A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis

Flickinger, John C.; Kondziolka, Douglas; Lunsford, L. Dade; Coffey, Robert J.; Goodman, Michael L.; Shaw, Edward G.; Hudgins, W. Robert; Weiner, Richard L.; Harsh, Griffith R.; Sneed, Penny K.; Larson, David A.

doi:10.1016/0360-3016(94)90098-1

Cited by 655 publications

(264 citation statements)

References 16 publications

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“…The results of these studies are very good, especially in patients with a solitary metastasis, where survival times of several years were observed (77,78 …”

Section: Brain Metastasesmentioning

confidence: 98%

Brain Tumors

Blomgren¹

1996

Acta Oncologica

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“…The results of these studies are very good, especially in patients with a solitary metastasis, where survival times of several years were observed (77,78 …”

Section: Brain Metastasesmentioning

confidence: 98%

Brain Tumors

Blomgren¹

1996

Acta Oncologica

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“…1 Radiosurgery has been shown to be very effective for controlling intracranial malignancies. 38,[55][56][57][58][59][60] Stereotactic radiosurgery has been demonstrated to be an effective treatment for brain metastases (including breast metastases), either with or without whole-brain radiation therapy, with an 85-95% control rate. The emerging technique of spinal radiosurgery represents a logical extension of the current state-of-the-art radiation therapy.…”

Section: Figurementioning

confidence: 99%

“…Several clinical studies have described stereotactic radiosurgery (SRS) for the treatment of brain metastases specifically from breast carcinoma as an effective treatment associated with a low complication rate. [37][38][39][40][41][42] Other researchers have previously shown the feasibility and clinical efficacy of spinal hypofractionated stereotactic body radiotherapy for breast metastases. 19,[21][22][23][24][25][26][27]43 Our previous work has demonstrated both the feasibility as well as the clinical efficacy of spinal radiosurgery for a variety of both benign and malignant lesions using an image-guided frameless SRS delivery system known as the CyberKnife Image-Guided Radiosurgery System (Accuray, Sunnyvale, CA).…”

mentioning

confidence: 99%

Single‐fraction radiosurgery for the treatment of spinal breast metastases

Gerszten

Burton

Welch

et al. 2005

Cancer

126

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BACKGROUNDThe spine is the most common site of bony metastases in patients with osseous breast carcinoma metastases. Spine metastases are the source of significant pain and occasionally neurologic deficit in this patient population. Conventional external beam radiotherapy lacks the precision to allow delivery of large single‐fraction doses of radiation and simultaneously limit the dose to radiosensitive structures such as the spinal cord. This study evaluated the clinical efficacy of the treatment of spinal breast carcinoma metastases with a single‐fraction radiosurgical technique.METHODSIn this prospective cohort evaluation, 68 breast carcinoma metastases to the spine in 50 patients were treated with a single‐fraction radiosurgery technique with a follow‐up period of 6–48 months, median 16 months. The most common indication for radiosurgery treatment was pain in 57 lesions, as a primary treatment modality in 8 patients, and for radiographic tumor progression, as a postsurgical boost, and for a progressive neurologic deficit in 1 patient each.RESULTSTumor volume ranged from 0.8–197 cm3 (mean, 27.7 cm3). Maximum tumor dose was maintained at 15–22.5 Gy (mean, 19 Gy). No radiation‐induced toxicity occurred during the follow‐up period (6–48 mo). Long‐term axial and radicular pain improvement occurred in 55 of 57 (96%) patients who were treated primarily for pain. Long‐term radiographic tumor control was seen in all patients who underwent radiosurgery as their primary treatment modality, for radiographic tumor progression, or as a postsurgical treatment.CONCLUSIONSSpinal radiosurgery was found to be feasible, safe, and clinically effective for the treatment of spinal metastases from breast carcinoma. The results indicate the potential of radiosurgery in the treatment of patients with spinal breast metastases, especially those with solitary sites of spine involvement, to improve long‐term palliation. Cancer 2005. © 2005 American Cancer Society.

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“…7,8 Stereotactic radiosurgery is an effective treatment for brain metastases, either with or without whole-brain radiotherapy, with an 85 to 95% control rate. 8,13,24,26 Its role in the primary treatment of benign lesions, including arteriovenous malformations, pituitary adenomas, acoustic neuromas, and meningiomas is well supported by the literature. 6,11,14,22,23,34 The role of radiotherapy in the treatment of spinal tumors has been well documented.…”

mentioning

confidence: 94%

Feasibility of frameless single-fraction stereotactic radiosurgery for spinal lesions

Gerszten

Ozhasoglu

Burton

et al. 2002

FOC

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Object The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited by the availability of effective target-immobilizing devices. In this study the authors evaluated the CyberKnife Real-Time Image-Guided Radiosurgery System for spinal lesion treatment involving a single-fraction radiosurgical technique. Methods This frameless image-guided radiosurgery system uses the coupling of an orthogonal pair of x-ray cameras to a dynamically manipulated robot-mounted linear accelerator possessing six degrees of freedom, which guides the therapy beam to the target without the use of frame-based fixation. Cervical lesions were located and tracked relative to osseous skull landmarks; lower spinal lesions were tracked relative to percutaneously placed gold fiducial bone markers. Fifty-six spinal lesions in 46 consecutive patients were treated using single-fraction radiosurgery (26 cervical, 15 thoracic, and 11 lumbar, and four sacral). There were 11 benign and 45 metastatic lesions. Tumor volume ranged from 0.3 to 168 ml (mean 26.7 ml). Thirty-one lesions had previously received external-beam radiotherapy with maximum spinal cord doses. Dose plans were calculated based on computerized tomography scans acquired using 1.25-mm slices. Tumor dose was maintained at 12 to 18 Gy to the 80% isodose line; spinal cord lesions receiving greater than 8 Gy ranged from 0 to 1.3 ml (mean 0.3 ml). All patients tolerated the procedure in an outpatient setting. No acute radiation-induced toxicity or new neurological deficits occurred during the follow-up period. Axial and radicular pain improved in all patients who were symptomatic prior to treatment. Conclusions Spinal stereotactic radiosurgery involving a frameless image-guided system was found to be feasible and safe. The major potential benefits of radiosurgical ablation of spinal lesions are short treatment time in an outpatient setting with rapid recovery and symptomatic response. This procedure offers a successful alternative therapeutic modality for the treatment of a variety of spinal lesions not amenable to open surgical techniques; the intervention can be performed in medically untreatable patients, lesions located in previously irradiated sites, or as an adjunct to surgery.

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A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis

Cited by 655 publications

References 16 publications

Brain Tumors

Brain Tumors

Single‐fraction radiosurgery for the treatment of spinal breast metastases

Feasibility of frameless single-fraction stereotactic radiosurgery for spinal lesions

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