Long-term experience with fractionated stereotactic radiotherapy in pharmacoresistant epilepsy: Neurological and MRI changes

Evidence on the efficacy of primary radiosurgery or stereotactic radiotherapy for drug-resistant non-neoplastic focal epilepsy in adults: A systematic review

“…Twelve of the 16 studies reported a positive effect of RT on the seizure outcome defined by the total percentage of RAEC I and II patients, ranging from 25%-95% per study, with an overall average of 57% (98 patients). In the two smallest studies (two and three patients, respectively), RT had no favorable effect on the seizure outcome (class IV), although treatment was delivered with similar techniques, dose per fraction and target volumes compared to the other studies [28,30,31].…”

“…The included studies used a wide range of dose schedules, from single fractions prescribing 13-25 Gy as marginal dose to 2, 7, 12 and 15 fractions of 6, 3, 4, 2.5, 3 and 2 Gy, respectively, prescribed to the 95% isodose (Table 1). The maximum dose in the target volume was only reported in the study of Rauch et al [31].…”

“…To be able to compare study outcome, the investigators independently assessed these seven studies and transformed the seizure outcome to RAEC (Fig. 1) [16,[26][27][28][30][31][32][33]. RAEC I and II were subsequently combined since these classes are both assumed to give a beneficial effect after treatment (class I no seizures; class II rare seizures; Fig.…”

Low-dose radiosurgery or hypofractionated stereotactic radiotherapy as treatment option in refractory epilepsy due to epileptogenic lesions in eloquent areas – Preliminary report of feasibility and safety

“…In this series stereotactic irradiation was performed highly selective on the epileptogenic lesion. The series published by Rauch et al [16] reported 11 patients, who were treated stereotactically with a LINAC. This series included 2 patients with extratemporal lesions, which were treated with a dedicated LINAC.…”

“…Modern radiosurgical techniques include, in addition to the classical SRS (single-stage high-precision radiation), the so-called hypofractionated or fractionated stereotactic high precision radiotherapy (SRT). Fractionated SRT is an increasingly used method of radiotherapy treatment for many benign and malignant brain lesions and has been already carried out for treatment of drug-resistant focal epilepsy, but conclusive evidence is still lacking [14][15][16]. Although the use of SRS and SRT has been mainly used to treat MTLE or hypothalamic hamartomas, there are other highly epileptogenic lesions, which could benefit from these treatment modalities as well.…”