Impact of Fractionation Regimen on Local Control Following Frameless Linear Accelerator-Based Image-Guided Stereotactic Radiosurgery and Radiotherapy for Intracranial Meningioma.

Objective: Stereotactic radiosurgery (SRS) is an established treatment for intracranial meningioma, yet this approach is often precluded by tumor size or proximity to critical structures. Fractionated radiotherapy (RT) may be employed to address these limitations. We performed a comparison of local control (LC) outcomes between 3 stereotactic techniques.

Pediatric Intracranial Arteriovenous Malformation: Long-Term Outcomes with Linear Accelerator (LINAC)-Based Radiosurgery.

Purpose: To analyze and report the long-term outcomes of intracranial arteriovenous malformations (AVM) treated with linear accelerator (LINAC)-based radiosurgery (LBRS) in the pediatric population.

Methods And Materials: A series of 34 pediatric patients (≤18 years old) who were treated between 2002 and 2016 were analyzed. All patients were treated with LBRS in a single fraction, with a median dose of 16.

A comparative outcomes analysis of patients treated for arteriovenous malformation with LINAC-based stereotactic radiosurgery by a standard frame-based technique or a frameless technique utilizing 3-dimensional rotational angiography.

Previous work at our institution treating arteriovenous malformation (AVM) with radiosurgery (RS) demonstrated superior nidus visualization and geometric accuracy with use of 3-dimensional rotational angiography (3DRA) compared to biplanar digital subtraction angiography. We have since adopted a unique radiosurgical protocol that utilizes 3DRA in the planning of linear accelerator (LINAC)-based RS delivered in a frameless manner. This study seeks to compare clinical outcomes between patients treated by this novel approach and those treated by our historic frame-based protocol.

Long-Term Outcomes of Newly Diagnosed Resected Atypical Meningiomas and the Role of Adjuvant Radiotherapy.

Objective: The role of adjuvant radiotherapy (ART) in patients with World Health Organization Grade II atypical meningiomas (AMs) remains controversial.

Methods: We retrospectively reviewed 149 patients with newly diagnosed resected AMs from 2000 to 2012. Gross total resection (GTR) was defined as Simpson Grades I-III and subtotal resection (STR) as Grades IV and V.

De novo superior cerebellar artery aneurysm following radiosurgery for trigeminal neuralgia.

Stereotactic radiosurgery is a commonly used method for treatment of trigeminal neuralgia. Radiation has been known to be a factor in the later development of aneurysms. Aneurysms have been reported to occur after radiation delivered in a variety of methods including both externally delivered radiation radiosurgery and brachytherapy.

Hypofractionated stereotactic radiosurgery for treatment of cerebral arteriovenous malformations: outcome analysis with use of the modified arteriovenous malformation scoring system.

Radiosurgery has long been an accepted modality for definitive treatment of cerebral arteriovenous malformations (AVM). Efforts to improve the therapeutic ratio for this indication include use of staged volume procedures and hypofractionation. This study reviews our experience with a cohort of patients treated with hypofractionated radiosurgery.

Integral Whole Brain Dose from Stereotactic Radiosurgery of 47 Metastatic Lesions: A Dosimetric Case Study.

This report describes the case of a 15-year-old male diagnosed with primary ALK-positive adenocarcinoma of the lung metastatic to the brain. He was treated with surgical resection for a single lesion followed by whole brain radiotherapy and subsequently underwent 10 courses of stereotactic radiosurgery for 47 lesions delivered over a four-year period. Currently, all metastatic lesions in the brain are completely resolved or locally controlled.

A comparative study of stereotactic radiosurgery, hypofractionated, and fractionated stereotactic radiotherapy in the treatment of skull base meningioma.

Objectives: To compare the outcomes of skull base meningiomas treated with stereotactic radiosurgery (SRS), hypofractionated stereotactic radiotherapy (hFSRT), and fractionated stereotactic radiotherapy (FSRT).

Methods: A total of 220 basal meningiomas in 213 patients were treated using SRS (N=55), hFSRT (N=22), and FSRT (N=143). The median age was 59 years (28 to 84 y).

Photon-based fractionated stereotactic radiotherapy for postoperative treatment of skull base chordomas.

Objectives: We report our series of skull base chordoma patients who underwent surgical resection followed by high-dose fractionated stereotactic radiotherapy (FSRT) as an alternative to proton radiotherapy (RT).

Methods: Between 2002 and 2009, 12 patients with skull base chordomas without prior radiation history were treated with adjuvant or salvage RT. FSRT with dynamic conformal arcs and intensity-modulated radiation therapy boost was used until 2006 when image-guided intensity-modulated FSRT was instituted.

Frameless image-guided radiosurgery for initial treatment of typical trigeminal neuralgia.

Objective: To review retrospectively initial experience at a single institution using frameless image-guided radiosurgery (IGRS) for trigeminal neuralgia employing the Novalis linear accelerator (LINAC) with ExacTrac robotic patient positioning device.

Methods: Over an 18-month period, 44 patients (27 women and 17 men; median age 65 years) were treated with frameless IGRS for typical trigeminal neuralgia (14 cases involved left-sided pain and 30 cases involved right-sided pain), responsive to anticonvulsant medications, with Barrow Neurological Institute Pain Scale (BNI-PS) scores of 4 or 5. All cases were initial radiosurgery treatments with an isocenter dose of 90 Gy delivered via a 4-mm circular collimator forming a spheroid dose envelope.

Control of brain metastases using frameless image-guided radiosurgery.

Object: Radiosurgery is an important and well-accepted method in the management of brain metastases. Using conventional frame-based techniques, high lesional control rates are expected. The introduction of image-guided techniques allows for improved patient comfort and workflow.

Prognostic factors for radiosurgery treatment of trigeminal neuralgia.

Objective: Trigeminal neuralgia treatment results are thought to be highly dependent upon selection criteria. We retrospectively analyzed a series of patients to determine the likelihood of treatment success for patients treated with radiosurgery.

Methods: A retrospective analysis of 82 patients treated with linear accelerator radiosurgery was undertaken with a median follow-up period of 18 months.

Comparison of early complications for patients with convexity and parasagittal meningiomas treated with either stereotactic radiosurgery or fractionated stereotactic radiotherapy.

Objective: Patients with convexity and parasagittal (CPS) meningiomas treated with stereotactic radiosurgery (SRS) have been shown to be at risk for posttreatment symptomatic peritumoral edema (SPTE). We sought to analyze the pattern of this complication and compare it with the SPTE experienced in our patients treated with fractionated stereotactic radiotherapy.

Methods: From January 2003 to October 2005, 32 patients with CPS meningiomas were treated.

Contemporary methods of radiosurgery treatment with the Novalis linear accelerator system.

Radiosurgery has emerged as an indispensable component of the multidisciplinary approach to neoplastic, functional, and vascular diseases of the central nervous system. In recent years, a number of newly developed integrated systems have been introduced for radiosurgery and fractionated stereotactic radiotherapy treatments. These modern systems extend the flexibility of radiosurgical treatment in allowing the use of frameless image-guided radiation delivery as well as high-precision fractionated treatments.

Breast conserving surgery and accelerated partial breast irradiation using the MammoSite system: initial clinical experience.

Hypothesis: Balloon catheter-based accelerated partial breast irradiation (APBI) may result in desirable short-term outcomes in patients undergoing breast conserving surgery.

Design: Prospective consecutive case series.

Setting: Tertiary multidisciplinary referral center.

Geometrical accuracy of the Novalis stereotactic radiosurgery system for trigeminal neuralgia.

Object: Stringent geometrical accuracy and precision are required in the stereotactic radiosurgical treatment of patients. Accurate targeting is especially important when treating a patient in a single fraction of a very high radiation dose (90 Gy) to a small target such as that used in the treatment of trigeminal neuralgia (3 to 4-mm diameter). The purpose of this study was to determine the inaccuracies in each step of the procedure including imaging, fusion, treatment planning, and finally the treatment.

Treatment of trigeminal neuralgia with linear accelerator radiosurgery: initial results.

Object: Radiosurgery has emerged as an important treatment of trigeminal neuralgia. Substantial advantages have been demonstrated in safety and comfort over other modalities. Radiosurgical treatment of trigeminal neuralgia has been well investigated with gamma knife devices involving fixed cobalt sources.