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Missouri Medicine 2024The landscape of the cranial neurosurgery has changed tremendously in past couple of decades. The main frontiers including introduction of neuro-endoscopy, minimally... (Review)
Review
The landscape of the cranial neurosurgery has changed tremendously in past couple of decades. The main frontiers including introduction of neuro-endoscopy, minimally invasive skull base approaches, SRS, laser interstitial thermal therapy and use of tubular retractors have revolutionized the management of intracerebral hemorrhages, deep seated tumors other intracranial pathologies. Introduction of these novel techniques is based on smaller incisions with maximal operative corridors, decreased blood loss, shorter hospital stays, decreased post-operative pain and cosmetically appealing scars that improves patient satisfaction and clinical outcomes. The sophisticated tools like neuroendoscopy have improved light source, and better visualization around the corners. Advanced navigated tools and channel-based retractors help us to target deeply seated lesions with increased precision and minimal disruption of the surrounding neurovascular tissues. Advent of stereotactic radiosurgery has provided us alternative feasible, safe and effective options for treatment of patients who are otherwise not medically stable to undergo complex cranial surgical interventions. This paper review advances in treatment of intracranial pathologies, and how the neurosurgeons and other medical providers at the University of Missouri-Columbia (UMC) are optimizing these treatments for their patients.
Topics: Humans; Neurosurgical Procedures; Radiosurgery; Cerebral Hemorrhage; Brain Neoplasms; Neuroendoscopy
PubMed: 38694609
DOI: No ID Found -
Magyar Onkologia Mar 2024Stereotactic radiosurgery is today a well-established treatment modality for various intracranial pathologies. The principle of high dose focused intracranial radiation... (Review)
Review
Stereotactic radiosurgery is today a well-established treatment modality for various intracranial pathologies. The principle of high dose focused intracranial radiation guided by stereotactic technique ("Gamma Knife") was introduced by the Swedish neurosurgeon Prof. Lars Leksell in 1968. After the advent of CT and later MR imaging, stereotactic radiosurgery evolved rapidly regarding indications, and new technical solutions made it possible for linear accelerator systems to perform radiosurgery. A huge number of patients are treated yearly worldwide with this technology. In this article we overview the major indications, advantages and possible complications of stereotactic radiosurgery.
Topics: Humans; Brain Neoplasms; Radiosurgery
PubMed: 38484375
DOI: No ID Found -
Cancer Journal (Sudbury, Mass.)Stereotactic body radiation therapy has emerged as a safe and effective treatment modality for properly selected hepatocellular cancer (HCC) patients with normal liver... (Review)
Review
Stereotactic body radiation therapy has emerged as a safe and effective treatment modality for properly selected hepatocellular cancer (HCC) patients with normal liver function. However, many HCC patients have reduced baseline liver function due to underlying cirrhosis or prior liver-directed therapies. Therefore, because of the increased risk of hepatotoxicity, the use of stereotactic body radiation therapy for patients with reduced liver function has been approached with caution. Individualized, response-based radiotherapy incorporates models, imaging tools, and biomarkers that determine the dose-response relationship of the liver before, during, and after treatment and has been useful in reducing the likelihood of liver damage without sacrificing tumor control. This review discusses the evolution of response-based radiotherapy for HCC and highlights areas for further investigation.
Topics: Humans; Liver Neoplasms; Carcinoma, Hepatocellular; Treatment Outcome; Radiotherapy Dosage; Radiosurgery
PubMed: 37796644
DOI: 10.1097/PPO.0000000000000679 -
The Journal of Thoracic and... Jun 2016
Topics: Radiosurgery
PubMed: 27207128
DOI: 10.1016/j.jtcvs.2015.12.069 -
Radiation Oncology (London, England) Sep 2022Linac stereotactic radiosurgery (SRS) is gaining popularity as a form of radiation treatment for cerebral arteriovenous malformations (AVMs) since the theory of combined...
PURPOSE
Linac stereotactic radiosurgery (SRS) is gaining popularity as a form of radiation treatment for cerebral arteriovenous malformations (AVMs) since the theory of combined radiosurgical and endovascular treatment poses much uncertainty and due to significant technical progress for SRS. This study focuses on how to evaluate obliteration and re-bleeding rates, and to determine factors and adverse effects influencing obliteration after linac-based SRS for cerebral AVMs.
MATERIAL AND METHODS
From a statistical record of 71 patients, 31 had partial embolisation, five surgery and 29 had no prior treatment. Using Kaplan-Meier survival and life table analyses, actuarial obliteration and annual bleeding hazard rates were calculated after SRS.
RESULTS
After a follow up of 1, 2 and 3 years the actual obliteration rates were 22, 59 and 66%, respectively whereby it was noted that prior embolization had no effect on the obliteration rate. Annual bleeding hazard rates were further analyzed after stereotactic radiosurgery to be 2.1% and 1.4% for the first and second year respectively. Asymptomatic abnormalities were detected after imaging in 33.9% of patients. A dose of less than 18 Gy significantly reduced the obliteration probability.
CONCLUSION
SRS is a therapeutic option for intracerebral AVM. In general, there is a low rate of morbidity and a high probability of nidus obliteration.
Topics: Brain; Follow-Up Studies; Humans; Intracranial Arteriovenous Malformations; Radiosurgery; Retrospective Studies; Treatment Outcome
PubMed: 36175931
DOI: 10.1186/s13014-022-02130-2 -
Seminars in Radiation Oncology Apr 2023Progress in biological cancer characterization, targeted systemic therapies and multimodality treatment strategies have shifted the goals of radiotherapy for spinal... (Review)
Review
Progress in biological cancer characterization, targeted systemic therapies and multimodality treatment strategies have shifted the goals of radiotherapy for spinal metastases from short-term palliation to long-term symptom control and prevention of compilations. This article gives an overview of the spine stereotactic body radiotherapy (SBRT) methodology and clinical results of SBRT in cancer patients with painful vertebral metastases, metastatic spinal cord compression, oligometastatic disease and in a reirradiation situation. Outcomes after dose-intensified SBRT are compared with results of conventional radiotherapy and patient selection criteria will be discussed. Though rates of severe toxicity after spinal SBRT are low, strategies to minimize the risk of vertebral compression fracture, radiation induced myelopathy, plexopathy and myositis are summarized, to optimize the use of SBRT in multidisciplinary management of vertebral metastases.
Topics: Humans; Radiosurgery; Fractures, Compression; Spinal Fractures; Spinal Neoplasms; Re-Irradiation
PubMed: 36990633
DOI: 10.1016/j.semradonc.2022.11.006 -
Chinese Clinical Oncology Sep 2017Stereotactic body radiation therapy (SBRT) stems from the initial developments of intra-cranial stereotactic radiosurgery (SRS). Despite similarity in their names and... (Review)
Review
Stereotactic body radiation therapy (SBRT) stems from the initial developments of intra-cranial stereotactic radiosurgery (SRS). Despite similarity in their names and clinical goals of delivering a sufficiently high tumoricidal dose, maximal sparing of the surrounding normal tissues and a short treatment course, SBRT technologies have transformed from the early days of body frame-based treatments with X-ray verification to primarily image-guided procedures with cone-beam CT or stereoscopic X-ray systems and non-rigid body immo-bilization. As a result of the incorporation of image-guidance systems and multi-leaf col-limators into mainstream linac systems, and treatment planning systems that have also evolved to allow for routine dose calculations to permit intensity modulated radiotherapy and volumetric modulated arc therapy (VMAT), SBRT has disseminated rapidly in the community to manage many disease sites that include oligometastases, spine lesions, lung, prostate, liver, renal cell, pelvic tumors, and head and neck tumors etc. In this article, we review the physical principles and paradigms that led to the widespread adoption of SBRT practice as well as technical caveats specific to individual SBRT technologies. From the perspective of treatment delivery, we categorically described (I) C-arm linac-based SBRT technologies; (II) robotically manipulated X-band CyberKnife® technology; and (III) emerging specialized systems for SBRT that include integrated MRI-linear accelerators and the imaged-guided Gamma Knife Perfexion Icon system with expanded multi-isocenter treatments of skull-based tumors, head-and-neck and cervical-spine lesions.
Topics: Cone-Beam Computed Tomography; Humans; Male; Neoplasms; Radiosurgery; Radiotherapy; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Conformal; Radiotherapy, Image-Guided; Radiotherapy, Intensity-Modulated
PubMed: 28917250
DOI: 10.21037/cco.2017.06.19 -
Revue Medicale de Liege May 2024Liver lesions are common in oncology, and various focal treatments can be used, such as surgery, chemoembolization, radiofrequency, and systemic treatment. However,... (Review)
Review
Liver lesions are common in oncology, and various focal treatments can be used, such as surgery, chemoembolization, radiofrequency, and systemic treatment. However, these treatments are often not feasible for a number of reasons, including the patient's general health or the characteristics of the lesion itself. Additionally, localized relapses may occur after focal treatments. In the past, liver radiotherapy was limited by the toxicities it caused and was mainly used in palliative situations or specific pre-transplant management. However, advancements in high-precision radiotherapy, like hypofractionated radiotherapy in stereotactic conditions, have allowed to treat the lesions with minimal margins, delivering higher doses while reducing the healthy liver's exposure. Increasingly, retrospective and prospective studies have demonstrated the effectiveness and safety of hypofractionation for both primary and secondary liver lesions. This review discusses the indications, results, and techniques of this type of treatment.
Topics: Humans; Liver Neoplasms; Radiosurgery
PubMed: 38778645
DOI: No ID Found -
Technology in Cancer Research &... Feb 2015Proton therapy through the use of the Bragg peak affords clinicians a tool with which highly conformal dose can be delivered to the target while minimizing integral dose... (Review)
Review
Proton therapy through the use of the Bragg peak affords clinicians a tool with which highly conformal dose can be delivered to the target while minimizing integral dose to surrounding healthy tissue. To gain maximum benefit from proton therapy adequate patient immobilization must be maintained to ensure accurate dose delivery. While immobilization in external beam radiation therapy is designed to minimize inter- and intra-fraction target motion, in proton therapy there are other additional aspects which must be considered, chief of which is accurately determining and maintaining the targets water-equivalent depth along the beam axis. Over the past 23 years of treating with protons, the team at the James M. Slater Proton Treatment and Research Center at Loma Linda University Medical Center have developed and implemented extensive immobilization systems to address the specific needs of protons. In this publication we review the immobilization systems that are used at Loma Linda in the treatment of head and neck, prostate, upper GI, lung and breast disease, along with a description of the intracranial radiosurgery immobilization system used in the treatment of brain metastasis and arteriovenous malformations (AVM's).
Topics: Humans; Neoplasms; Proton Therapy; Radiosurgery
PubMed: 24354755
DOI: 10.7785/tcrt.2012.500398 -
Neurotherapeutics : the Journal of the... Jul 2014
Topics: Deep Brain Stimulation; Electrodes, Implanted; Humans; Nervous System Diseases; Radiosurgery; Ultrasonography, Interventional
PubMed: 25012391
DOI: 10.1007/s13311-014-0290-1