Preliminary Report of Multisession Gamma Knife Radiosurgery for Benign Perioptic Lesions: Visual Outcome in 22 Patients

Kim, Jong-Won; Im, Yong-Seok; Nam, Do‐Hyun; Park, Kwan; Kim, Jong Hyun; Lee, Jung-Il

doi:10.3340/jkns.2008.44.2.67

Cited by 28 publications

(18 citation statements)

References 8 publications

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“…Results on the anti secretory and anti tumoral efficacy of this approach are based on a low number of patients and a shortterm followup and thus no firm conclusions about the advantages and dis advantages of this technique can be drawn. 9,10,46,47 Comparison with fractionated radiotherapy…”

Section: Optic Nerve Neuropathy and Ophthalmoplegiamentioning

confidence: 99%

Role of stereotactic radiosurgery in the management of pituitary adenomas

et al. 2010

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Trans-sphenoidal neurosurgery is the gold standard treatment for pituitary adenomas, but it can be contraindicated or ineffective. Stereotactic radiosurgery is a procedure aimed at controlling hormone hypersecretion and tumor size of pituitary adenomas. This Review discusses the long-term efficacy and adverse effects of stereotactic radiosurgery with the Gamma Knife((R)) in secreting and nonsecreting pituitary adenomas. Long-term data confirm the antisecretory efficacy of the procedure (about 50% remission in hypersecreting tumors) but also a previously unknown low risk of recurrence (2-10% of cases). The time to remission is estimated to range from 12 to 60 months. The antitumoral efficacy of this treatment against nonsecreting tumors is observed in about 90% of cases. Hypopituitarism is the main adverse effect, observed in 20-40% of cases. Comparisons with conventional fractionated radiotherapy reveal a lower rate of remission with Gamma Knife((R)) radiosurgery, counterbalanced by a more rapid efficacy and a lower rate of hypopituitarism. Short-term follow-up results on stereotactic fractionated radiotherapy suggest a risk of hypopituitarism similar to the one observed with radiosurgery. Therefore, stereotactic radiosurgery is probably still useful to treat some cases of pituitary adenoma, despite the fact that antisecretory drugs, particularly for acromegaly and prolactinomas, are becoming more effective and are well tolerated, thus increasing the probability of success with nonsurgical therapy.

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Section: Optic Nerve Neuropathy and Ophthalmoplegiamentioning

confidence: 99%

Role of stereotactic radiosurgery in the management of pituitary adenomas

et al. 2010

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“…Although there is some evidence to support the use of a total dose of 20 Gy in 4 fractions as a safe and effective dose in the treatment of benign perioptic tumors, 4,9,25 this evidence is nevertheless relatively limited, and further investigation is necessary to better determine the efficacy and toxicity profile associated with this dose/fractionation scheme.…”

Section: Discussionmentioning

confidence: 99%

Emerging Indications for Fractionated Gamma Knife Radiosurgery

et al. 2017

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BACKGROUND Gamma Knife radiosurgery (GKRS) allows for the treatment of intracranial tumors with a high degree of dose conformality and precision. There are, however, certain situations wherein the dose conformality of GKRS is desired, but single session treatment is contraindicated. In these situations, a traditional pin-based GKRS head frame cannot be used, as it precludes fractionated treatment. OBJECTIVE To report our experience in treating patients with fractionated GKRS using a relocatable, noninvasive immobilization system. METHODS Patients were considered candidates for fractionated GKRS if they had one or more of the following indications: a benign tumor >10 cc in volume or abutting the optic pathway, a vestibular schwannoma with the intent of hearing preservation, or a tumor previously irradiated with single fraction GKRS. The immobilization device used for all patients was the Extend system (Leksell Gamma Knife Perfexion, Elekta, Kungstensgatan, Stockholm). RESULTS We identified 34 patients treated with fractionated GKRS between August 2013 and February 2015. There were a total of 37 tumors treated including 15 meningiomas, 11 pituitary adenomas, 6 brain metastases, 4 vestibular schwannomas, and 1 hemangioma. At last follow-up, all 21 patients treated for perioptic tumors had stable or improved vision and all 4 patients treated for vestibular schwannoma maintained serviceable hearing. No severe adverse events were reported. CONCLUSION Fractionated GKRS was well-tolerated in the treatment of large meningiomas, perioptic tumors, vestibular schwannomas with intent of hearing preservation, and in reirradiation of previously treated tumors.

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“…A single high dose fraction with GK offers efficient radiosurgical treatment to number of clinical indications, functional neurological disorders and others (Firlik et al, 1998;Haselsberger et al, 2009;Iwai et al, 2001;Javalkar et al, 2009;Kim et al, 2008). Treating the tumor with relatively lower radiation dose fractions (also called hypofractionation) increases the radiobiological effect on tumor in addition to sparing adjacent normal tissue (Kim et al, 2008;Niranjan et al, 2004;Adler et al, 2008;Tuniz et al, 2009;Milker-Zabel et al, 2009).…”

Section: Introductionmentioning

confidence: 98%