Local control and toxicity outcomes in brainstem metastases treated with single fraction radiosurgery: is there a volume threshold for toxicity?

Gamma Knife Radiosurgery (GKRS) has been reported in the treatment of brainstem metastases while dose volume toxicity thresholds remain mostly undefined. A retrospective review of 52 brainstem metastases in 44 patients treated with GKRS was completed. A median dose of 18 Gy (range 10-22 Gy) was prescribed to the tumor margin (median 50 % isodose).

Single-institution retrospective series of gamma knife radiosurgery in the treatment of multiple sclerosis-related trigeminal neuralgia: factors that predict efficacy.

Background: Gamma knife radiosurgery (GKRS) has been reported as a treatment option for multiple sclerosis (MS)-related trigeminal neuralgia.

Objective: To report the outcomes of a single-institution retrospective series of MS-related trigeminal neuralgia.

Methods: Between 2002 and 2010, 35 patients with MS-related trigeminal neuralgia were treated with GKRS.

Retrospective analysis of imaging techniques for treatment planning and monitoring of obliteration for gamma knife treatment of cerebral arteriovenous malformation.

Background: It has been well established that Gamma Knife radiosurgery (GKS) is an effective treatment for brain arteriovenous malformations (AVMs).

Objective: To evaluate complete obliteration rates for magnetic resonance imaging (MRI)-based GKS treatment planning performed with and without angiography and to conduct a preliminary assessment of the utility of using pulsed arterial spin labeling (PASL) magnetic resonance (MR) perfusion imaging to confirm complete obliteration.

Methods: Forty-six patients were identified who had undergone GKS without embolization with a minimum follow-up of 2 years.

Gamma knife radiosurgery in the treatment of tumor-related facial pain.

Background: Intracranial neoplasms can cause pain similar to trigeminal neuralgia. Literature regarding radiosurgery for this is limited. We present a retrospective review of patients with tumor-related facial pain from benign lesions treated with gamma knife radiosurgery (GKRS) at Wake Forest University.

Patterns of failure after treatment of atypical meningioma with gamma knife radiosurgery.

Atypical meningiomas have poor local control with emerging literature indicating the use of radiosurgery in treatment. The purpose of this study was to evaluate clinical outcomes including local control and failure pattern after Gamma Knife radiosurgery (GKRS) and factors that may affect these outcomes. Between 1999 and 2008, 24 patients were treated with GKRS as either primary or salvage treatment for pathologically proven atypical meningiomas.

Gamma knife stereotactic radiosurgery as salvage therapy after failure of whole-brain radiotherapy in patients with small-cell lung cancer.

Purpose: Radiosurgery has been successfully used in selected cases to avoid repeat whole-brain irradiation (WBI) in patients with multiple brain metastases of most solid tumor histological findings. Few data are available for the use of radiosurgery for small-cell lung cancer (SCLC).

Methods And Materials: Between November 1999 and June 2009, 51 patients with SCLC and previous WBI and new brain metastases were treated with GammaKnife stereotactic radiosurgery (GKSRS).

Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery.

Background: Gamma Knife radiosurgery (GKRS) has been reported to be an effective modality to treat trigeminal neuralgia.

Objective: To determine predictive factors for the successful treatment of trigeminal neuralgia with GKRS.

Methods: Between 1999 and 2008, 777 GKRS procedures for patients with trigeminal neuralgia were performed at our institution.

Toxicity of gamma knife radiosurgery in the treatment of intracranial tumors in patients with collagen vascular diseases or multiple sclerosis.

Purpose: To assess toxicity in patients with either a collagen vascular disease (CVD) or multiple sclerosis (MS) treated with intracranial radiosurgery.

Methods And Materials: Between January 2004 and April 2009, 6 patients with MS and 14 patients with a CVD were treated with Gamma Knife radiosurgery (GKRS) for intracranial tumors. Treated lesions included 15 total brain metastases in 7 patients, 11 benign brain tumors, 1 low grade glioma, and 1 cavernous malformation.

Cavity-directed radiosurgery as adjuvant therapy after resection of a brain metastasis.

Object: As a strategy to delay or avoid whole-brain radiotherapy (WBRT) after resection of a brain metastasis, the authors used high-resolution MR imaging and cavity-directed radiosurgery for the detection and treatment of further metastases.

Methods: Between April 2001 and October 2009, 112 resection cavities in 106 patients with no prior WBRT were treated using radiosurgery directed to the tumor cavity and for any synchronous brain metastases detected on high-resolution MR imaging at the time of radiosurgical planning. A median dose of 17 Gy to the 50% isodose line was prescribed to the gross tumor volume, defined as the rim of enhancement around the resection cavity.

Repeat gamma knife radiosurgery for trigeminal neuralgia.

Purpose: Repeat gamma knife stereotactic radiosurgery (GKRS) for recurrent or persistent trigeminal neuralgia induces an additional response but at the expense of an increased incidence of facial numbness. The present series summarized the results of a repeat treatment series at Wake Forest University Baptist Medical Center, including a multivariate analysis of the data to identify the prognostic factors for treatment success and toxicity.

Methods And Materials: Between January 1999 and December 2007, 37 patients underwent a second GKRS application because of treatment failure after a first GKRS treatment.

Use of 3.0-T MRI for stereotactic radiosurgery planning for treatment of brain metastases: a single-institution retrospective review.

Purpose: To investigate the efficacy of 3.0-T magnetic resonance imaging (MRI) for detecting brain metastases for stereotactic radiosurgery (SRS) planning.

Methods And Materials: All adult patients scheduled for SRS treatment for brain metastases at our institution between October 2005 and January 2008 were eligible for analysis.

Clinical experience with radiation therapy in the management of neurofibromatosis-associated central nervous system tumors.

Purpose: Patients with neurofibromatosis (NF) develop tumors of the central nervous system (CNS). Radiation therapy (RT) is used to treat these lesions. To better define the efficacy of RT in these patients, we reviewed our 20-year experience.

Photon spectral characteristics of dissimilar 6 MV linear accelerators.

This work measures and compares the energy spectra of four dosimetrically matched 6 MV beams, generated from four physically different linear accelerators. The goal of this work is twofold. First, this study determines whether the spectra of dosimetrically matched beams are measurably different.

A simple model predicts freedom from biochemical recurrence after low-dose rate prostate brachytherapy alone.

Objective: The objective of this study was to describe a simple model that predicts freedom from biochemical recurrence (FFBR) in men with prostate cancer after treatment with low-dose rate prostate brachytherapy (LDRPB) alone.

Materials And Methods: One hundred thirty-two men were treated with LDRPB alone between September 1997 and April 2001. Sixty-four percent of men had low-risk disease (prostate-specific antigen [PSA] <10, Gleason <7, and T stage or =10, Gleason > or =7, or T stage T2b).

Optically guided linac radiosurgery with a Leksell head frame as an adjunct to Gamma Knife treatment.

Because of geometrical limitations in the helmet of the Leksell Gamma Knife(Elekta Corp., Atlanta, GA, USA) certain regions within the cranium cannot be targeted for treatment. We describe a method by which lesions in these regions can be treated with the Varian-Zmed stereotactic radiosurgery system utilizing an infrared optical positioning system attached to a Leksell head frame.

Gamma Knife surgery targeting the resection cavity of brain metastasis that has progressed after whole-brain radiotherapy.

Object: Salvage treatment of large, symptomatic brain metastases after failure of whole-brain radiotherapy (WBRT) remains challenging. When these lesions require resection, there are few options to lower expected rates of local recurrence at the resection cavity margin. The authors describe their experience in using Gamma Knife surgery (GKS) to target the resection cavity in patients whose tumors had progressed after WBRT.

Does dose rate affect efficacy? The outcomes of 256 gamma knife surgery procedures for trigeminal neuralgia and other types of facial pain as they relate to the half-life of cobalt.

Object: Gamma Knife surgery (GKS) is a treatment option for patients with refractory typical trigeminal neuralgia (TN), TN with atypical features, and atypical types of facial pain. The Gamma Knife's 201 60Co sources decay with a half-life of 5.26 years.

Dosimetric quantifiers for low-dose-rate prostate brachytherapy: is V(100) superior to D(90)?

Purpose: The purpose of the present report is to describe the relationship between two dosimetric quantifiers (V(100) and D(90)) and freedom from biochemical recurrence (FFBR) in a cohort of men treated with low-dose-rate prostate brachytherapy (LDRPB) alone.

Methods And Materials: One hundred three men were treated with LDRPB alone between September 1997 and December 1999. All men had histologically confirmed clinically localized prostate cancer.

Dosimetry and cancer control after low-dose-rate prostate brachytherapy.

Purpose: To describe the relationship between two commonly used dosimetric quantifiers (dose received by 90% of the prostate [D(90)] and volume receiving 100% of dose [V(100)]) and biochemical disease-free survival (bDFS) in a cohort of men treated with low-dose-rate prostate brachytherapy (LDRPB).

Methods And Materials: The information in this report concerned the first 63 men treated with LDRPB alone at our institution between September 1997 and September 1998. All men had histologically confirmed, clinically localized prostate cancer.

Cancer control after low-dose-rate prostate brachytherapy performed by a multidisciplinary team with no previous prostate brachytherapy experience.

Objectives: To describe the biochemical disease-free survival observed in the first cohort men treated by a multidisciplinary team of clinicians with no previous experience in low-dose-rate prostate brachytherapy (LDRPB).

Methods: The information in this report concerns the first 63 men treated with LDRPB alone at our institution between September 1997 and September 1998. All men had histologically confirmed, clinically localized prostate cancer.

Radiation dose to the neurovascular bundles or penile bulb does not predict erectile dysfunction after prostate brachytherapy.

Purpose: To examine the relationship between calculated doses to the neurovascular bundles (NVBs) and the penile bulb (PB) and the development of erectile dysfunction (ED) after low-dose-rate prostate brachytherapy (LDRPB) alone.

Methods And Materials: Between September 1997 and June 1999, 84 men were treated with LDRPB alone. Inclusion criteria for this study were (1) no ED according to a self-administered questionnaire before PB, (2) treatment with PB alone (125I; 144 Gy), (3) postimplant CT scan of the prostate 1 month after PB, and (4) minimum of 24 months of continuous follow-up.

The use of a Leksell-BRW adapter for linac radiosurgery as an adjunct to Gamma Knife treatment.

We have investigated the use of an adapter that permits the use of a Leksell coordinate frame with a linear accelerator stereotactic radiosurgery system based on the Brown-Robert-Wells (BRW) design. This device is useful when lesions that are planned for treatment on a Leksell Gamma Knife system are found to be inaccessible to the Gamma Knife. We have found that with this device objects within a head phantom can be targeted by the linear accelerator within an accuracy of approximately 1 mm.

Radioactive sources embedded in suture are associated with improved postimplant dosimetry in men treated with prostate brachytherapy.

Background And Purpose: Reports using the retropubic and transperineal technique of prostate brachytherapy suggest that adequate radiation doses are required for good clinical results with I-125. After 3 years of using loose sources (LS), radioactive sources embedded in suture (SES) were introduced into our prostate brachytherapy technique. The purpose of the present report is to determine whether dosimetric quantifiers of implant adequacy were affected by the use of SES.