Gamma knife for glioma: Selection factors and survival

Larson, David A.; Gutin, Philip H.; McDermott, Michael W.; Lamborn, Kathleen R.; Sneed, Penny K.; Wara, William M.; Flickinger, John C.; Kondziolka, Douglas; Lunsford, L. Dade; Hudgins, W. Robert; Friehs, Gerhard; Haselsberger, K.; Leber, K.; Pendl, G.; Chung, Sang Sup; Coffey, Robert J.; Dinapoli, Robert P.; Shaw, Edward G.; Vermeulen, Sandra; Young, Ronald F.; Hirato, Masafumi; Inoué, Hiroshi; Ohye, Chihiro; Shibazaki, Toshio

doi:10.1016/s0360-3016(96)00427-0

Cited by 119 publications

(42 citation statements)

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“…) of R3616 or buffer with a Hamilton syringe; (3) mice subjected to ionizing radiation and either not injected or injected with buffer solution; and (4) control mice or mice administered R3616 and subjected to irradiation for 20 Gy at 1 day after infection or mock infection and with 25 Gy at 2 days after infection or mock infection. Although large for conventional clinical radiation fractionation protocols, fraction sizes of 20-25 Gy are employed in stereotactic radiosurgery [17][18][19] and preliminary experiments suggest that smaller radiation doses will also be effective. The tumor mass was measured biweekly for 60 days or at least until the tumor mass reached 2000 mm 3 .…”

Section: Resultsmentioning

confidence: 99%

“…Although large for conventional clinical radiation fractionation protocols, fraction sizes of 20-25 Gy are employed in stereotactic radiosurgery. [17][18][19] The tumor mass was measured biweekly for 60 days or at least until the tumor mass reached 2000 mm 3 . Tumor volumes were calculated using the formula (length × width × height)/2 which is derived from the formula for an ellipsoid ( d 3 )/6.…”

Section: Cells and Virusesmentioning

confidence: 99%

See 1 more Smart Citation

Enhancement of replication of genetically engineered herpes simplex viruses by ionizing radiation: a new paradigm for destruction of therapeutically intractable tumors

et al. 1998

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Section: Resultsmentioning

confidence: 99%

Section: Cells and Virusesmentioning

confidence: 99%

Enhancement of replication of genetically engineered herpes simplex viruses by ionizing radiation: a new paradigm for destruction of therapeutically intractable tumors

et al. 1998

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“…SRS is useful in controlling relatively well-demarcated glioma such as ependymoma, pilocytic astrocytoma, and pleomorphic xanthoastrocytoma. [8][9][10][11][12][13] However, the majority of glioma is infiltrative to brain parenchyma and is difficult to target with SRS. A randomized controlled study proved that there was no benefit in upfront SRS before conventional fractionated radiation therapy for patients with glioblastoma.…”

Section: Introductionmentioning

confidence: 99%

Extended field stereotactic radiosurgery for recurrent glioblastoma

Koga

Maruyama

Tanaka

et al. 2011

Cancer

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BACKGROUND: Stereotactic radiosurgery (SRS) is among the few therapeutic options for glioblastoma that recurs after standard radiation and chemotherapy, but its efficacy has been limited. METHODS: Since November 2007, the authors have modified the clinical target volume by adding a 0.5-to 1-cm margin to the gadolinium-enhanced area (extended field SRS), in contrast to conventional SRS using no margin to set the clinical target volume. A total of 35 recurred glioblastoma lesions in 9 patients were treated with conventional SRS between December 1990 and January 2007, and 14 lesions in 9 patients were treated with extended field SRS. RESULTS: The median follow-up periods were 7 months (range, 3-29 months) and 8 months (range, 6-27 months), respectively. The local control rate was 47% for conventional SRS and 93% for extended field SRS (P ¼ .0035), and the numbers of radiation necrosis observed in SRS-treated lesions were 2 and 4, respectively. The median overall survival from the diagnosis was 24 months (range, 14-57 months) for conventional SRS and 21 months (range, 15-51 months) for extended field SRS (statistically not significant). Seven patients treated with conventional SRS died during follow-up, 6 from progression of the SRS-treated tumor, whereas 7 patients treated with extended field SRS died during follow-up, 6 from remote intracerebral dissemination. CONCLUSIONS: Extended field SRS was superior to conventional SRS in the local control of small recurrent lesions of glioblastoma, although a further device to suppress remote dissemination may be necessary to increase survival. KEYWORDS: glioblastoma, glioma, gamma knife, stereotactic radiosurgery, radiation therapy, recurrence. INTRODUCTIONGlioblastoma is a highly malignant and aggressive tumor of the central nervous system that corresponds to grade IV of the World Health Organization histological classification. 1 The current standard treatment for glioblastoma is a maximal resection with functional preservation, followed by radiation and chemotherapy. When temozolomide is used for chemotherapy, the median survival is 14.6 months after initial presentation, 2 and ranges from 5 to 13 months after recurrence. 3,4 Because of the aggressive and invasive nature of the tumor, recurrence is seen in >90% of patients. 5 The most common pattern of recurrence is local regrowth 6 ; therefore, successful local control should lead to prolongation of patients' survival. Various local treatment strategies have been attempted, including repeated operations, conformal radiotherapy, brachytherapy, and local chemotherapy. 7 Although stereotactic radiosurgery (SRS) is an option as salvage treatment for recurrent glioblastoma in clinical settings, the role of SRS is still limited for glioma. SRS is useful in controlling relatively well-demarcated glioma such as ependymoma, pilocytic astrocytoma, and pleomorphic xanthoastrocytoma. [8][9][10][11][12][13] However, the majority of glioma is infiltrative to brain parenchyma and is difficult to target with SRS. A randomized controlle...

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“…Although stereotactic radiosurgery can control relatively well-demarcated gliomas, 19,43,44,46,50,66) the majority of gliomas infiltrate the brain parenchyma and are difficult to target by stereotactic radiosurgery. A randomized controlled study proved that there was no benefit in upfront radiosurgery prior to conventional fractionated radiation therapy for patients with glioblastoma.…”

Section: Clinical Applications I Metastatic Brain Tumors and Other Mmentioning

confidence: 99%

Role of Gamma Knife Radiosurgery in Neurosurgery: Past and Future Perspectives

Koga

Shin

Saito

2010

Neurol. Med. Chir.(Tokyo)

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The gamma knife was the first radiosurgical device developed at the Karolinska Institute in 1967. Stereotactic radiosurgery using the gamma knife has been widely accepted in clinical practice and has contributed to the development of neurosurgery. More than 500,000 patients have been treated by gamma knife stereotactic radiosurgery so far, and the method is now an indispensable neurosurgical tool. Here we review long-term outcomes and development of stereotactic radiosurgery using the gamma knife and discuss its future perspectives. The primary role of stereotactic radiosurgery is to control small well-demarcated lesions such as metastatic brain tumors, meningiomas, schwannomas, and pituitary adenomas while preserving the function of surrounding brain tissue. The gamma knife has been used as a primary treatment or in combination with surgery, and some applications have been accepted as standard treatment in the field of neurosurgery. Treatment of cerebral arteriovenous malformations has also been drastically changed after emergence of this technology. Controlling functional disorders is another role of stereotactic radiosurgery. There is a risk of radiation-induced adverse events, which are usually mild and less frequent. However, especially in large or invasive lesions, those risks are not negligible and pose limitations. Advancement of irradiation technology and dose planning software have enabled more sophisticated and safer treatment, and further progress will contribute to better treatment outcomes not only for brain lesions but also for cervical lesions with less invasive treatment.

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Gamma knife for glioma: Selection factors and survival

Cited by 119 publications

References 10 publications

Enhancement of replication of genetically engineered herpes simplex viruses by ionizing radiation: a new paradigm for destruction of therapeutically intractable tumors

Enhancement of replication of genetically engineered herpes simplex viruses by ionizing radiation: a new paradigm for destruction of therapeutically intractable tumors

Extended field stereotactic radiosurgery for recurrent glioblastoma

Role of Gamma Knife Radiosurgery in Neurosurgery: Past and Future Perspectives

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