Evaluation of Linear Accelerator (Linac)-Based Stereotactic Radiosurgery (Srs) for The Treatment of Craniopharyngiomas

Abstract

Although benign histologically, craniopharyngiomas may display clinically malignant behavior with a strong propensity for recurrence. Contemporary therapeutic approaches for craniopharyngiomas include stereotactic irradiation in the form of Stereotactic Radiosurgery (SRS) or Fractionated Stereotactic Radiation Therapy (FSRT) as part of multimodality treatment particularly when complete surgical removal is not feasible. In this study, we evaluate the use of Linear Accelerator (LINAC)-based SRS in the multidisciplinary management of patients with craniopharyngiomas. Between July 1998 and July 2013, 20 patients (11 male, 9 female) with residual or recurrent craniopharyngiomas were treated using LINAC-based SRS at Department of Radiation Oncology, Gulhane Military Medical Academy. Median age was 37 (9-69) years. Median tumor volume was 1.1 (0.9-6.9) cc. Median dose was 13 Gy (range: 10-16 Gy) prescribed to the 80%-95% isodose line encompassing the target volume. Median follow-up time was 47 (7-93) months. Overall local control rate was 88% at 1 year, 79% at 3 years and 66% at 5 years. Three and 5-year progression free survival rates were 95% and 91% whereras 3 and 5-year overall survival rates were 94% and 88%, respectively. Our study supports the usage of LINAC-based SRS as a safe and effective management strategy for patients with recurrent or residual craniopharyngiomas. ÖZET Kraniofarinjiyom Tedavisinde Lineer Akseleratör Tabanlı Stereotaktik Radyocerrahinin DeğerlendirilmesiKraniofarinjiyomlar histolojik olarak benign olsalar da rekürrens için güçlü bir eğilimle klinik olarak malign davranış sergileyebilirler. Güncel terapötik yaklaşımlar özellikle tam cerrahi rezeksiyonun uygun olmadığı durumlarda multimodal tedavinin bir parçası olarak stereotaktik radyocerrahi ya da fraksiyone stereotaktik radyoterapi şeklinde stereotaktik ışın tedavisini içermektedir. Bu çalışmada kraniofarinjiyomların multidisipliner manajmanında lineer akseleratör tabanlı stereotaktik radyocerrahinin kullanımı değerlendirilmektedir. Temmuz 1998 ile Temmuz 2013 arasında rezidüel ya da rekürren kraniofarinjiyomlu 20 hasta (11 erkek, 9 kadın) Gülhane Askeri Tıp Akademisi Radyasyon Onkolojisi Departmanında lineer akseleratör tabanlı stereotaktik radyocerrahi kullanılarak tedavi edilmiştir. Medyan yaş 37 (9-69) idi. Medyan tümör volümü 1.1 (0.9-6.9) cc idi. Hedef volümü saran %80-%95 izodoz çizgisine preskribe edilen medyan doz 13 Gy (ranj: 10-16 Gy) idi. Medyan takip süresi 47 (7-93) ay idi. Lokal kontrol oranı 1. yılda %88, 3. yılda %79, 5. yılda %66 idi. 3 ve 5 yıllık progresyonsuz sağkalım oranları sırasıyla %95 ve %91 iken 3 ve 5 yıllık toplam sağkalım oranları sırasıyla %94 ve %88 idi. Çalışmamız rekürren veya rezidüel kraniofarinjiyomlu hastalar için lineer akseleratör tabanlı stereotaktik radyocerrahinin güvenli ve etkin bir manajman stratejisi olarak kullanımını desteklemektedir.

Evaluation of Radiosurgery Target Volume Determination for Meningiomas Based on Computed Tomography (CT) And Magnetic Resonance Imaging (MRI)

“…Stereotactic Body Radiation Therapy (SBRT) has emerged as a viable radiotherapeutic modality for management several benign and malign tumors throughout the human body including meningiomas, brain metastases, arteriovenous malformations, pituitary adenomas, vestibular schwannomas, cerebral cavernous malformations, craniopharyngiomas, glomus jugulare tumors, pulmonary oligometastases, and recurrent glioblastomas [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Multimodality Imaging for Radiosurgical Management of Arteriovenous Malformations

“…In this context, microvascular surgical resection, endovascular embolization and radiosurgical treatment may be used for management of AVMs. Stereotactic Radiosurgery (SRS) has been utilized for management of several benign and malign indications with considerable success [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. In the context of AVMs, surgery offers effective management of AVMs in selected patients, however, radiosurgery may be considered when there may be an excessive risk of surgical complications for deep-seated lesions located at eloquent brain regions.…”

A Concise Review of Irradiation for Temporal Bone Chemodectomas (TBC)

“…Herein, we provide a concise review of RT for temporal bone chemodectomas. and HFSRT has proved to be safe and effective for management of several intracranial and extracranial disorders [1,2,[84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102].…”