Gamma Knife radiosurgery for occipital condyle metastasis

Krishnamurthy, Satish; Navarro-Martín, Arturo; Maitz, Ann

doi:10.1007/s12094-009-0414-y

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…8 In our literature review, we found 1 case report of a patient with an occipital condyle metastasis treated with GKS, which resulted in a reduction in tumor size without evidence of disease recurrence after a prescribed peripheral marginal dose of 8 Gy (with a maximal dose of 17.77 Gy). 12 In our study, however, destruction of both tables of the skull was typical and the underlying dura was often involved. Therefore, considering the adjacent brain parenchyma, we applied our traditional brain metastasis dosing guidelines to maximize tumor control.…”

Section: Discussioncontrasting

confidence: 50%

Calvarial and skull base metastases: expanding the clinical utility of Gamma Knife surgery

Kotecha¹,

Angelov

Barnett

et al. 2014

JNS

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ObjectTraditionally, the treatment of choice for patients with metastases to the calvaria or skull base has been conventional radiation therapy. Because patients with systemic malignancies are also at risk for intracranial metastases, the utility of Gamma Knife surgery (GKS) for these patients has been explored to reduce excess radiation exposure to the perilesional brain parenchyma. The purpose of this study was to report the efficacy of GKS for the treatment of calvarial metastases and skull base lesions.MethodsThe authors performed a retrospective chart review of 21 patients with at least 1 calvarial or skull base metastatic lesion treated with GKS during 2001–2013. For 7 calvarial lesions, a novel technique, in which a bolus was placed over the treatment site, was used. For determination of local control or disease progression, radiation therapy data were examined and posttreatment MR images and oncology records were reviewed. Survival times from the date of procedure were estimated by using Kaplan-Meier analyses.ResultsThe median patient age at treatment was 57 years (range 29–84 years). A total of 19 (90%) patients received treatment for single lesions, 1 patient received treatment for 3 lesions, and 1 patient received treatment for 4 lesions. The most common primary tumor was breast cancer (24% of patients). Per lesion, the median clinical and radiographic follow-up times were 10.3 months (range 0–71.9 months) and 7.1 months (range 0–61.3 months), respectively. Of the 26 lesions analyzed, 14 (54%) were located in calvarial bones and 12 (46%) were located in the skull base. The median lesion volume was 5.3 cm3 (range 0.3–55.6 cm3), and the median prescription margin dose was 15 Gy (range 13–24 Gy). The median overall survival time for all patients was 35.9 months, and the 1-year local control rate was 88.9% (95% CI 74.4%–100%). Local control rates did not differ between lesions treated with the bolus technique and those treated with traditional methods or between calvarial lesions and skull base lesions (p > 0.05). Of the 3 patients for whom local treatment failed, 1 patient received no further treatment and 2 patients responded to salvage chemotherapy. Subsequent brain parenchymal metastases developed in 2 patients, who then underwent GKS.ConclusionsGKS is an effective treatment modality for patients with metastases to the calvarial bones or skull base. For patients with superficial calvarial lesions, a novel approach with bolus application resulted in excellent rates of local control. GKS provides an effective therapeutic alternative to conventional radiation therapy and should be considered for patients at risk for calvarial metastases and brain parenchymal metastases.

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Section: Discussioncontrasting

confidence: 50%

Calvarial and skull base metastases: expanding the clinical utility of Gamma Knife surgery

Kotecha¹,

Angelov

Barnett

et al. 2014

JNS

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“…5,20 Though evidence specific to the CVJ is limited, small case series have yielded promising results. 9,16,21 SRS at the CVJ is not without challenges, given the proximity of adjacent neurocritical structures including the brainstem, upper cervical spinal, and lower cranial nerves. We present the largest patient series, to our knowledge, of SRS for CVJ metastasis and demonstrate the role of this treatment modality in preserving spinal stability and alleviating pain.…”

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confidence: 99%

Stereotactic radiosurgery for metastasis to the craniovertebral junction preserves spine stability and offers symptomatic relief

Azad¹,

Esparza²,

Chaudhary³

et al. 2016

SPI

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OBJECT Metastatic disease to the craniovertebral junction (CVJ) is rare but presents unique management challenges. To date, studies on using stereotactic radiosurgery (SRS) for CVJ metastases have been limited to case reports and small case series. The aim of this analysis was to evaluate the utility of SRS in the management of these secondary lesions. METHODS Clinical and radiological information from the charts of 25 patients with metastatic disease of the CVJ who were treated with SRS between 2005 and 2013 at the Stanford CyberKnife Center were retrospectively reviewed. RESULTS Seven male and 18 female patients with a median age of 58 years (range 34–94 years) were identified. The most common primary tumors were breast cancer (n = 5) and non-small cell lung cancer (n = 5), and the most frequent symptom was neck pain (n = 17). The average tumor volume treated was 15.9 cm3 (range 0.16–54.1 cm3), with a mean marginal radiation dose of 20.3 Gy (range 15–25.5 Gy). The median follow-up was 18 months (range 1–81 months), though 1 patient was lost to follow-up. SRS provided radiographic tumor stability in over 80% of patients, offered pain alleviation in nearly two-thirds of patients, and produced no serious complications. Moreover, SRS preserved spinal stability in all but 1 patient, in whom pre-SRS stability was established. There was no evidence of radiation toxicity in the patient population. Median survival was 28 months (range 2–81 months), with survival of 13.3% at 5 years. CONCLUSIONS In the absence of unstable pathological fracture and spinal cord compression, metastatic tumors of the CVJ can be safely and effectively treated with SRS. This treatment option offers palliative pain relief and can halt tumor progression with only a low risk of complications or spinal instability.

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Radiosurgery for Metastatic Disease at the Craniocervical Junction

Tuchman

Chang

et al. 2014

World Neurosurgery

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Gamma Knife radiosurgery for occipital condyle metastasis

Abstract: We present a 45 year old female with right occipital condylar metastases who was treated at William Beaumont Hospital in the Gamma Knife Unit. Clinical results at 17 months follow-up and MRI are exposed.

Cited by 3 publications

References 5 publications

Calvarial and skull base metastases: expanding the clinical utility of Gamma Knife surgery

Calvarial and skull base metastases: expanding the clinical utility of Gamma Knife surgery

Stereotactic radiosurgery for metastasis to the craniovertebral junction preserves spine stability and offers symptomatic relief

Radiosurgery for Metastatic Disease at the Craniocervical Junction

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