Stereotactic Interstitial Radiosurgery With the Photon Radiosurgery System (PRS) for Metastatic Brain Tumors: A Prospective Single-Center Clinical Trial

Pantazis, Georgios; Trippel, Michael; Birg, W.; Ostertag, Christoph B.; Nikkhah, Guido

doi:10.1016/j.ijrobp.2009.01.022

Cited by 13 publications

(9 citation statements)

References 48 publications

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“…In addition, 14 Gy to a 2-mm depth may not be optimal, although comparisons with the results of Curry et al 10 (mean 16 Gy, local control rate 81%) and Pantazis et al 28 (15 or 18 Gy, with local control rates < 50% at 1 year) suggest that our local and distant control rates are comparable to those of other studies and other treatment methods such as surgery alone, surgery plus WBRT, or SRS alone, while having enhanced, on average, rates of progression-free, posttreatment, and overall survival. Furthermore, the treated lesions had diverse origins, differing natural histories, and different presentations.…”

Section: Discussionmentioning

confidence: 85%

“…16 Two recent studies evaluated the use of IORT at the time of stereotactic biopsies in patients with BrMs. 10,28 Curry et al 10 reported that of 60 patients with 72 lesions treated with a 16-Gy peripheral dose (range 10-20 Gy), those patients (n = 37) with a single treated lesion survived a mean of 11 months. Pantazis et al 28 reported on a series of 35 patients with a single metastasis treated with IORT after stereotactic biopsy and implantation of the IORT source; 32 of the patients received a dose of 18 Gy to the lesion wall, and 3 patients received a dose of 15 Gy.…”

Section: Discussionmentioning

confidence: 99%

“…This dose was chosen on the basis of previous experience reported in the literature and on experience with SRS dosing at our institution. 1,8,10,11,14,16,18,28,34 All nonessential personnel left the operating room. The surgeon and anesthetist remained behind a leaded-glass shield while the treatment was delivered.…”

Section: Intraoperative Radiotherapymentioning

confidence: 99%

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Intraoperative radiotherapy to treat newly diagnosed solitary brain metastasis: initial experience and long-term outcomes

Weil

Mavinkurve

Chao

et al. 2015

JNS

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abbreviatioNs BrM = brain metastasis; GPA = Graded Prognostic Assessment; IORT = intraoperative radiotherapy; KPS = Karnofsky Performance Scale; LMD = leptomeningeal (metastatic) disease; NSCLCa = non-small cell lung cancer; RPA = recursive partitioning analysis; SRS = stereotactic radiosurgery; WBRT = whole-brain radiation therapy; XRS = radiation source. submitted January 30, 2014. accepted November 13, 2014. iNclude wheN citiNg Published online January 23, 2015; DOI: 10.3171/2014.11.JNS1449. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect The authors assessed the feasibility of intraoperative radiotherapy (IORT) using a portable radiation source to treat newly diagnosed, surgically resected, solitary brain metastasis (BrM). methods In a nonrandomized prospective study, 23 patients with histologically confirmed BrM were treated with an Intrabeam device that delivered 14 Gy to a 2-mm depth to the resection cavity during surgery. results In a 5-year minimum follow-up period, progression-free survival from the time of surgery with simultaneous IORT averaged (± SD) 22 ± 33 months (range 1-96 months), with survival from the time of BrM treatment with surgery+IORT of 30 ± 32 months (range 1-96 months) and overall survival from the time of first cancer diagnosis of 71 ± 64 months (range 4-197 months). For the Graded Prognostic Assessment (GPA), patients with a score of 1.5-2.0 (n = 12) had an average posttreatment survival of 21 ± 26 months (range 1-96 months), those with a score of 2.5-3.0 (n = 7) had an average posttreatment survival of 52 ± 40 months (range 5-94 months), and those with a score of 3.5-4.0 (n = 4) had an average posttreatment survival of 17 ± 12 months (range 4-28 months). A BrM at the treatment site recurred in 7 patients 9 ± 6 months posttreatment, and 5 patients had new but distant BrM 17 ± 3 months after surgery+IORT. Six patients later received whole-brain radiation therapy, 7 patients received radiosurgery, and 2 patients received both treatments. The median Karnofsky Performance Scale scores before and 1 and 3 months after surgery were 80, 90, and 90, respectively; at the time of this writing, 3 patients remain alive with a CNS progression-free survival of > 90 months without additional BrM treatment. coNclusioNs The results of this study demonstrate the feasibility of resection combined with IORT at a dose of 14 Gy to a 2-mm peripheral margin to treat a solitary BrM. Local control, distant control, and long-term survival were comparable to those of other commonly used modalities. Surgery combined with IORT seems to be a potential adjunct to patient treatment for CNS involvement by systemic cancer. Clinical trial registration no.: NCT00107367 (clinicaltrials.gov)

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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Intraoperative radiotherapy to treat newly diagnosed solitary brain metastasis: initial experience and long-term outcomes

Weil

Mavinkurve

Chao

et al. 2015

JNS

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“…IORT has advantages of eliminating challenges in target definition, steep conformal dose delivery that may afford dose-escalation relative to SRS, and increased patient convenience by integrating resection and radiotherapy into 1 procedure. A variety of techniques have been used for IORT in brain metastases including low-energy photons and permanent low dose rate brachytherapy with 131 Cs and 125 I [6–8, 11, 12]. However, dose selection for low energy photon based IORT in brain tumors remains largely empiric with doses ranging from 10 to 30 Gy in 1 fraction to varying prescription depths of 0–5 mm [6–10].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of dose escalation using intraoperative radiotherapy following resection of large brain metastases compared to post-operative stereotactic radiosurgery

et al. 2018

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“…[19][20][21] The device emits lowenergy X-rays from the tip of a cylindrical probe. From the point of view of radiology, the IR with PRS aims at delivering a necrotizing dose of radiation in the tumor volume, thus minimizing the dose in the surrounding tissue.…”

Section: The Robotized Radiological Treatmentmentioning

confidence: 99%

A delayed force-reflecting haptic controller for master–slave neurosurgical robots

Boscariol¹,

Gasparetto²,

Vidoni³

et al. 2015

Advanced Robotics

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This paper presents a new force-reflecting control system for master-slave haptic devices. This controller has been implemented and tested on the robotic systems for minimally invasive neurosurgery developed by our Research Group. Robot-assisted surgery is a very valuable treatment, since it allows benefits of high precision, accuracy, and repeatability of robotic devices. The proposed controller is meant to be used for master-slave haptic robotic surgery, but it can be used for any device that provides haptic feedback. The new controller merges the paradigms of force reflection (FR) control and delayed reference control. Unlike the FR control, the proposed solution enhances the safety since it does not allow an unwanted motion of the slave device once the operator releases the haptic controller. Experimental tests are provided to show the capabilities and the performance of the controller. Closed-loop stability is investigated both theoretically and experimentally. The analytic results on stability impose a limit on the ratio between the measured contact force and the sampling frequency of the closed-loop controller.

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Stereotactic Interstitial Radiosurgery With the Photon Radiosurgery System (PRS) for Metastatic Brain Tumors: A Prospective Single-Center Clinical Trial

Cited by 13 publications

References 48 publications

Intraoperative radiotherapy to treat newly diagnosed solitary brain metastasis: initial experience and long-term outcomes

Intraoperative radiotherapy to treat newly diagnosed solitary brain metastasis: initial experience and long-term outcomes

Feasibility of dose escalation using intraoperative radiotherapy following resection of large brain metastases compared to post-operative stereotactic radiosurgery

A delayed force-reflecting haptic controller for master–slave neurosurgical robots

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