Upfront Gamma Knife Surgery for Giant Central Neurocytoma

Chen, Kuan-Pin; Lee, Cheng‐Chia; Liao, Chia-Lin; Yang, Tao-Chieh; Chiu, Ted H.; Su, Chain-Fa

doi:10.1016/j.wneu.2016.10.073

Cited by 8 publications

(11 citation statements)

References 30 publications

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“…Therefore, the risks of surgery-related morbidity and mortality are not negligible, but some studies have reported the effectiveness of primary SRS for CNs. 20,21 Before the era of SRS, conventional fractionated RT was a common noninvasive approach used to manage residual or recurrent CNs after resection. 2,7,32 The effectiveness of RT for recurrent or residual CNs has been reported with high tumor control rates.…”

Section: Discussionmentioning

confidence: 99%

“…The effectiveness of Gamma Knife radiosurgery (GKRS) for CNs has been reported, with a high rate of tumor control and a low complication rate. 12,[18][19][20][21][22][23] To our knowledge, a limited number of studies have evaluated the usefulness of SRS as a primary treat-ment for CNs. 8,12,24,25 The goal of this study was to report a single-center experience with GKRS as a primary treatment for CNs.…”

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confidence: 99%

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Gamma Knife radiosurgery as a primary treatment for central neurocytoma

Jeon¹,

Park²,

Choi³

et al. 2021

Journal of Neurosurgery

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OBJECTIVEThis study was performed to evaluate the role of Gamma Knife radiosurgery (GKRS) as a primary treatment for central neurocytomas (CNs).METHODSThe authors retrospectively assessed the treatment outcomes of patients who had undergone primary treatment with GKRS for CNs in the period between December 2001 and December 2018. The diagnosis of CN was based on findings on neuroimaging studies. The electronic medical records were retrospectively reviewed for additional relevant preoperative data, and clinical follow-up data had been obtained during office evaluations of the treated patients. All radiographic data were reviewed by a dedicated neuroradiologist.RESULTSFourteen patients were treated with GKRS as a primary treatment for CNs in the study period. Seven patients (50.0%) were asymptomatic at initial presentation, and 7 (50.0%) presented with headache. Ten patients (71.4%) were treated with GKRS after the diagnosis of CN based on characteristic MRI findings. Four patients (28.6%) initially underwent either stereotactic or endoscopic biopsy before GKRS. The median tumor volume was 3.9 cm3 (range 0.46–18.1 cm3). The median prescription dose delivered to the tumor margin was 15 Gy (range 5.5–18 Gy). The median maximum dose was 30 Gy (range 11–36 Gy). Two patients were treated with fractionated GKRS, one with a prescription dose of 21 Gy in 3 fractions and another with a dose of 22 Gy in 4 fractions. Control of tumor growth was achieved in all 14 patients. The median volume reduction was 26.4% (range 0%–78.3%). Transient adverse radiation effects were observed in 2 patients but resolved with improvement in symptoms. No recurrences were revealed during the follow-up period, which was a median of 25 months (range 12–89 months).CONCLUSIONSPrimary GKRS for CNs resulted in excellent tumor control rates without recurrences. These results suggest that GKRS may be a viable treatment option for patients with small- to medium-sized or incidental CNs.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Gamma Knife radiosurgery as a primary treatment for central neurocytoma

Jeon¹,

Park²,

Choi³

et al. 2021

Journal of Neurosurgery

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“…Overall, local control of GKR for central neurocytoma was 92.2%, which supported the efficacy of GKR for central neurocytoma. [7,15,20] In these studies, stereotactic radiosurgery was usually performed on asymptomatic, relatively small tumors in the absence of hydrocephalus. In addition, even with hydrocephalus symptoms, GKR with ETV can be performed when the tumors are placed deep in a location where surgical access was difficult.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have reported the effectiveness of stereotactic radiosurgery. [7,8] In particular, recurring cases, deep-seated lesions with difficult surgical access, or high operative risks, such as old age or general weakness, have been treated.…”

Section: Introductionmentioning

confidence: 99%

Tumor control of third ventricular central neurocytoma after gamma knife radiosurgery in an elderly patient

Park¹,

Jung²,

Kim³

et al. 2018

Medicine

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Rationale:Central neurocytoma is rare benign tumor that occurs in high probability in young adults in the lateral ventricle. Herein, we report an unusual case of an elderly woman who was diagnosed with central neurocytoma isolated to the third ventricle. This deeply located tumor was effectively treated using gamma knife radiosurgery (GKR).Patient concerns:A 79-year-old woman was admitted to hospital with gait disturbance and cognitive dysfunction.Diagnosis:Brain magnetic resonance imaging (MRI) revealed a homogenously enhancing multilobulated mass in the posterior third ventricle measuring 1.8 cm in size. The tumor was diagnosed as a central neurocytoma isolated to the third ventricle.Interventions:Neuronavigation-guided endoscopic third ventriculostomy and biopsy were performed. One week following surgery, GKR was performed using a prescribed dose of 14 Gy with 50% isodose lines, and a target volume of 1.62 cc.Outcomes:Three months after GKR, brain MRI revealed a decrease in the size (to 1.4 cm) of the multilobulated strong enhancing mass in the posterior third ventricle, and the patient's symptom of confusion was improved.Lessons:Previous studies have reported that tumors in unusual locations, such as those isolated to the third ventricle, are different according to age, either in young children or elderly individuals. Although complete surgical resection is an effective treatment for central neurocytoma, it is often difficult to approach these tumors through surgery. GKR could, therefore, be an alternative primary treatment option for deeply located central neurocytomas in elderly patients.

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“…[8][9][10] Upfront stereotactic radiosurgery (SRS) achieves good tumor control rates for biopsy-proven CNs, even in some cases of large tumors. 11 The tumor control rates are high with both conventional fractionated external-beam radiation therapy (EBRT) and SRS, but the incidence of adverse radiation effects (AREs) may be lower after SRS (3%-20% with SRS vs 60% with EBRT). 4,[12][13][14] However, while SRS ameliorates the risk of AREs with its focused targeting and steep dose falloff, the potential for distant (out-field) recurrence remains with this therapeutic modality.…”

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confidence: 99%

Stereotactic radiosurgery for central neurocytomas: an international multicenter retrospective cohort study

Hung

Lee

Yang

et al. 2021

Journal of Neurosurgery

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OBJECTIVECentral neurocytomas (CNs) are uncommon intraventricular tumors, and their rarity renders the risk-to-benefit profile of stereotactic radiosurgery (SRS) unknown. The aim of this multicenter, retrospective cohort study was to evaluate the outcomes of SRS for CNs and identify predictive factors.METHODSThe authors retrospectively analyzed a cohort of patients with CNs treated with SRS at 10 centers between 1994 and 2018. Tumor recurrences were classified as local or distant. Adverse radiation effects (AREs) and the need for a CSF shunt were also evaluated.RESULTSThe study cohort comprised 60 patients (median age 30 years), 92% of whom had undergone prior resection or biopsy and 8% received their diagnosis based on imaging alone. The median tumor volume and margin dose were 5.9 cm3 and 13 Gy, respectively. After a median clinical follow-up of 61 months, post-SRS tumor recurrence occurred in 8 patients (13%). The 5- and 10-year local tumor control rates were 93% and 87%, respectively. The 5- and 10-year progression-free survival rates were 89% and 80%, respectively. AREs were observed in 4 patients (7%), but only 1 was symptomatic (2%). Two patients underwent post-SRS tumor resection (3%). Prior radiotherapy was a predictor of distant tumor recurrence (p = 0.044). Larger tumor volume was associated with pre-SRS shunt surgery (p = 0.022).CONCLUSIONSTreatment of appropriately selected CNs with SRS achieves good tumor control rates with a reasonable complication profile. Distant tumor recurrence and dissemination were observed in a small proportion of patients, which underscores the importance of close post-SRS surveillance of CN patients. Patients with larger CNs are more likely to require shunt surgery before SRS.

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Upfront Gamma Knife Surgery for Giant Central Neurocytoma

Cited by 8 publications

References 30 publications

Gamma Knife radiosurgery as a primary treatment for central neurocytoma

Gamma Knife radiosurgery as a primary treatment for central neurocytoma

Tumor control of third ventricular central neurocytoma after gamma knife radiosurgery in an elderly patient

Stereotactic radiosurgery for central neurocytomas: an international multicenter retrospective cohort study

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