Time course of pain response and toxicity after whole-nerve-encompassing LINAC-based stereotactic radiosurgery for trigeminal neuralgia—a prospective observational study

Koca, Selim; Distel, Luitpold; Łubgan, Dorota; Weissmann, Thomas; Lambrecht, Ulrike; Lang-Welzenbach, Marga; Eyüpoglu, Ilker Y.; Bischoff, Barbara; Buchfelder, Michael; Semrau, Sabine; Fietkau, Rainer; Lettmaier, Sebastian; Putz, Florian

doi:10.1007/s00066-019-01450-9

Cited by 8 publications

(8 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients were immobilized in an individually manufactured thermoplastic head mask attached to a stereotactic base frame (BrainLAB, Feldkirchen, Germany). Treatment planning was performed using Iplan (BrainLAB, Feldkirchen, Germany) (10,11). Patients received a dedicated planning CT, which was rigidly coregistered with the baseline MRI using the Iplan software.…”

Section: Radiation Therapymentioning

confidence: 99%

Volumetric Regression in Brain Metastases After Stereotactic Radiotherapy: Time Course, Predictors, and Significance

et al. 2021

Self Cite

View full text Add to dashboard Cite

BackgroundThere is insufficient understanding of the natural course of volumetric regression in brain metastases after stereotactic radiotherapy (SRT) and optimal volumetric criteria for the assessment of response and progression in radiotherapy clinical trials for brain metastases are currently unknown.MethodsVolumetric analysis via whole-tumor segmentation in contrast-enhanced 1 mm³-isotropic T1-Mprage sequences before SRT and during follow-up. A total of 3,145 MRI studies of 419 brain metastases from 189 patients were segmented. Progression was defined using a volumetric extension of the RANO-BM criteria. A subset of 205 metastases without progression/radionecrosis during their entire follow-up of at least 3 months was used to study the natural course of volumetric regression after SRT. Predictors for volumetric regression were investigated. A second subset of 179 metastases was used to investigate the prognostic significance of volumetric response at 3 months (defined as ≥20% and ≥65% volume reduction, respectively) for subsequent local control.ResultsMedian relative metastasis volume post-SRT was 66.9% at 6 weeks, 38.6% at 3 months, 17.7% at 6 months, 2.7% at 12 months and 0.0% at 24 months. Radioresistant histology and FSRT vs. SRS were associated with reduced tumor regression for all time points. In multivariate linear regression, radiosensitive histology (p=0.006) was the only significant predictor for metastasis regression at 3 months. Volumetric regression ≥20% at 3 months post-SRT was the only significant prognostic factor for subsequent control in multivariate analysis (HR 0.63, p=0.023), whereas regression ≥65% was no significant predictor.ConclusionsVolumetric regression post-SRT does not occur at a constant rate but is most pronounced in the first 6 weeks to 3 months. Despite decreasing over time, volumetric regression continues beyond 6 months post-radiotherapy and may lead to complete resolution of controlled lesions by 24 months. Radioresistant histology is associated with slower regression. We found that a cutoff of ≥20% regression for the volumetric definition of response at 3 months post-SRT was predictive for subsequent control whereas the currently proposed definition of ≥65% was not. These results have implications for standardized volumetric criteria in future radiotherapy trials for brain metastases.

show abstract

Section: Radiation Therapymentioning

confidence: 99%

Volumetric Regression in Brain Metastases After Stereotactic Radiotherapy: Time Course, Predictors, and Significance

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Patients were immobilized in an individually manufactured thermoplastic head mask attached to a stereotactic base frame (BrainLAB, Feldkirchen, Germany). Treatment planning was performed using Iplan (BrainLAB, Feldkirchen, Germany) (16,17). Patients received a dedicated planning CT, which was rigidly co-registered with the baseline MRI using the Iplan software.…”

Section: Radiation Therapymentioning

confidence: 99%

FSRT vs. SRS in Brain Metastases—Differences in Local Control and Radiation Necrosis—A Volumetric Study

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: While the role of stereotactic radiotherapy for brain metastases is increasing, evidence on the comparative efficacy and safety of fractionated stereotactic radiotherapy (FSRT) and single-session radiosurgery (SRS) is scarce. Methods: Longitudinal volumetric analysis was performed in a consecutive cohort of 120 patients and 190 brain metastases (>0.065 cm 3 in volume / > ∼5 mm in diameter) treated exclusively with FSRT (n = 98) and SRS (n = 92), respectively. A total of 972 tumor segmentations was used, averaging 5.1 time points per metastasis. Progression was defined using a volumetric extension of the RANO-BM criteria. Local control and radionecrosis were compared for lesions treated with FSRT and SRS, respectively. Results: Metastases treated with FSRT were significantly larger at baseline (mean, 4.66 vs. 0.40 cm 3 , p < 0.001). Biologically effective dose (BED) for metastases (α/β = 12, linear-quadratic-cubic model) was significantly associated with local control, whereas BED for normal brain (α/β = 2, linear-quadratic model) was significantly associated with radionecrosis. Median time to local progression was 22.9 months in the FSRT group compared to 14.5 months in the SRS group (p = 0.022). Overall radionecrosis rate at 12 months was 3.4% for FSRT and 14.8% for SRS (p = 0.010). Radionecrosis • IV requiring resection with histologic proof of radiation necrosis also was significantly reduced in the FSRT group (FSRT 0.0% vs. SRS 3.9%, p = 0.041). In multivariate analysis, FSRT was associated with reduced risk of progression (HR 0.47, p = 0.015) and reduced risk of radionecrosis (HR 0.18, p = 0.045). Conclusions: This volumetric study provides initial evidence that the improvements in therapeutic ratio expected for FSRT in larger brain metastases, might equally extend into the domain of smaller metastases, traditionally less considered for fractionated treatment. FSRT might constitute an important tool to further increase local control and reduce radionecrosis risk in stereotactic radiotherapy for brain metastases, that should be assessed in randomized intervention trials.

show abstract

“…Since then, intracranial stereotactic radiosurgery (SRS, 1 treatment session) and intracranial fractionated stereotactic radiotherapy (FSRT, 2-12 treatment sessions) have become an integral part in the treatment of single and multiple brain metastases, also in combination with immune-and targeted-therapies [8], benign tumors (e.g., meningioma, acoustic neuromas, or pituitary adenomas) [9], vascular malformations and functional disorders (e.g., trigeminal neuralgia) [10], among others. With recent advances in image guidance and motion management for organ and target movements (e.g., due to respiration), extracranial stereotactic body radiotherapy (SBRT, 1-12 treatment sessions) has also become a standard treatment option for many indications including primary lung, liver, pancreas, kidney, and prostate cancer [11][12][13], as well as oligometastases in lung, liver, bone, and abdominal localization [14][15][16].…”

Section: Radiosurgery and Stereotactic Body Radiotherapymentioning

confidence: 99%

Radiosurgery for ventricular tachycardia: preclinical and clinical evidence and study design for a German multi-center multi-platform feasibility trial (RAVENTA)

et al. 2020

View full text Add to dashboard Cite

Background Single-session high-dose stereotactic radiotherapy (radiosurgery) is a new treatment option for otherwise untreatable patients suffering from refractory ventricular tachycardia (VT). In the initial single-center case studies and feasibility trials, cardiac radiosurgery has led to significant reductions of VT burden with limited toxicities. However, the full safety profile remains largely unknown. Methods/design In this multi-center, multi-platform clinical feasibility trial which we plan is to assess the initial safety profile of radiosurgery for ventricular tachycardia (RAVENTA). High-precision image-guided single-session radiosurgery with 25 Gy will be delivered to the VT substrate determined by high-definition endocardial electrophysiological mapping. The primary endpoint is safety in terms of successful dose delivery without severe treatment-related side effects in the first Jürgen Dunst and Hendrik Bonnemeier have equally contributed to this work. This is the first publication for the RAVENTA study.

show abstract

Time course of pain response and toxicity after whole-nerve-encompassing LINAC-based stereotactic radiosurgery for trigeminal neuralgia—a prospective observational study

Cited by 8 publications

References 36 publications

Volumetric Regression in Brain Metastases After Stereotactic Radiotherapy: Time Course, Predictors, and Significance

Volumetric Regression in Brain Metastases After Stereotactic Radiotherapy: Time Course, Predictors, and Significance

FSRT vs. SRS in Brain Metastases—Differences in Local Control and Radiation Necrosis—A Volumetric Study

Radiosurgery for ventricular tachycardia: preclinical and clinical evidence and study design for a German multi-center multi-platform feasibility trial (RAVENTA)

Contact Info

Product

Resources

About