-
CNS Oncology Apr 2017Stereotactic radiosurgery (SRS) has become an increasingly popular treatment modality for spinal tumors due to its noninvasive and targeted approach. Whether SRS has the... (Review)
Review
Stereotactic radiosurgery (SRS) has become an increasingly popular treatment modality for spinal tumors due to its noninvasive and targeted approach. Whether SRS has the promise of relieving pretreatment symptoms and providing local tumor control for patients with intradural spine tumors is still debated. This review explores the current literature on SRS treatment for both metastatic and benign intradural tumors, with a focus on differential use for intramedullary and intradural extramedullary neoplasms. Although mortality rates from underlying malignant disease remain high, SRS may benefit patients with spinal metastatic lesions. Benign tumors have shown a promising response to SRS therapy with low rates of complications. Larger studies are necessary to determine the indications and outcome profile of SRS for intradural spinal neoplasms.
Topics: Humans; Radiosurgery; Spinal Cord Neoplasms; Spinal Neoplasms
PubMed: 28425771
DOI: 10.2217/cns-2016-0039 -
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 -
CNS Oncology May 2014Despite therapeutic advances in management, the prognosis of patients with brain metastasis remains dismal. Treatment options include surgical resection, whole brain... (Review)
Review
Despite therapeutic advances in management, the prognosis of patients with brain metastasis remains dismal. Treatment options include surgical resection, whole brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS). Patients who undergo surgical resection typically receive WBRT as adjuvant therapy. However, several studies have demonstrated an association between WBRT and neurotoxicity. Thus, clinicians are increasingly delaying WBRT in favor of postoperative use of SRS. In this review, we will discuss the current literature exploring the efficacy and toxicity of postoperative SRS in the treatment of patients with resected brain metastasis.
Topics: Brain; Brain Neoplasms; Combined Modality Therapy; Humans; Postoperative Period; Radiosurgery; Randomized Controlled Trials as Topic; Time Factors
PubMed: 25055128
DOI: 10.2217/cns.14.18 -
In Vivo (Athens, Greece) 2023The aim of this narrative review of the literature was to collect and analyze the results of the published preclinical studies on stereotactic arrhythmia radioablation... (Review)
Review
The aim of this narrative review of the literature was to collect and analyze the results of the published preclinical studies on stereotactic arrhythmia radioablation (STAR) in the treatment of refractory cardiac arrhythmias. A literature search was conducted on PubMed using the following terms: ("stereotactic" OR "SBRT" OR "SABR" OR "radioablation" OR "radiosurgery") AND ("arrhythmia" OR "tachycardia"). Preclinical and pathological reports published in English without time limit, comprising studies of STAR in animal models and histological analyzes of explanted animal and human hearts were included. The analyzed studies confirm that doses lower than 25 Gy seem to produce sub-optimal therapeutic results whereas doses >35 Gy are less safe in terms of radiation-induced toxicity. However, long-term results (>1 year) are still missing and reporting outcomes based on low dose irradiation (≤15 Gy). Finally, STAR proved to be an effective therapy in the analyzed studies despite the irradiation of rather different cardiac targets. Therefore, additional studies are needed to: 1) compare the outcomes of STAR at doses of 25 Gy versus 30 Gy; 2) evaluate the long-term results (>1 year) in animal models irradiated at doses similar to those used in the clinic; 3) define the optimal target.
Topics: Animals; Humans; Arrhythmias, Cardiac; Radiosurgery; Heart; Models, Animal; Time Factors
PubMed: 37103087
DOI: 10.21873/invivo.13170 -
Stereotactic and Functional Neurosurgery 2012
Topics: Humans; Neurosurgery; Radiosurgery; Therapies, Investigational
PubMed: 22189871
DOI: 10.1159/000334675 -
CMAJ : Canadian Medical Association... Mar 1998Radiosurgery can be defined as 3-dimensional stereotactic irradiation of small intracranial targets by various radiation techniques. The goal is to deliver, with great... (Comparative Study)
Comparative Study Review
Radiosurgery can be defined as 3-dimensional stereotactic irradiation of small intracranial targets by various radiation techniques. The goal is to deliver, with great accuracy, a large, single fraction dose to a small intracranial target, while minimizing the absorbed dose in the surrounding tissue. This article describes certain technical aspects of radiosurgery and compares the different methods of performing such treatment. The 2 most frequently used types of devices for radiosurgery are units with multiple cobalt sources (e.g., the Gamma Knife) and those based on a linear accelerator. In the former, highly collimated beams of radiation from the cobalt sources intersect at the target. In the latter, the source of a highly collimated beam of high-energy photons directed at the target turns through an arc or set of arcs. The accuracy of target localization, the steepness of fall-off of the radiation dose outside the target and the ability to irradiate an irregularly shaped target are all comparable for these 2 types of devices, despite claims to the contrary.
Topics: Humans; Radiosurgery; Treatment Outcome
PubMed: 9526480
DOI: No ID Found -
Neurology India 2020Cushing's disease is caused by a pituitary tumor causing increased production of adrenocorticotropic hormone, which leads to chronic hypersecretion of cortisol through... (Review)
Review
Cushing's disease is caused by a pituitary tumor causing increased production of adrenocorticotropic hormone, which leads to chronic hypersecretion of cortisol through adrenal cortices. Endoscopic trans-sphenoidal adenomectomy is the first choice of treatment with greatest efficiency for the treatment of the disease. However, in the absence of remission or recurrence of hypercortisolism after neurosurgical resection (adenomectomy), as well as in cases when surgical intervention cannot be carried due to medical contraindications to surgical intervention, radiation treatment is used as an alternative or adjoining therapy. In this literature review the efficiency of different radiation techniques (the conventional and the modern techniques), as well as possible complications of modern methods of radiosurgery and radiotherapy have been looked for.
Topics: Humans; Pituitary ACTH Hypersecretion; Proton Therapy; Radiosurgery; Treatment Outcome
PubMed: 32611903
DOI: 10.4103/0028-3886.287663 -
Annals of Palliative Medicine Apr 2016Stereotactic radiosurgery (SRS) and its extracranial first cousin, stereotactic body radiation therapy (SBRT) have become increasingly important in the palliative... (Review)
Review
Stereotactic radiosurgery (SRS) and its extracranial first cousin, stereotactic body radiation therapy (SBRT) have become increasingly important in the palliative treatment of cancer patients over the past decade. Appropriately designed and adequately powered clinical trials have in many clinical scenarios amply justified the time, effort, and expense associated with the development and delivery of these highly conformal and complex radiation treatment plans. Ongoing trials are anticipated to provide further confirmatory documentation of the benefits that have been readily observed by caregivers, patients, and their families. It may be predicted that future directions for palliative radiosurgery will include simplification, through greater automation, of the detailed steps that are still required for safe treatment, and thereby increase the chances for patients to receive these advanced palliative interventions at local institutions, from local caregivers.
Topics: Humans; Neoplasms; Palliative Care; Radiation Oncology; Radiosurgery
PubMed: 27121742
DOI: 10.21037/apm.2016.03.05 -
International Journal of Radiation... Mar 2010We have reviewed the published data regarding radiotherapy (RT)-induced brain injury. Radiation necrosis appears a median of 1-2 years after RT; however, cognitive... (Meta-Analysis)
Meta-Analysis Review
We have reviewed the published data regarding radiotherapy (RT)-induced brain injury. Radiation necrosis appears a median of 1-2 years after RT; however, cognitive decline develops over many years. The incidence and severity is dose and volume dependent and can also be increased by chemotherapy, age, diabetes, and spatial factors. For fractionated RT with a fraction size of <2.5 Gy, an incidence of radiation necrosis of 5% and 10% is predicted to occur at a biologically effective dose of 120 Gy (range, 100-140) and 150 Gy (range, 140-170), respectively. For twice-daily fractionation, a steep increase in toxicity appears to occur when the biologically effective dose is >80 Gy. For large fraction sizes (>or=2.5 Gy), the incidence and severity of toxicity is unpredictable. For single fraction radiosurgery, a clear correlation has been demonstrated between the target size and the risk of adverse events. Substantial variation among different centers' reported outcomes have prevented us from making toxicity-risk predictions. Cognitive dysfunction in children is largely seen for whole brain doses of >or=18 Gy. No substantial evidence has shown that RT induces irreversible cognitive decline in adults within 4 years of RT.
Topics: Adult; Age Factors; Brain; Cognition Disorders; Cranial Irradiation; Dose-Response Relationship, Radiation; Humans; Models, Biological; Models, Theoretical; Necrosis; Radiation Tolerance; Radiosurgery
PubMed: 20171513
DOI: 10.1016/j.ijrobp.2009.02.091 -
Journal of Cancer Research and Clinical... Jan 2023Meningioma is a common type of benign tumor that can be managed in several ways, ranging from close observation, surgical resection, and various types of radiation. We... (Review)
Review
PURPOSE
Meningioma is a common type of benign tumor that can be managed in several ways, ranging from close observation, surgical resection, and various types of radiation. We present here results from a 10 year experience treating meningiomas with a hypofractionated approach.
MATERIALS AND METHODS
To define the rate of tumor control and factors associated with the relief of symptoms and radiation-related complications after radiosurgery and hypofractionated radiosurgery for patients with imaging-defined intracranial meningiomas. We reviewed the charts of 48 patients treated with stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (SRT) from 2002 to 2018. A total of 37 (82%) patients had WHO Grade 1 disease, and 11 (22%) had Grade 2. Outcomes that were analyzed included local control rates and the rate and grade of any reported toxicity.
RESULTS
Only 36 patients with 38 lesions, who underwent the follow-up regime, were enrolled in the retrospective analysis. The follow-up mean was 40 months (12-120 months). 25/34 patients had surgery before the radiotherapy. Sixteen underwent SRS with a median dose of 13, 5, and 20 received hypofractionated SBRT with a median dose of 26.9 (22-45 Gy) in median six fractions (5-13 fractions). Local control at 2 and 5 years for all patients was 90 and 70%, respectively. No patient suffered from toxicity > 2 CTC. 21/36 patients showed stable disease, while 8/36 patients showed partial Remission. 7/36 developed recurrent meningioma (five in-field), only one patient with grade 1 meningioma, in a median of 22 months (13-48 months).
CONCLUSION
SFRT was superior to SRS for local control in our analysis of Grade I meningiomas. This might be due to a tendency for higher EQD2 in the PTV with SFRT compared to SRS, which was reduced to avoid brain necrosis in large PTVs. Therefore, SFRT appears preferable for typical meningioma PTVs.
Topics: Humans; Meningioma; Radiosurgery; Meningeal Neoplasms; Retrospective Studies; Radiation Dose Hypofractionation; Follow-Up Studies; Neoplasm Recurrence, Local; Particle Accelerators; Treatment Outcome
PubMed: 36307558
DOI: 10.1007/s00432-022-04450-y