Gamma knife surgery for pineal region tumors: an alternative strategy for negative pathology

Abstract

ARTICLE Gamma knife surgery for pineal region tumors: an alternative strategy for negative pathologyCirurgia com gamma knife como tratamento experimental para tumores da região da pineal: uma estratégia alternativa quando os dados anatomopatológicos são negativos AbstrActObjective: Pineal region tumors (PRTs) are uncommon, and treatments vary among neoplasm types. The authors report their experience with gamma knife surgery (GKS) as an initial treatment in a series of PRT patients with unclear pathological diagnoses. Method: Seventeen PRT patients with negative pathology who underwent GKS were retrospectively studied. Nine patients had further whole-brain and spinal cord radiotherapy and chemotherapy 6-9 months after GKS. Results: Sixteen of 17 cases were followed up over a mean of 33.3 months. The total response rate was 75%, and the control rate was 81.3%. No obvious neurological deficits or complications were attributable to GKS. Conclusion: The findings indicate that GKS may be an alternative strategy in selected PRT patients who have negative pathological diagnoses, and that good outcomes and quality of life can be obtained with few complications.Keywords: gamma knife surgery, pineal region tumors, radiosurgery.resumo Tumores da região da pineal (TRP) são pouco frequentes e as propostas de tratamento são bastante variadas. Os autores relatam sua experiência em cirurgias com uso gamma knife (CGK) como tratamento experimental inicial em séries de TRP que não têm diagnóstico anatomopatológico ou nos quais o diagnóstico não ficou claro. Foram estudados retrospectivamente 17 pacientes com TRP nestas condições e que foram submetidos a CGK. Destes, 9 pacientes foram submetidos posteriormente a radioterapia de todo o encéfalo e medula espinhal entre 6 e 9 meses depois da CGK. Dezesseis dos 17 pacientes foram acompanhados por um período médio de 33,3 meses. A taxa total de resposta nos pacientes foi de 75% e a taxa dos controles, 81,3%. Não houve nenhum déficit neurológico evidente que pudesse ser atribuído à CGK. A CGK como tratamento experimental pode ser uma estratégia alternativa no grupo específico de pacientes com TRP em que não há diagnós-tico anatomopatológico, podendo ser obtida uma boa qualidade de vida com poucas complicações para esse grupo de pacientes.Palavras-chave: cirurgia com gamma knife, tumors da região da pineal, radiocirurgia.Pineal region tumors (PRTs) account for 1-3% of all primary brain tumors

Stereotactic radiosurgery for tumors of the pineal region: A single-center experience

“…No significant complications were observed in our study after GKRS, similar to the literature findings. [3,6,7,15] Other radiosurgery treatment methods, including CyberKnife radiosurgery, are also available for TPRs. Ahn et al [16] published a series of 6 cases of pineal parenchymal tumors, and except for 1 patient, all achieved complete or partial remission.…”

“…[10,11,12] GKRS is a single high-dose radiotherapy that targets the lesion using stereotactic techniques and protects the surrounding tissues as much as possible; it is an effective therapeutic modality for deep cerebral tumors. [6,7] GKRS can be performed for TPR tumors with or without a histopathological diagnosis. [13] In Gamma Knife treatment planning, similar doses of radiation are given to different histopathological types of pineal region tumors, which causes a debate about whether the histopathological diagnosis is necessary when making the final treatment decision; unfortunately, it cannot be provided in some cases.…”

“…[4,5] More biopsy material is also needed for pathologists. [6] When there is no histopathological confirmation of TPR, radiosurgery is an alternative treatment, [7] but decisions to treat pineal tumors with only radiotherapy may also be made.…”

Primary Gamma Knife Radiosurgery for pineal region tumors: A systematic review and pooled analysis of available literature with histological stratification

“…After scanning, 69 studies were retained for further analysis, and a total of 14 papers were considered eligible for inclusion. [13][14][15][16][17][18][19][20][21][22][23]27,28 Aiming at performing a histological stratification of the outcomes and to calculate predictive variables of response, the papers published by Li 28 and Yang, 29 although meeting the original inclusion criteria, needed to be excluded from data analysis because presented only aggregated outcomes from primary GKSR treatments. Data arising from the excluded articles are discussed along with the outcomes of this present analysis in the Discussion section.…”

“…Nevertheless, given the rarity of the disease, literature reports on the topic are limited to small series and sporadic case reports, thus making it difficult or even impossible to draw any conclusive observations. [13][14][15][16][17][18][19][20][21][22][23] The lack of formal evidence on the efficacy/safety profile of GKRS as primary treatment in this specific field makes it fundamental to analyse results from the clinical experiences reported to date in the literature.…”