Risk of Malignancy After Gamma Knife Stereotactic Radiosurgery

Rowe, Jeremy; Grainger, Alison; Walton, Lee; Silcocks, Paul; Radatz, Matthias; Kemeny, Andras

doi:10.1227/01.neu.0000255492.34063.32

Cited by 170 publications

(82 citation statements)

References 18 publications

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“…There is a risk for development of neoplasia after radiotherapy, but only very few cases have been reported (15). In our case, the tumor was far from the therapeutic field, and the level of irradiation at this point was below 1 Gy.…”

Section: Discussionmentioning

confidence: 53%

Gamma knife stereotactic radiosurgery of Nelson syndrome

Vik-Mo

Øksnes

Pedersen

et al. 2009

European Journal of Endocrinology

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Objective: Gamma knife radiosurgery (GKR) can be used as primary or adjuvant therapy for the treatment of an ACTH-producing pituitary tumor after bilateral adrenalectomy, called Nelson syndrome (NS). We have examined the effect of GKR on tumor growth and ACTH-hypersecretion, and characterized the adverse events of this treatment in patients with NS. Design: Cross-sectional follow-up study. First, retrospective data pre-and post-GKR were collected. Patients then underwent a predefined survey including radiological, endocrinological, ophthalmological, and neurosurgical evaluation. Subjects: Ten patients treated with GKR for NS after previous bilateral adrenalectomy. The mean followup was 7 years. No patient was lost to follow-up. Results: Tumor growth was stopped in all patients. The ACTH levels declined in eight patients, and normalized in one patient. There was a significant drop in ACTH levels, with a half-time of 2.8 years.No patient developed visual field defects or any other cranial nerve dysfunction as a result of treatment. Four patients started hormone substitution therapy during the follow-up period. The substitution therapy of three pituitary axes present at GKR treatment could be stopped during the same period. One patient developed a glioblastoma in the left parieto-occipital region 14 years after GKR, far from the field of treatment. As the radiation level was below 1Gy to this area, it is unlikely that the GKR treatment itself induced the malignant tumor. Conclusion: In patients with NS, GKR is an effective adjuvant treatment, carrying relatively few adverse effects. Although the risk of developing a secondary neoplasia after GKR is present, it is probably extremely low.

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Section: Discussionmentioning

confidence: 53%

Gamma knife stereotactic radiosurgery of Nelson syndrome

Vik-Mo

Øksnes

Pedersen

et al. 2009

European Journal of Endocrinology

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“…10) The possibility of radiation-induced tumor formation after radiosurgery must be considered, especially if applied to patients with benign lesions. 5,130,150) Although an epidemiologic study in England did not show that incidence of malignancy was higher in the cohort who underwent gamma knife radiosurgery, 118) the results based on long-term follow up are still unknown. Therefore, the risk of radiation-induced tumors should be kept in mind and should be discussed with patients.…”

Section: Benign Tumorsmentioning

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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“…The exquisite sub-millimetre precision of radiosurgery, particularly using Gamma Knife technology, offers a very dramatic reduction of the low-dose radiation volume into the normal tissues surrounding the target and, as a result, the risk of secondary oncogenesis is truly minimised [1]. At the same time, the one-day treatment offers such convenience that tolerance and compliance is vastly improved without compromising efficacy and safety.…”

mentioning

confidence: 99%

Tolosa-Hunt Syndrome: Another legitimate target for radiosurgery?

Kemeny

2015

Acta Neurochir

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Risk of Malignancy After Gamma Knife Stereotactic Radiosurgery

Cited by 170 publications

References 18 publications

Gamma knife stereotactic radiosurgery of Nelson syndrome

Gamma knife stereotactic radiosurgery of Nelson syndrome

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

Tolosa-Hunt Syndrome: Another legitimate target for radiosurgery?

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