Radiosurgery for palliation of base of skull recurrences from head and neck cancers

Kaplan, Irving; Adler, John R.; Hicks, Wesley L.; Fee, Willard E.; Goffinet, Don R.

doi:10.1002/1097-0142(19921001)70:7<1980::aid-cncr2820700728>3.0.co;2-l

Cited by 44 publications

(12 citation statements)

References 26 publications

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“…Radiosurgery has been used to treat many different intracranial lesions, both benign and malignant, and is widely accepted as both safe and effective. 4,9,17,21,22,26 There is reason to believe that radiosurgery involving similar doses would be equally efficacious for the treatment of benign spinal lesions.…”

Section: Discussionmentioning

confidence: 99%

CyberKnife frameless single-fraction stereotactic radiosurgery for benign tumors of the spine

Gerszten¹,

Ozhasoglu²,

Burton³

et al. 2003

FOC

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Object The role of stereotactic radiosurgery in the treatment of benign intracranial lesions is well established. Its role in the treatment of benign spinal lesions is more limited. Benign spinal lesions should be amenable to radiosurgical treatment similar to their intracranial counterparts. In this study the authors evaluated the effectiveness of the CyberKnife for benign spinal lesions involving a single-fraction radiosurgical technique. Methods The CyberKnife is a frameless radiosurgery system in which an orthogonal pair of x-ray cameras is coupled to a dynamically manipulated robot-mounted linear accelerator possessing six degrees of freedom, whereby the therapy beam is guided to the intended target without the use of frame-based fixation. Cervical spine lesions were located and tracked relative to skull osseous landmarks; lower spinal lesions were tracked relative to percutaneously placed fiducial bone markers. Fifteen patients underwent single-fraction radiosurgery (12 cervical, one thoracic, and two lumbar). Histological types included neurofibroma (five cases), paraganglioma (three cases), schwannoma (two cases), meningioma (two cases), spinal chordoma (two cases), and hemangioma (one case). Radiation dose plans were calculated based on computerized tomography scans acquired using 1.25-mm slices. Planning treatment volume was defined as the radiographic tumor volume with no margin. The tumor dose was maintained at 12 to 20 Gy to the 80% isodose line (mean 16 Gy). Tumor volume ranged from 0.3 to 29.3 ml (mean 6.4 ml). Spinal canal volume receiving more than 8 Gy ranged from 0.0 to 0.9 ml (mean 0.2 ml). All patients tolerated the procedure in an outpatient setting. No acute radiation-induced toxicity or new neurological deficits occurred during the follow-up period. Pain improved in all patients who were symptomatic prior to treatment. No tumor progression has been documented on follow-up imaging (mean 12 months). Conclusions Spinal stereotactic radiosurgery was found to be feasible, safe, and effective for the treatment of benign spinal lesions. Its major potential benefits are the relatively short treatment time in an outpatient setting and the minimal risk of side effects. This new technique offers an alternative therapeutic modality for the treatment of a variety of benign spinal neoplasms in cases in which surgery cannot be performed, in cases with previously irradiated sites, and in cases involving lesions not amenable to open surgical techniques or as an adjunct to surgery.

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Section: Discussionmentioning

confidence: 99%

CyberKnife frameless single-fraction stereotactic radiosurgery for benign tumors of the spine

Gerszten¹,

Ozhasoglu²,

Burton³

et al. 2003

FOC

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“…Radiosurgery has been reported in the treatment of many different intracranial lesions, both benign and malignant, and is widely accepted as safe and effective. 5,9,20,27,28,34 Stereotactic radiosurgery offers a method for delivering high-dose radiation in a single or limited number of fractions to a small volume encompassing the tumor while minimizing the dose to adjacent normal structures. The authors of a study originating from the University of Arizona in 1996 demonstrated that spinal stereotactic radiosurgery involving the use of a body frame was both feasible and safe.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of frameless single-fraction stereotactic radiosurgery for spinal lesions

Gerszten

Ozhasoglu

Burton

et al. 2002

FOC

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Object The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited by the availability of effective target-immobilizing devices. In this study the authors evaluated the CyberKnife Real-Time Image-Guided Radiosurgery System for spinal lesion treatment involving a single-fraction radiosurgical technique. Methods This frameless image-guided radiosurgery system uses the coupling of an orthogonal pair of x-ray cameras to a dynamically manipulated robot-mounted linear accelerator possessing six degrees of freedom, which guides the therapy beam to the target without the use of frame-based fixation. Cervical lesions were located and tracked relative to osseous skull landmarks; lower spinal lesions were tracked relative to percutaneously placed gold fiducial bone markers. Fifty-six spinal lesions in 46 consecutive patients were treated using single-fraction radiosurgery (26 cervical, 15 thoracic, and 11 lumbar, and four sacral). There were 11 benign and 45 metastatic lesions. Tumor volume ranged from 0.3 to 168 ml (mean 26.7 ml). Thirty-one lesions had previously received external-beam radiotherapy with maximum spinal cord doses. Dose plans were calculated based on computerized tomography scans acquired using 1.25-mm slices. Tumor dose was maintained at 12 to 18 Gy to the 80% isodose line; spinal cord lesions receiving greater than 8 Gy ranged from 0 to 1.3 ml (mean 0.3 ml). All patients tolerated the procedure in an outpatient setting. No acute radiation-induced toxicity or new neurological deficits occurred during the follow-up period. Axial and radicular pain improved in all patients who were symptomatic prior to treatment. Conclusions Spinal stereotactic radiosurgery involving a frameless image-guided system was found to be feasible and safe. The major potential benefits of radiosurgical ablation of spinal lesions are short treatment time in an outpatient setting with rapid recovery and symptomatic response. This procedure offers a successful alternative therapeutic modality for the treatment of a variety of spinal lesions not amenable to open surgical techniques; the intervention can be performed in medically untreatable patients, lesions located in previously irradiated sites, or as an adjunct to surgery.

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“…Durch die Integration der stereotaktischen Radiochirurgie mittels Gammaknife-Behandlung sowie durch die stereotaktische Bestrahlung mittels Linearbeschleuniger (LINAC) und mittels Protonenbestrahlung hat die Therapie von komplexen Schädelbasisläsionen weitere wichtige Facetten hinzugewonnen [1,11,15]. Auch der robotergeführte Linearbeschleuniger (Cyberknife) wird insbesondere im kraniozervikalen Übergang und im Bereich der Wirbelsäule sein Haupteinsatzgebiet haben [24].…”

Section: Präzisionsbestrahlung Und Strahlenchirurgieunclassified

Moderne Schädelbasischirurgie aus Sicht des Neurochirurgen

Spetzger

2011

HNO

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At present, modern skull base surgery is a highly sophisticated interdisciplinary collaboration of various diagnostic and therapeutic disciplines. The overall goal is the treatment of complex tumorous, traumatic, vascular and inflammatory processes or developmental disorders of the skull base with preservation of function. The paper presents modern concepts, procedures and minimally invasive strategies in skull base surgery and also critically discusses the current trend to endoscopic and robot-assisted surgical techniques.

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Radiosurgery for palliation of base of skull recurrences from head and neck cancers

Cited by 44 publications

References 26 publications

CyberKnife frameless single-fraction stereotactic radiosurgery for benign tumors of the spine

CyberKnife frameless single-fraction stereotactic radiosurgery for benign tumors of the spine

Feasibility of frameless single-fraction stereotactic radiosurgery for spinal lesions

Moderne Schädelbasischirurgie aus Sicht des Neurochirurgen

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