CYBERKNIFE IN THE TREATMENT OF SPINALCORD TUMOURS
When treating benign spinal tumors with radiosurgery, the primary intermediate objective is to stop all tumor growth. Over the long term, these tumors will gradually shrink in size which may take a period of several years. Preliminary results with CyberKnife radiosurgery for meningioma and schwannoma show excellent control of tumor growth.
Treatment with CyberKnife radiosurgery utilizing a hypofractionated treatment regimen was indicated for maximum local control and to minimize the chance of injury to the spinal cord.
Outcome and Follow-Up
At 3-month follow-up:
* Neck, shoulder and arm pain dramatically decreased
* Neck and left arm mobility much improved
* MRI study showed no progression of meningioma
9-month follow-up:
* Improved neck and left shoulder mobility
* Left arm strength increasing
* Some numbness in left upper arm but improved compared to last visit
12-month follow-up:
* Increased left shoulder and neck mobility
* Increased left arm function
* No new symptoms or problems
22-month follow-up:
* Left arm range of motion improved, arm strength stable,
mild residual weakness
* No new problems
* No neck pain
* Follow-up MRI reveals no evidence of tumor progression and stability
of the previously treated lesion
Conclusion
The patient has experienced significant improvement since undergoing stereotactic radiosurgery. MRI shows no evidence of tumor progression. Follow-up will occur on an annual basis with continued MRI surveillance.
SOURCE : http://www.utmedicalcenter.org/lib/file/manager/pages/cancer-institute/resources/-utmc-cyberknife-annual-report_011711.pdf
FOR MORE INFORMATION ON CYBERKNIFE YOU MAY BLOG YOUR QUERIES OR WRITE TO lakshmipriya_b@apollohospitals.com
Thursday, April 19, 2012
CYBERKNIFE IN TREATMENT OF PITUITARY ADENOMAS
CYBERKNIFE IN TREATMENT OF PITUITARY ADENOMAS
In recent years, CyberKnife has emerged as an important treatment modality in the management of pituitary adenomas. Treatment results after performing CyberKnife and the complications of this procedure are reviewed.
Methods
Twenty-six patients with pituitary adenomas received stereotactic radiosurgery with the CyberKnife (CKRS). The follow-up periods ranged from 7 months to 47 months (mean±SD : 30±12.7 months). The patients consisted of 17 with non-functioning adenomas, 3 with prolactinomas and 6 with acromegaly. The change in the tumor volume, visual acuity, hormonal function, and complications by this therapy were analyzed in each case.
Results
The tumor control rate was 92.3%. Hormonal function was improved in all of the 9 (100%) functioning adenomas. Hormonal normalization was observed in 4 of the 9 (44%) patients with a mean duration of 16 months. In two patients (7.6%), visual acuity worsened due to cystic enlargement of the tumor after CKRS. No other complications were observed.
Conclusion
CyberKnife is considered safe and effective in selected patients with pituitary adenomas. However, longer follow-up is required for a more complete assessment of late toxicity and treatment efficacy.
FOR MORE INFORMATION YOU MAY BLOG YOUR COMMENTS OR WRITE TO lakshmipriya_b@apollohospitals.com
In recent years, CyberKnife has emerged as an important treatment modality in the management of pituitary adenomas. Treatment results after performing CyberKnife and the complications of this procedure are reviewed.
Methods
Twenty-six patients with pituitary adenomas received stereotactic radiosurgery with the CyberKnife (CKRS). The follow-up periods ranged from 7 months to 47 months (mean±SD : 30±12.7 months). The patients consisted of 17 with non-functioning adenomas, 3 with prolactinomas and 6 with acromegaly. The change in the tumor volume, visual acuity, hormonal function, and complications by this therapy were analyzed in each case.
Results
The tumor control rate was 92.3%. Hormonal function was improved in all of the 9 (100%) functioning adenomas. Hormonal normalization was observed in 4 of the 9 (44%) patients with a mean duration of 16 months. In two patients (7.6%), visual acuity worsened due to cystic enlargement of the tumor after CKRS. No other complications were observed.
Conclusion
CyberKnife is considered safe and effective in selected patients with pituitary adenomas. However, longer follow-up is required for a more complete assessment of late toxicity and treatment efficacy.
FOR MORE INFORMATION YOU MAY BLOG YOUR COMMENTS OR WRITE TO lakshmipriya_b@apollohospitals.com
Saturday, March 3, 2012
CYBERKNIFE TREATMENT FOR SPINAL CORD TUMORS
Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution.
Gerszten PC, Burton SA, Ozhasoglu C, Welch WC.
SourceDepartment of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. gersztenpc@upmc.edu
Abstract
STUDY DESIGN: A prospective nonrandomized, longitudinal cohort study.
OBJECTIVE: To evaluate the clinical outcomes of single-fraction radiosurgery as part of the management of metastatic spine tumors.
SUMMARY OF BACKGROUND DATA: The role of stereotactic radiosurgery for the treatment of spinal lesions has previously been limited by the availability of effective target immobilization and target tracking devices. Large clinical experience with spinal radiosurgery to properly assess clinical experience has previously been limited.
METHODS: A cohort of 500 cases of spinal metastases underwent radiosurgery. Ages ranged from 18 to 85 years (mean 56). Lesion location included 73 cervical, 212 thoracic, 112 lumbar, and 103 sacral.
RESULTS: The maximum intratumoral dose ranged from 12.5 to 25 Gy (mean 20). Tumor volume ranged from 0.20 to 264 mL (mean 46). Long-term pain improvement occurred in 290 of 336 cases (86%). Long-term tumor control was demonstrated in 90% of lesions treated with radiosurgery as a primary treatment modality and in 88% of lesions treated for radiographic tumor progression. Twenty-seven of 32 cases (84%) with a progressive neurologic deficit before treatment experienced at least some clinical improvement.
CONCLUSIONS: The results indicate the potential of radiosurgery in the treatment of patients with spinal metastases, especially those with solitary sites of spine involvement, to improve long-term palliation.
Source : http://www.ncbi.nlm.nih.gov/pubmed/17224814
For more information you may blog your comments or write to lakshmipriya_b@apollohospitals.com
Gerszten PC, Burton SA, Ozhasoglu C, Welch WC.
SourceDepartment of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. gersztenpc@upmc.edu
Abstract
STUDY DESIGN: A prospective nonrandomized, longitudinal cohort study.
OBJECTIVE: To evaluate the clinical outcomes of single-fraction radiosurgery as part of the management of metastatic spine tumors.
SUMMARY OF BACKGROUND DATA: The role of stereotactic radiosurgery for the treatment of spinal lesions has previously been limited by the availability of effective target immobilization and target tracking devices. Large clinical experience with spinal radiosurgery to properly assess clinical experience has previously been limited.
METHODS: A cohort of 500 cases of spinal metastases underwent radiosurgery. Ages ranged from 18 to 85 years (mean 56). Lesion location included 73 cervical, 212 thoracic, 112 lumbar, and 103 sacral.
RESULTS: The maximum intratumoral dose ranged from 12.5 to 25 Gy (mean 20). Tumor volume ranged from 0.20 to 264 mL (mean 46). Long-term pain improvement occurred in 290 of 336 cases (86%). Long-term tumor control was demonstrated in 90% of lesions treated with radiosurgery as a primary treatment modality and in 88% of lesions treated for radiographic tumor progression. Twenty-seven of 32 cases (84%) with a progressive neurologic deficit before treatment experienced at least some clinical improvement.
CONCLUSIONS: The results indicate the potential of radiosurgery in the treatment of patients with spinal metastases, especially those with solitary sites of spine involvement, to improve long-term palliation.
Source : http://www.ncbi.nlm.nih.gov/pubmed/17224814
For more information you may blog your comments or write to lakshmipriya_b@apollohospitals.com
Visual field preservation thru cyberknife radiosurgery
Visual field preservation after multisession cyberknife radiosurgery for perioptic lesions.
Adler JR Jr, Gibbs IC, Puataweepong P, Chang SD.
SourceDepartment of Neurosurgery, Stanford University Medical School, Stanford, California 94305, USA. jra@stanford.edu
Abstract
OBJECTIVE: The restricted radiation tolerance of the anterior visual pathways represents a unique challenge for ablating adjacent lesions with single-session radiosurgery. Although preliminary studies have recently demonstrated that multisession radiosurgery for selected perioptic tumors is both safe and effective, the number of patients in these clinical series was modest and the length of follow-up limited. The current retrospective study is intended to help address these shortcomings.
METHODS: Forty-nine consecutive patients with meningioma (n = 27), pituitary adenoma (n = 19), craniopharyngioma (n = 2), or mixed germ cell tumor (n = 1) situated within 2 mm of a "short segment" of the optic apparatus underwent multisession image-guided radiosurgery at Stanford University Medical Center. Thirty-nine of these patients had previous subtotal surgical resection, and six had previously been treated with conventional fractionated radiotherapy (6). CyberKnife radiosurgery was delivered in two to five sessions to an average tumor volume of 7.7 cm3 and a cumulative average marginal dose of 20.3 Gy. Formal visual testing and clinical examinations were performed before treatment and at follow-up intervals beginning at 6 months.
RESULTS: After a mean visual field follow-up of 49 months (range, 6-96 mo), vision was unchanged postradiosurgery in 38 patients, improved in eight (16%), and worse in three (6%). In each instance, visual deterioration was accompanied by tumor progression that ultimately resulted in patient death. However, one of these patients, who had a multiply recurrent adrenocorticotropic hormone-secreting pituitary adenoma, initially experienced early visual loss without significant tumor progression after both a previous course of radiotherapy and three separate sessions of radiosurgery. After a mean magnetic resonance imaging follow-up period of 46 months, tumor volume was stable or smaller in all other cases. Two patients died of unrelated nonbrain causes.
CONCLUSION: Multisession radiosurgery resulted in high rates of tumor control and preservation of visual function in this group of perioptic tumors. Ninety-four percent of patients retained or improved preradiosurgical vision. This intermediate-term experience reinforces the findings from earlier studies that suggested that multisession radiosurgery can be a safe and effective alternative to either surgery or fractionated radiotherapy for selected lesions immediately adjacent to short segments of the optic apparatus.
Source : http://www.ncbi.nlm.nih.gov/pubmed/18596432
For more information you may blog your comments or write to lakshmipriya_b@apollohospitals.com
Adler JR Jr, Gibbs IC, Puataweepong P, Chang SD.
SourceDepartment of Neurosurgery, Stanford University Medical School, Stanford, California 94305, USA. jra@stanford.edu
Abstract
OBJECTIVE: The restricted radiation tolerance of the anterior visual pathways represents a unique challenge for ablating adjacent lesions with single-session radiosurgery. Although preliminary studies have recently demonstrated that multisession radiosurgery for selected perioptic tumors is both safe and effective, the number of patients in these clinical series was modest and the length of follow-up limited. The current retrospective study is intended to help address these shortcomings.
METHODS: Forty-nine consecutive patients with meningioma (n = 27), pituitary adenoma (n = 19), craniopharyngioma (n = 2), or mixed germ cell tumor (n = 1) situated within 2 mm of a "short segment" of the optic apparatus underwent multisession image-guided radiosurgery at Stanford University Medical Center. Thirty-nine of these patients had previous subtotal surgical resection, and six had previously been treated with conventional fractionated radiotherapy (6). CyberKnife radiosurgery was delivered in two to five sessions to an average tumor volume of 7.7 cm3 and a cumulative average marginal dose of 20.3 Gy. Formal visual testing and clinical examinations were performed before treatment and at follow-up intervals beginning at 6 months.
RESULTS: After a mean visual field follow-up of 49 months (range, 6-96 mo), vision was unchanged postradiosurgery in 38 patients, improved in eight (16%), and worse in three (6%). In each instance, visual deterioration was accompanied by tumor progression that ultimately resulted in patient death. However, one of these patients, who had a multiply recurrent adrenocorticotropic hormone-secreting pituitary adenoma, initially experienced early visual loss without significant tumor progression after both a previous course of radiotherapy and three separate sessions of radiosurgery. After a mean magnetic resonance imaging follow-up period of 46 months, tumor volume was stable or smaller in all other cases. Two patients died of unrelated nonbrain causes.
CONCLUSION: Multisession radiosurgery resulted in high rates of tumor control and preservation of visual function in this group of perioptic tumors. Ninety-four percent of patients retained or improved preradiosurgical vision. This intermediate-term experience reinforces the findings from earlier studies that suggested that multisession radiosurgery can be a safe and effective alternative to either surgery or fractionated radiotherapy for selected lesions immediately adjacent to short segments of the optic apparatus.
Source : http://www.ncbi.nlm.nih.gov/pubmed/18596432
For more information you may blog your comments or write to lakshmipriya_b@apollohospitals.com
Tuesday, February 21, 2012
Nasopharynx Angiofibroma
Nasopharynx Angiofibroma
This 21 years old patient from Colombo Srilanka came to us in March 2010 with the following history.
He was diagnosed as a case of nasopharynx angiofibroma in 2005 after couple of episodes of nasal bleeding, he underwent surgery for the same, but his symptoms re-occurred within 8 months. CT scan revealed recurrence. He underwent re-excision in 2006. Again in 2008 he had recurrence and 3rd surgery was done. In January 2010 MRI scan revealed recurrent mass which measured 4.1x3.8x4.0 – Left nasopharynx with erosion of left Pterygoid plate and extension to extradural space. Patient being young and had faced multiple surgeries was very anxious. His parents were also stressed, we took up the case and subjected the patient for CyberKnife Radio surgery after proper planning and verification (patient received treatment from 3.3.2010 to 8.3 .2010).
Patient is on regular follow up. The follow up scans and volume analysis shows good response to treatment with couple resolution of disease. Patient is locally asymptomatic and is in a good job. His health has improved very well, looks handsome, Parents are having a nice smile in their face.
To know more about cyberknife you may blog your comments or write to lakshmipriya_b@apollohospitals.com
This 21 years old patient from Colombo Srilanka came to us in March 2010 with the following history.
He was diagnosed as a case of nasopharynx angiofibroma in 2005 after couple of episodes of nasal bleeding, he underwent surgery for the same, but his symptoms re-occurred within 8 months. CT scan revealed recurrence. He underwent re-excision in 2006. Again in 2008 he had recurrence and 3rd surgery was done. In January 2010 MRI scan revealed recurrent mass which measured 4.1x3.8x4.0 – Left nasopharynx with erosion of left Pterygoid plate and extension to extradural space. Patient being young and had faced multiple surgeries was very anxious. His parents were also stressed, we took up the case and subjected the patient for CyberKnife Radio surgery after proper planning and verification (patient received treatment from 3.3.2010 to 8.3 .2010).
Patient is on regular follow up. The follow up scans and volume analysis shows good response to treatment with couple resolution of disease. Patient is locally asymptomatic and is in a good job. His health has improved very well, looks handsome, Parents are having a nice smile in their face.
To know more about cyberknife you may blog your comments or write to lakshmipriya_b@apollohospitals.com
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