Young Hyun Cho1,2, Jung Min Lee3, Doheui Lee4, Jae Hong Park4, KyoungJun Yoon4, Seon Ok Kim5, Do Hoon Kwon3, Jeong Hoon Kim3, Chang Jin Kim3,4, Sung Woo Roh3,4. 1. Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro-43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea. yhyunc@amc.seoul.kr. 2. Radiosurgery Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. yhyunc@amc.seoul.kr. 3. Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro-43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea. 4. Radiosurgery Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 5. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Abstract
BACKGROUND: In this study, we compared the dosimetric properties between Gamma Knife (GK) and Cyberknife (CK), and investigated the clinical implications in treating brain metastases (BMs). METHODS: Between 2011 and 2013, 77 patients treated with either single-fraction GK for small BMs (n = 40) or fractionated CK for large BMs >3 cm (n = 37) were analyzed. Among a total of 160 lesions, 81 were treated with GK (median, 22 Gy) and 38 (large lesions) with three- or five-fraction CK (median, 35 Gy). The median tumor volume was 1.0 cc (IQR, 0.12-4.4 cc) for GK and 17.6 cc (IQR, 12.8-23.7 cc) for fractionated CK. A lesion-to-lesion dosimetric comparison was performed using the identical contour set in both systems. RESULTS: The mean dose to tumor was significantly higher in GK by 1.25-fold (P < 0.001), whereas normal tissue volume receiving 90-10 % of prescription dose was significantly larger in CK by 1.26-fold (P < 0.001). Nevertheless, no differences were observed in local tumor control (rates at 1 year, 89.7 % vs 87.0 %; P = 0.594) and overall survival (median, 14 vs 16 months; P = 0.493) between GK and fractionated CK groups. The incidences of radiation necrosis were also not different (12.3 % vs 15.8 %; P = 0.443). CONCLUSIONS: Despite slightly inferior dosimetric properties of CK, fractionated CK for large BMs appears to be as effective and safe as single-fraction GK for small BMs, representing fractionation as an effective strategy for enhancing efficacy and moderating toxicity in stereotactic radiosurgery for BMs.
BACKGROUND: In this study, we compared the dosimetric properties between Gamma Knife (GK) and Cyberknife (CK), and investigated the clinical implications in treating brain metastases (BMs). METHODS: Between 2011 and 2013, 77 patients treated with either single-fraction GK for small BMs (n = 40) or fractionated CK for large BMs >3 cm (n = 37) were analyzed. Among a total of 160 lesions, 81 were treated with GK (median, 22 Gy) and 38 (large lesions) with three- or five-fraction CK (median, 35 Gy). The median tumor volume was 1.0 cc (IQR, 0.12-4.4 cc) for GK and 17.6 cc (IQR, 12.8-23.7 cc) for fractionated CK. A lesion-to-lesion dosimetric comparison was performed using the identical contour set in both systems. RESULTS: The mean dose to tumor was significantly higher in GK by 1.25-fold (P < 0.001), whereas normal tissue volume receiving 90-10 % of prescription dose was significantly larger in CK by 1.26-fold (P < 0.001). Nevertheless, no differences were observed in local tumor control (rates at 1 year, 89.7 % vs 87.0 %; P = 0.594) and overall survival (median, 14 vs 16 months; P = 0.493) between GK and fractionated CK groups. The incidences of radiation necrosis were also not different (12.3 % vs 15.8 %; P = 0.443). CONCLUSIONS: Despite slightly inferior dosimetric properties of CK, fractionated CK for large BMs appears to be as effective and safe as single-fraction GK for small BMs, representing fractionation as an effective strategy for enhancing efficacy and moderating toxicity in stereotactic radiosurgery for BMs.
Authors: Alexandra Hellerbach; Klaus Luyken; Mauritius Hoevels; Andreas Gierich; Daniel Rueß; Wolfgang W Baus; Martin Kocher; Maximilian I Ruge; Harald Treuer Journal: Radiat Oncol Date: 2017-08-17 Impact factor: 3.481
Authors: Kyoung Jun Yoon; Byungchul Cho; Jung Won Kwak; Doheui Lee; Do Hoon Kwon; Seung Do Ahn; Sang-Wook Lee; Chang Jin Kim; Sung Woo Roh; Young Hyun Cho Journal: J Korean Neurosurg Soc Date: 2018-10-30
Authors: Michael T Milano; Jimm Grimm; Andrzej Niemierko; Scott G Soltys; Vitali Moiseenko; Kristin J Redmond; Ellen Yorke; Arjun Sahgal; Jinyu Xue; Anand Mahadevan; Alexander Muacevic; Lawrence B Marks; Lawrence R Kleinberg Journal: Int J Radiat Oncol Biol Phys Date: 2020-09-11 Impact factor: 8.013