months and local control rates were 100%, 100%, and 79% at 3, 6, and 12 months, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…3,5,6,[13][14][15] In addition, there are other studies in which linac-based systems were used as a means of SRS. 16,17 All of these studies have shown that SRS is a safe, reliable, and efficient treatment method for brainstem metastases. [3][4][5][6][13][14][15][16][17] This study differs from others in reporting treatment results of not only metastases in the brainstem but also those that are adjacent to brainstem (≤5 mm) and using CyberKnife as an FSRT/ SRS system.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 All of these studies have shown that SRS is a safe, reliable, and efficient treatment method for brainstem metastases. [3][4][5][6][13][14][15][16][17] This study differs from others in reporting treatment results of not only metastases in the brainstem but also those that are adjacent to brainstem (≤5 mm) and using CyberKnife as an FSRT/ SRS system. The CyberKnife SRT system has certain improved features of utility compared to the Gamma Knife radiosurgery system.…”

Section: Discussionmentioning

confidence: 99%

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Cyberknife® Radiosurgery and Fractionated Stereotactic Radiotherapy For Brainstem or Adjacent-to-Brainstem Metastases

Güney¹,

Ozseker²,

İnan³

et al. 2013

Turkiye Klinikleri J Med Sci

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Efficacy and Safety of Stereotactic Radiosurgery for Brainstem Metastases

Chen

Baal

et al. 2021

JAMA Oncol

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IMPORTANCEOwing to the proximity to critical neurologic structures, treatment options for brainstem metastases (BSM) are limited, and BSM growth can cause acute morbidity or death. Stereotactic radiosurgery (SRS) is the only local therapy for BSM, but efficacy and safety of this approach are incompletely understood because patients with BSM are excluded from most clinical trials.OBJECTIVE To perform a systematic review and comparative meta-analysis of SRS studies for BSM in the context of prospective trials of SRS or molecular therapy for nonbrainstem brain metastases (BM).

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Minimized Doses for Linear Accelerator Radiosurgery of Brainstem Metastasis

Cited by 38 publications

References 27 publications

Gamma Knife Radiosurgery for Brainstem Metastasis

Gamma Knife Radiosurgery for Brainstem Metastasis

Cyberknife® Radiosurgery and Fractionated Stereotactic Radiotherapy For Brainstem or Adjacent-to-Brainstem Metastases

Efficacy and Safety of Stereotactic Radiosurgery for Brainstem Metastases

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