J Korean Med Sci.
2019 Mar;34(8):e57. 10.3346/jkms.2019.34.e57.
Frameless Fractionated Gamma Knife Radiosurgery with ICONâ„¢ for Large Metastatic Brain Tumors
- Affiliations
-
- 1Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.
- 2Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea. paeksh@snu.ac.kr
- 3Department of Neurosurgery, Pusan National University Hospital, Pusan, Korea.
- 4Cancer Research Institute, Seoul National University, Seoul, Korea.
- 5Ischemia Hypoxia Disease Institute, Seoul National University, Seoul, Korea.
- KMID: 2441907
- DOI: http://doi.org/10.3346/jkms.2019.34.e57
Abstract
- BACKGROUND
Recently, a new generation of gamma knife radiosurgery (GKRS) equipped with a frameless immobilization system has encouraged the use of fractionated GKRS as an increasingly favorable treatment option. We investigated the preliminary outcome of efficacy and toxicity associated with frameless fractionated gamma knife radiosurgery (FF GKRS) for the treatment of large metastatic brain tumors.
METHODS
Fifteen patients with 17 lesions were treated using FF GKRS and included in this study, because of the large tumor size of more than 10 cm3. FF GKRS was performed based on a thermoplastic mask system for 3 to 5 consecutive days.
RESULTS
The mean duration of clinical follow-up was 12 months (range, 4-24), and the local control rate was 100%. Tumor volume decreased in 13 lesions (76.5%), and remained stable in 4 lesions (23.5%). One patient was classified as new lesion development because of the occurrence of leptomeningeal seeding regardless of the tumor volume change. Compared with the initial volume at the time of FF GKRS, tumor volume change at the last follow-up was 62.32% ± 29.80%. Cumulative survival rate at 12 months was 93.3% ± 6.4%. One patient died during the follow-up period because of the progression of the primary disease. No patient showed radiation necrosis on the follow-up images.
CONCLUSION
Daily FF GKRS by gamma knife ICONâ„¢ revealed satisfactory tumor control rate and low morbidity, despite the short follow-up period. Further prospective studies and a longer follow-up of a large cohort of patients diagnosed with brain metastases are required to elucidate the effect of FF GKRS in brain metastases.
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