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RADI-14. FRAMELESS STEREOTACTIC RADIOSURGERY ON THE GAMMA KNIFE ICON: EARLY EXPERIENCE FROM 42 PATIENTS WITH BRAIN METASTASES

BACKGROUND: The Gamma Knife (GK) Icon uses a Cone-Beam CT (CBCT) scanner and an infrared camera system to support the delivery of frameless radiosurgery. There are limited data on patients treated with frameless GK radiosurgery (GKRS) for brain metastases. OBJECTIVE: To describe the early experience...

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Autores principales: Vulpe, Horia, Save, Akshay, Xu, Yuanguang, Elliston, Carl, Garrett, Matthew, Wu, Cheng-Chia, Cheng, Simon, Jani, Ashish, Bruce, Jeffrey, McKhann, Guy, Sisti, Michael, Wang, Tony
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213152/
http://dx.doi.org/10.1093/noajnl/vdz014.107
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author Vulpe, Horia
Save, Akshay
Xu, Yuanguang
Elliston, Carl
Garrett, Matthew
Wu, Cheng-Chia
Cheng, Simon
Jani, Ashish
Bruce, Jeffrey
McKhann, Guy
Sisti, Michael
Wang, Tony
author_facet Vulpe, Horia
Save, Akshay
Xu, Yuanguang
Elliston, Carl
Garrett, Matthew
Wu, Cheng-Chia
Cheng, Simon
Jani, Ashish
Bruce, Jeffrey
McKhann, Guy
Sisti, Michael
Wang, Tony
author_sort Vulpe, Horia
collection PubMed
description BACKGROUND: The Gamma Knife (GK) Icon uses a Cone-Beam CT (CBCT) scanner and an infrared camera system to support the delivery of frameless radiosurgery. There are limited data on patients treated with frameless GK radiosurgery (GKRS) for brain metastases. OBJECTIVE: To describe the early experience, process, technical details, and short-term outcomes with frameless GKRS for brain metastases at our institution. METHODS: We describe our patient selection and workflow for frameless GKRS in detail. Because of the short interval of follow-up, we provide crude rates of local control. RESULTS: 42 patients had a total of 96 brain metastases. Median age was 69. 77 intact lesions were treated definitively, 18 cavities postoperatively, and 1 had GKRS for recurrence after resection. 11 patients underwent repeat GKRS to the same area. Median dose was 20Gy in 1 fraction (range: 14–21), 24Gy in 3 fractions (range: 19.5–27), and 25Gy in 5 fractions (Range: 25–30). Median treatment time was 23.7 minutes (Range: 7.3 – 85.5). 29 patients had a follow-up MRI in our records after completing GKRS. Median follow-up time was 105 days (Range: 16 – 314). 16 local recurrences (LR) were identified in 9 patients. An additional 6 patients had distant brain recurrence without LR. Crude mean time between GKRS and LR was 101 days (range 44–161 days). There were 6 patients with grade 1, 3 with grade 2, 2 with grade 3, and 1 with grade 4 toxicity. We found an improvement in workflow and a greater number of patients eligible for GKRS due to the ability to fractionate treatments. CONCLUSION: We report a large cohort of consecutive patients with brain metastases treated with frameless GKRS. We look forward to studies with longer follow-up to provide valuable data on clinical outcomes and to further our understanding of the radiobiology of hypofractionation in the brain.
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spelling pubmed-72131522020-07-07 RADI-14. FRAMELESS STEREOTACTIC RADIOSURGERY ON THE GAMMA KNIFE ICON: EARLY EXPERIENCE FROM 42 PATIENTS WITH BRAIN METASTASES Vulpe, Horia Save, Akshay Xu, Yuanguang Elliston, Carl Garrett, Matthew Wu, Cheng-Chia Cheng, Simon Jani, Ashish Bruce, Jeffrey McKhann, Guy Sisti, Michael Wang, Tony Neurooncol Adv Abstracts BACKGROUND: The Gamma Knife (GK) Icon uses a Cone-Beam CT (CBCT) scanner and an infrared camera system to support the delivery of frameless radiosurgery. There are limited data on patients treated with frameless GK radiosurgery (GKRS) for brain metastases. OBJECTIVE: To describe the early experience, process, technical details, and short-term outcomes with frameless GKRS for brain metastases at our institution. METHODS: We describe our patient selection and workflow for frameless GKRS in detail. Because of the short interval of follow-up, we provide crude rates of local control. RESULTS: 42 patients had a total of 96 brain metastases. Median age was 69. 77 intact lesions were treated definitively, 18 cavities postoperatively, and 1 had GKRS for recurrence after resection. 11 patients underwent repeat GKRS to the same area. Median dose was 20Gy in 1 fraction (range: 14–21), 24Gy in 3 fractions (range: 19.5–27), and 25Gy in 5 fractions (Range: 25–30). Median treatment time was 23.7 minutes (Range: 7.3 – 85.5). 29 patients had a follow-up MRI in our records after completing GKRS. Median follow-up time was 105 days (Range: 16 – 314). 16 local recurrences (LR) were identified in 9 patients. An additional 6 patients had distant brain recurrence without LR. Crude mean time between GKRS and LR was 101 days (range 44–161 days). There were 6 patients with grade 1, 3 with grade 2, 2 with grade 3, and 1 with grade 4 toxicity. We found an improvement in workflow and a greater number of patients eligible for GKRS due to the ability to fractionate treatments. CONCLUSION: We report a large cohort of consecutive patients with brain metastases treated with frameless GKRS. We look forward to studies with longer follow-up to provide valuable data on clinical outcomes and to further our understanding of the radiobiology of hypofractionation in the brain. Oxford University Press 2019-08-12 /pmc/articles/PMC7213152/ http://dx.doi.org/10.1093/noajnl/vdz014.107 Text en © The Author(s) 2019. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Vulpe, Horia
Save, Akshay
Xu, Yuanguang
Elliston, Carl
Garrett, Matthew
Wu, Cheng-Chia
Cheng, Simon
Jani, Ashish
Bruce, Jeffrey
McKhann, Guy
Sisti, Michael
Wang, Tony
RADI-14. FRAMELESS STEREOTACTIC RADIOSURGERY ON THE GAMMA KNIFE ICON: EARLY EXPERIENCE FROM 42 PATIENTS WITH BRAIN METASTASES
title RADI-14. FRAMELESS STEREOTACTIC RADIOSURGERY ON THE GAMMA KNIFE ICON: EARLY EXPERIENCE FROM 42 PATIENTS WITH BRAIN METASTASES
title_full RADI-14. FRAMELESS STEREOTACTIC RADIOSURGERY ON THE GAMMA KNIFE ICON: EARLY EXPERIENCE FROM 42 PATIENTS WITH BRAIN METASTASES
title_fullStr RADI-14. FRAMELESS STEREOTACTIC RADIOSURGERY ON THE GAMMA KNIFE ICON: EARLY EXPERIENCE FROM 42 PATIENTS WITH BRAIN METASTASES
title_full_unstemmed RADI-14. FRAMELESS STEREOTACTIC RADIOSURGERY ON THE GAMMA KNIFE ICON: EARLY EXPERIENCE FROM 42 PATIENTS WITH BRAIN METASTASES
title_short RADI-14. FRAMELESS STEREOTACTIC RADIOSURGERY ON THE GAMMA KNIFE ICON: EARLY EXPERIENCE FROM 42 PATIENTS WITH BRAIN METASTASES
title_sort radi-14. frameless stereotactic radiosurgery on the gamma knife icon: early experience from 42 patients with brain metastases
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213152/
http://dx.doi.org/10.1093/noajnl/vdz014.107
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