Cargando…
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...
Autores principales: | , , , , , , , , , , , |
---|---|
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 |
_version_ | 1783531741256876032 |
---|---|
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. |
format | Online Article Text |
id | pubmed-7213152 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT vulpehoria radi14framelessstereotacticradiosurgeryonthegammaknifeiconearlyexperiencefrom42patientswithbrainmetastases AT saveakshay radi14framelessstereotacticradiosurgeryonthegammaknifeiconearlyexperiencefrom42patientswithbrainmetastases AT xuyuanguang radi14framelessstereotacticradiosurgeryonthegammaknifeiconearlyexperiencefrom42patientswithbrainmetastases AT ellistoncarl radi14framelessstereotacticradiosurgeryonthegammaknifeiconearlyexperiencefrom42patientswithbrainmetastases AT garrettmatthew radi14framelessstereotacticradiosurgeryonthegammaknifeiconearlyexperiencefrom42patientswithbrainmetastases AT wuchengchia radi14framelessstereotacticradiosurgeryonthegammaknifeiconearlyexperiencefrom42patientswithbrainmetastases AT chengsimon radi14framelessstereotacticradiosurgeryonthegammaknifeiconearlyexperiencefrom42patientswithbrainmetastases AT janiashish radi14framelessstereotacticradiosurgeryonthegammaknifeiconearlyexperiencefrom42patientswithbrainmetastases AT brucejeffrey radi14framelessstereotacticradiosurgeryonthegammaknifeiconearlyexperiencefrom42patientswithbrainmetastases AT mckhannguy radi14framelessstereotacticradiosurgeryonthegammaknifeiconearlyexperiencefrom42patientswithbrainmetastases AT sistimichael radi14framelessstereotacticradiosurgeryonthegammaknifeiconearlyexperiencefrom42patientswithbrainmetastases AT wangtony radi14framelessstereotacticradiosurgeryonthegammaknifeiconearlyexperiencefrom42patientswithbrainmetastases |