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Zubatkina I, Toma-Dasu I, Dasu A, Levivier M, Tuleasca C, Ivanov P. Clinically Driven Alpha/Beta Ratios for Melanoma Brain Metastases and Investigation of Biologically Effective Dose as a Predictor for Local Control After Radiosurgery: A Proof of Concept in a Retrospective Longitudinal Series of 274 Consecutive Lesions. Neurosurgery 2024; 94:423-430. [PMID: 37665222 DOI: 10.1227/neu.0000000000002639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/14/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Brain metastases (BM) develop in nearly half of the patients with advanced melanoma. The aim of this retrospective historical cohort study was to analyze radiological response of melanoma BM to single-fraction Gamma Knife radiosurgery (GKRS), in relation to biologically effective dose (BED) for various alpha/beta ratios. METHODS Included in the study were 274 lesions. Primary outcome was local control (LC). Mean marginal dose was 21.6 Gy (median 22, range 15-25). Biologically effective dose was calculated for an alpha/beta ratio of 3 (Gy 3 ), 5 (Gy 10 ), 10 (Gy 10 ), and 15 (Gy 15 ). RESULTS Receiver operating characteristic value for LC and BED was 85% (most statistically significant odds ratio 1.14 for BED Gy 15 , P = .006), while for LC and physical dose was 79% ( P = .02). When comparing equality of 2 receiver operating characteristic areas, this was statistically significant ( P = .02 and .03). Fractional polynomial regression revealed BED (Gy 10 and Gy 15 ) as statistically significant ( P = .05) with BED of more than 63 Gy 10 or 49 Gy 15 as relevant, also for higher probability of quick decrease in volume first month after GKRS and lower probability of radiation necrosis. Shorter irradiation time was associated with better LC ( P = .001), particularly less than 40 minutes (LC below 90%, P = .05). CONCLUSION BED Gy 10 and particularly Gy 15 were more statistically significant than physical dose for LC after GKRS for radioresistant melanoma BM. Irradiation time (per lesion) longer than 40 minutes was predictive for lower rates of LC. Such results need to be validated in larger cohorts.
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Affiliation(s)
- Irina Zubatkina
- Department of Radiosurgery, Stereotactic Radiotherapy and General Oncology Clinic MIBS, Saint Petersburg , Russia
- Peter the Great St. Petersburg Polytechnic University, Saint Petersburg , Russia
| | - Iuliana Toma-Dasu
- Oncology Pathology Department, Karolinska Institutet, Stockholm , Sweden
- Medical Radiation Physics, Stockholm University, Stockholm , Sweden
| | - Alexandru Dasu
- Medical Radiation Sciences, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala , Sweden
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne , Switzerland
- University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), Lausanne , Switzerland
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne , Switzerland
- University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), Lausanne , Switzerland
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne, Lausanne , Switzerland
| | - Pavel Ivanov
- Department of Radiosurgery, Stereotactic Radiotherapy and General Oncology Clinic MIBS, Saint Petersburg , Russia
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Tuleasca C, Carey G, Barriol R, Touzet G, Dubus F, Luc D, Carriere N, Reyns N. Impact of biologically effective dose on tremor decrease after stereotactic radiosurgical thalamotomy for essential tremor: a retrospective longitudinal analysis. Neurosurg Rev 2024; 47:73. [PMID: 38296852 PMCID: PMC10830596 DOI: 10.1007/s10143-024-02296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/03/2024] [Accepted: 01/14/2024] [Indexed: 02/02/2024]
Abstract
Stereotactic radiosurgery (SRS) is one of the surgical alternatives for drug-resistant essential tremor (ET). Here, we aimed at evaluating whether biologically effective dose (BEDGy2.47) is relevant for tremor improvement after stereotactic radiosurgical thalamotomy in a population of patients treated with one (unplugged) isocenter and a uniform dose of 130 Gy. This is a retrospective longitudinal single center study. Seventy-eight consecutive patients were clinically analyzed. Mean age was 69.1 years (median 71, range 36-88). Mean follow-up period was 14 months (median 12, 3-36). Tremor improvement was assessed at 12 months after SRS using the ET rating assessment scale (TETRAS, continuous outcome) and binary (binary outcome). BED was defined for an alpha/beta of 2.47, based upon previous studies considering such a value for the normal brain. Mean BED was 4573.1 Gy2.47 (median 4612, 4022.1-4944.7). Mean beam-on time was 64.7 min (median 61.4; 46.8-98.5). There was a statically significant correlation between delta (follow-up minus baseline) in TETRAS (total) with BED (p = 0.04; beta coefficient - 0.029) and beam-on time (p = 0.03; beta coefficient 0.57) but also between TETRAS (ADL) with BED (p = 0.02; beta coefficient 0.038) and beam-on time (p = 0.01; beta coefficient 0.71). Fractional polynomial multivariate regression suggested that a BED > 4600 Gy2.47 and a beam-on time > 70 min did not further increase clinical efficacy (binary outcome). Adverse radiation events (ARE) were defined as larger MR signature on 1-year follow-up MRI and were present in 7 out of 78 (8.9%) cases, receiving a mean BED of 4650 Gy2.47 (median 4650, range 4466-4894). They were clinically relevant with transient hemiparesis in 5 (6.4%) patients, all with BED values higher than 4500 Gy2.47. Tremor improvement was correlated with BED Gy2.47 after SRS for drug-resistant ET. An optimal BED value for tremor improvement was 4300-4500 Gy2.47. ARE appeared for a BED of more than 4500 Gy2.47. Such finding should be validated in larger cohorts.
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Affiliation(s)
- Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Rue du Bugnon 44-46, BH-08, CH-1011, Lausanne, Switzerland.
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
- Ecole Polytechnique Fédérale de Lausanne (EPFL, LTS-5), Lausanne, Switzerland.
| | - Guillaume Carey
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Romain Barriol
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Gustavo Touzet
- Neurosurgery Department, CHU-Lille, Roger Salengro Hospital, 1, Rue Emile Laine, 59000, Lille, France
| | - Francois Dubus
- Medical Physics Department, University Hospital, Lille, France
| | - Defebvre Luc
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Nicolas Carriere
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Nicolas Reyns
- Neurosurgery Department, CHU-Lille, Roger Salengro Hospital, 1, Rue Emile Laine, 59000, Lille, France
- U1189-ONCO-THAI-Assisted Laser Therapy and Immunotherapy for Oncology, University of Lille, INSERM, CHU-Lille, 59000, Lille, France
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Tang K, Zhang N, Yuan X, Qian Z, Li Y, Feng X. MatBED_B&C: A 3-dimensional biologically effective dose analytic approach for the retrospective study of gamma knife radiosurgery in a B&C model. MethodsX 2023; 11:102320. [PMID: 37601290 PMCID: PMC10433126 DOI: 10.1016/j.mex.2023.102320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023] Open
Abstract
The biological effect of irradiation is not solely determined by the physical dose. Gamma knife radiosurgery may be influenced by dose rate, beam-on-time, numbers of iso-centers, the gap between the individual iso-centers, and the dose‒response of various tissues. The biologically effective dose (BED) for radiosurgery considers these issues. Millions of patients treated with Models B and C provide a vast database to mine BED-related information. This research aims to develop MatBED_B&C, a 3-dimensional (3D) BED analytic approach, to generate a BED for individual voxels in the calculation matrix with related parameters extracted from Gammaplan. This approach calculates the distribution profiles of the BED in radiosurgical targets and organs at risk. A BED calculated on a voxel-by-voxel basis can be used to show the 3D morphology of the iso-BED surface and visualize the BED spatial distribution in the target. A 200 × 200 × 200 matrix can cover a greater range of the organ at risk. The BED calculated by MatBED_B&C can also be used to form BED-volume histograms to generate plan quality metrics, which will be studied in a retrospective study of gamma knife radiosurgery to guide future BED planning.•We develop MatBED_B&C to calculate the 3D BED in radiosurgical targets.•The BED of MatBED_B&C can visualize the BED spatial distribution profiles.•The BED of MatBED_B&C will generate plan quality metrics studied in a retrospective study.
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Affiliation(s)
- Ke Tang
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, PR China
| | - Nan Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi (Middle) Road, Shanghai, PR China
| | - Xiaodong Yuan
- Department of Radiology, The Eighth Medical Center of Chinese PLA General Hospital, 17 Heishanhu Road, Beijing, PR China
| | - Zenghui Qian
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119 Fanyang Road, Fengtai District, Beijing, PR China
| | - Yang Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Road, Beijing, PR China
| | - Xu Feng
- Department of Basic Medicine, Xiamen Medical College, 1999 Guankouzhong Road, Xiamen, Fujian Province, PR China
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Peters DR, Asher A, Conti A, Schiappacasse L, Daniel RT, Levivier M, Tuleasca C. Single fraction and hypofractionated radiosurgery for perioptic meningiomas-tumor control and visual outcomes: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:287. [PMID: 37897519 DOI: 10.1007/s10143-023-02197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/21/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023]
Abstract
Perioptic meningiomas, defined as those that are less than 3 mm from the optic apparatus, are challenging to treat with stereotactic radiosurgery (SRS). Tumor control must be weighed against the risk of radiation-induced optic neuropathy (RION), as both tumor progression and RION can lead to visual decline. We performed a systematic review and meta-analysis of single fraction SRS and hypofractionated radiosurgery (hfRS) for perioptic meningiomas, evaluating tumor control and visual preservation rates. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we reviewed articles published between 1968 and December 8, 2022. We retained 5 studies reporting 865 patients, 438 cases treated in single fraction, while 427 with hfRS. For single fraction SRS, the overall rate of tumor control was 95.1%, with actuarial rates at 5 and 10 years of 96% and 89%, respectively; tumor progression was 7.7%. The rate of visual stability was 90.4%, including visual improvement in 29.3%. The rate of visual decline was 9.6%, including blindness in 1.2%. For hfRS, the overall rate of tumor control was 95.6% (range 92.1-99.1, p < 0.001); tumor progression was 4.4% (range 0.9-7.9, p = 0.01). Overall rate of visual stability was 94.9% (range 90.9-98.9, p < 0.001), including visual improvement in 22.7% (range 5.0-40.3, p = 0.01); visual decline was 5.1% (range 1.1-9.1, p = 0.013). SRS is an effective and safe treatment option for perioptic meningiomas. Both hypofractionated regimens and single fraction SRS can be considered.
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Affiliation(s)
- David R Peters
- Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA.
- Department of Neurosurgery, Atrium Health, Charlotte, NC, USA.
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Anthony Asher
- Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA
- Department of Neurosurgery, Atrium Health, Charlotte, NC, USA
| | - Alfredo Conti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Unit of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bellaria Hospital, Bologna, Italy
| | - Luis Schiappacasse
- Radiation Oncology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Roy T Daniel
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Marc Levivier
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Constantin Tuleasca
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL, LTS-5), Lausanne, Switzerland
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Park HR, Jeong SS, Kim JH, Myeong HS, Park HJ, Park KH, Park K, Yoon BW, Park S, Kim JW, Chung HT, Kim DG, Paek SH. Long-Term Outcome of Unilateral Acoustic Neuromas With or Without Hearing Loss: Over 10 Years and Beyond After Gamma Knife Radiosurgery. J Korean Med Sci 2023; 38:e332. [PMID: 37846791 PMCID: PMC10578997 DOI: 10.3346/jkms.2023.38.e332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/09/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Since the long-term outcomes of 162 patients who underwent gamma knife radiosurgery (GKS) as an initial or adjuvant treatment for acoustic neuromas (ANs) with unilateral hearing loss were first reported in 1998, there has been no report of a comprehensive analysis of what has changed in GKS practice. METHODS We performed a retrospective study of the long-term outcomes of 106 patients with unilateral sporadic ANs who underwent GKS as an initial treatment. The mean patient age was 50 years, and the mean initial tumor volume was 3.68 cm3 (range, 0.10-23.30 cm3). The median marginal tumor dose was 12.5 Gy (range, 8.0-15.0 Gy) and the median follow-up duration was 153 months (range, 120-216 months). RESULTS The tumor volume increased in 11 patients (10.4%), remained stationary in 27 (25.5%), and decreased in 68 patients (64.2%). The actuarial 3, 5, 10, and 15-year tumor control rates were 95.3 ± 2.1%, 94.3 ± 2.2%, 87.7 ± 3.2%, and 86.6 ± 3.3%, respectively. The 10-year actuarial tumor control rate was significantly lower in the patients with tumor volumes of ≥ 8 cm3 (P = 0.010). The rate of maintaining the same Gardner-Robertson scale grade was 28.6%, and that of serviceable hearing was 46.4%. The rates of newly developed facial and trigeminal neuropathy were 2.8% and 4.7%, respectively. The patients who received marginal doses of less than 12 Gy revealed higher tumor control failure rates (P = 0.129) and newly occurred facial or trigeminal neuropathy rates (P = 0.040 and 0.313, respectively). CONCLUSION GKS as an initial treatment for ANs could be helpful in terms of tumor control, the preservation of serviceable hearing, and the prevention of cranial neuropathy. It is recommended to perform GKS as soon as possible not only for tumor control in unilateral ANs with hearing loss but also for hearing preservation in those without hearing loss.
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Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sang Soon Jeong
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Jung Hoon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Ho Sung Myeong
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Hyun Joo Park
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwang Hyon Park
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
| | - Kawngwoo Park
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Byung Woo Yoon
- Department of Internal Medicine, School of Medicine, Chung-Ang University, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Tai Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Dong Gyu Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
- Hypoxia/Ischemia Disease Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Advanced Institutes of Convergence Technology, Suwon, Korea.
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Santacroce A, Trandafirescu MF, Levivier M, Peters D, Fürweger C, Toma-Dasu I, George M, Daniel RT, Maire R, Nakamura M, Faouzi M, Schiappacasse L, Dasu A, Tuleasca C. Proton beam radiation therapy for vestibular schwannomas-tumor control and hearing preservation rates: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:163. [PMID: 37402894 PMCID: PMC10319703 DOI: 10.1007/s10143-023-02060-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Proton beam therapy is considered, by some authors, as having the advantage of delivering dose distributions more conformal to target compared with stereotactic radiosurgery (SRS). Here, we performed a systematic review and meta-analysis of proton beam for VSs, evaluating tumor control and cranial nerve preservation rates, particularly with regard to facial and hearing preservation. METHODS We reviewed, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) articles published between 1968 and September 30, 2022. We retained 8 studies reporting 587 patients. RESULTS Overall rate of tumor control (both stability and decrease in volume) was 95.4% (range 93.5-97.2%, p heterogeneity= 0.77, p<0.001). Overall rate of tumor progression was 4.6% (range 2.8-6.5%, p heterogeneity < 0.77, p<0.001). Overall rate of trigeminal nerve preservation (absence of numbness) was 95.6% (range 93.5-97.7%, I2 = 11.44%, p heterogeneity= 0.34, p<0.001). Overall rate of facial nerve preservation was 93.7% (range 89.6-97.7%, I2 = 76.27%, p heterogeneity<0.001, p<0.001). Overall rate of hearing preservation was 40.6% (range 29.4-51.8%, I2 = 43.36%, p heterogeneity= 0.1, p<0.001). CONCLUSION Proton beam therapy for VSs achieves high tumor control rates, as high as 95.4%. Facial rate preservation overall rates are 93%, which is lower compared to the most SRS series. Compared with most currently reported SRS techniques, proton beam radiation therapy for VSs does not offer an advantage for facial and hearing preservation compared to most of the currently reported SRS series.
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Affiliation(s)
- Antonio Santacroce
- European Radiosurgery Centre Munich, Munich, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Hamm, 59073, Germany
| | | | - Marc Levivier
- Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital (CHUV), Rue du Bugnon 44-46, BH-08, CH-1011, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - David Peters
- Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital (CHUV), Rue du Bugnon 44-46, BH-08, CH-1011, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | | | - Iuliana Toma-Dasu
- Oncology Pathology Department, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Medical Radiation Physics, Stockholm University, Stockholm, Sweden
| | - Mercy George
- ENT Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Roy Thomas Daniel
- Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital (CHUV), Rue du Bugnon 44-46, BH-08, CH-1011, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Raphael Maire
- ENT Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Makoto Nakamura
- Department of Neurosurgery, Academic Hospital Köln-Merheim, Köln, 51058, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, 58455, Germany
| | - Mohamed Faouzi
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Luis Schiappacasse
- Radiation Oncology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Alexandru Dasu
- The Skandion Clinic and Uppsala University, Uppsala, Sweden
- Medical Radiation Sciences, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Constantin Tuleasca
- Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital (CHUV), Rue du Bugnon 44-46, BH-08, CH-1011, Lausanne, Switzerland.
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
- Ecole Polytechnique Fédérale de Lausanne (EPFL, LTS-5), Lausanne, Switzerland.
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Koffler D, Sidiqi B, Keohane M, Viswanatha S, Huang L, Garcia B, Calugaru E, Chang J, Ellis J, Schulder M, Goenka A. Does Size Matter? On the Role of Stereotactic Radiosurgery for Large Vestibular Schwannomas as Seen in an Institutional Experience of Gamma Knife Radiosurgery for High-Grade Tumors. World Neurosurg 2022:S1878-8750(22)01819-8. [PMID: 36587898 DOI: 10.1016/j.wneu.2022.12.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Management of large vestibular schwannoma (VS) is controversial. Surgery has historically been the treatment of choice, but emerging literature suggests that definitive stereotactic radiosurgery is feasible. We report our institutional experience of control and morbidity outcomes treating Koos grade 3-4 VS with Gamma Knife radiosurgery (GKRS). METHODS An institutional review board-approved database compiled outcomes of Koos grade 3-4 VS treated by GKRS from March 2014 to January 2021 with >6 months' follow-up. Baseline symptoms per Common Terminology Criteria for Adverse Events definitions were recorded. Control rates, toxicities, and post-treatment volumetric changes were analyzed. Aggregate impairment scores (AIs) were defined by the sum of relevant Common Terminology Criteria for Adverse Events grades to categorize symptomatic burdens. Baseline and post-treatment AIs were tested for association with definitive versus adjuvant strategies. RESULTS In total, 34 patients with Koos grade 3-4 VS were identified, 19 treated with definitive GKRS (GKRS-D) and 15 with adjuvant GKRS (GKRS-A). Median follow-up was 34.2 months for GKRS-D and 48.8 months for GKRS-A. Patients who received GKRS-A had greater AIs at presentation (3.73 vs. 2.11, P = 0.017). Irrespective of treatment approach, tumor control rates were 100% without instances of brainstem necrosis or shunt placement. Six of 19 patients who received GKRS-D had improved post-treatment AI, and 63% of patients who received GKRS-D and 66% of patients who received GKRS-A had tumor shrinkage >20%. CONCLUSIONS In well-selected patients with Koos grade 3-4 VS, definitive stereotactic radiosurgery may be an appropriate strategy with excellent control and minimal toxicity. Our data suggest that the need for surgical decompression should be considered based on pretreatment symptom burden rather than tumor size.
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Hopewell JW, Moore J, Villafuerte CJ, Paddick I, Jones B, Hill MA, Tsang DS. Improving the Accuracy of Biologically Effective Dose Estimates, from a Previously Published Study, After Radiosurgery for Acoustic Neuromas. World Neurosurg 2022; 172:e130-e143. [PMID: 36587897 DOI: 10.1016/j.wneu.2022.12.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To recalculate biological effective dose values (BED) for radio-surgical treatments of acoustic neuroma from a previous study. BEDs values were previously overestimated by only using beam-on times in calculations, so excluding the important beam-off-times (when deoxyribonucleic acid repair continues) which contribute to the overall treatment time. Simple BED estimations using a mono-exponential approximation may not always be appropriate but if used should include overall treatment time. METHODS Time intervals between isocenters were estimated. These were especially important for the Gamma Knife Model 4C cases since manual changes significantly increase overall treatment times. Individual treatment parameters, such as iso-center number, beam-on-time, and beam-off-time, were then used to calculate BED values using a more appropriate bi-exponential model that includes fast and slow components of DNA damage repair over a wider time range. RESULTS The revised BED estimates differed significantly from previously published values. The overestimates of BED, obtained using beam-on-time only, varied from 0%-40.3%. BED subclasses, each with a BED range of 5 Gy2.47, indicated that revised values were consistently reduced when compared with originally quoted values, especially for 4C compared with Perfexion cases. Furthermore, subdivision of 4C cases by collimator number further emphasized the impact of scheduled gap times on BED. Further analysis demonstrated important limitations of the mono-exponential model. Target volume was a major confounding factor in the interpretation of the results of this study. CONCLUSIONS BED values should be estimated by including beam-on and beam-off times. Suggestions are provided for more accurate BED estimations in future studies.
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Affiliation(s)
- John W Hopewell
- Green Templeton College, University of Oxford, Oxford, UK; Department of Oncology, University of Oxford, Oxford, UK.
| | - Joshua Moore
- School of Mathematics, Cardiff University, Cardiff, UK
| | | | - Ian Paddick
- Queen Square Gamma Knife Centre, National Hospital for Neurology and Neurosurgery, London, UK
| | - Bleddyn Jones
- Green Templeton College, University of Oxford, Oxford, UK; Department of Oncology, University of Oxford, Oxford, UK
| | - Mark A Hill
- Department of Oncology, University of Oxford, Oxford, UK
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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9
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Moutsatsos A, Kouris P, Zoros M, Athanasiou O, Koutsarnakis C, Pantelakos P, Pantelis E. On the effect of dose delivery temporal domain on the biological effectiveness of central nervous system CyberKnife radiosurgery applications: theoretical assessment using the concept of biologically effective dose. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac783b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/13/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective: The diversity in technical configuration between clinically available radiosurgery systems, results in accordingly diverse treatment times for the same physical dose prescription, spanning from several min to more than 1 h. This, combined with evidence supporting the impact of dose delivery temporal pattern on the bio-effectiveness of low-LET radiation treatments, challenges the ‘acute exposure’ assumption adopted clinically to estimate the biological outcome of a given treatment scheme under the concept of biologically effective dose (BED). Approach: In this work, the treatment plans of 30 patients underwent CyberKnife radiosurgery for vestibular schwannoma (VS), prescribing a marginal dose of 13 Gy to the tumor, were retrospectively reviewed and the corresponding dose distributions were resolved in the temporal domain. For this purpose, the dose delivery timeline for each treatment was calculated based on relevant treatment plan data and technical specifications of the CyberKnife system, while dosimetry data were independently acquired on a CT-based digital model of each patient using an in-house developed dose calculation algorithm. Main results: Results showed that CyberKnife delivers highly inhomogeneous dose rate distributions in the temporo-spatial domain. This influences the delivered BED levels due to alterations in the sublethal damage repair (SLR) occurring within the treatment session. Using a BED framework involving SLR effects, it was shown that each physical dose iso-surface is associated with a BEDslr range. For the patient cohort studied, a typical range of 2%, with respect to the mean BEDslr value was found at 1σ. Significance: The marginal BEDslr delivered to the tumor by the prescription dose iso-surface deteriorates with treatment time, involving both beam-on time and beam-off gaps. For treatment time, T, between 21 and 50 min, this can be expressed by
BED
slr
(
Gy
2.47
)
=
−
0.35
±
2.8
%
∙
T
min
+
(
76.74
±
0.4
%
)
.
Compared to the acute exposure approach, a BED ‘loss’ of 21% is associated with the delivery of 13 Gy to the VS-tumor in 35 min.
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Tuleasca C, Knisely J, Levivier M. Reply to the letter to the editor regarding "Biologically effective dose for vestibular schwannomas: the truth and nothing but the truth". Neurosurg Rev 2022. [PMID: 35513738 DOI: 10.1007/s10143-022-01804-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Jones B, Hopewell JW, Paddick I. Biologically effective dose correlates with linear tumour volume changes after upfront single-fraction stereotactic radiosurgery for vestibular schwannomas. Neurosurg Rev 2022; 45:2493-2495. [PMID: 35290549 DOI: 10.1007/s10143-022-01769-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/04/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Bleddyn Jones
- Green Templeton College, University of Oxford, Oxford, UK
- Gray Laboratory, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | | | - Ian Paddick
- Queens Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, UK
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