Mario A Grimm1, Ulrich Köppen1, Florian Stieler1, Grit Welzel1, Arne Mathias Ruder1, Martin Polednik1, Frederik Wenz2, Sabine K Mai1, Frank A Giordano3. 1. Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany. 2. Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany; University Medical Center Freiburg, Germany. 3. Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany; Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany. Electronic address: Frank.Giordano@ukbonn.de.
Abstract
PURPOSE: The newest generation of the Leksell Gamma Knife (GK) allows frame based as well as frameless treatment. We here report outcomes of a prospective non-randomized study on mask fixation (MF) versus frame fixation (FF) for GK treatment of brain metastases. METHODS: The decision for FF or MF was made on a case-by-case basis. Factors considered were patients' preference, proximity of critical structures, V12 and treatment time. Either stereotactic radiosurgery or fractionated stereotactic radiotherapy in up to 3 fractions was performed. For MF, a PTV margin of 1 mm was added. Follow-up included quarterly MRI scans. The primary outcome was local control. Secondary endpoints were progression-free survival (PFS), overall survival (OS) and the incidence of radionecrosis. RESULTS: A total of 197 lesions (169 FF and 28 MF) were treated in 76 patients (59 FF and 17 MF). 187 lesions were treated with SRS and 10 with FSRT. Median dose was 22 Gy in both groups and median follow-up was 9.3 months. There was a higher local failure rate (HR: 3.69; 95%CI: 1.13-12.0; p = 0.03) with 11 local failures in the FF and none in the MF cohort. No differences were observed between the groups for OS (median: n.r. vs. 16.9 months; HR:1.00; 95%CI: 0.41-2.46; p = 0.999) and PFS (median: 6.9 vs. 8.4 months; HR: 0.92; 95%CI: 0.47-1.79; p = 0.800). Three cases of radionecrosis occurred with FF but none with MF (p = 0.67). CONCLUSIONS: Gamma Knife treatment with MF does not result in worse outcome or increased rates of radionecrosis in this non-randomized study.
PURPOSE: The newest generation of the Leksell Gamma Knife (GK) allows frame based as well as frameless treatment. We here report outcomes of a prospective non-randomized study on mask fixation (MF) versus frame fixation (FF) for GK treatment of brain metastases. METHODS: The decision for FF or MF was made on a case-by-case basis. Factors considered were patients' preference, proximity of critical structures, V12 and treatment time. Either stereotactic radiosurgery or fractionated stereotactic radiotherapy in up to 3 fractions was performed. For MF, a PTV margin of 1 mm was added. Follow-up included quarterly MRI scans. The primary outcome was local control. Secondary endpoints were progression-free survival (PFS), overall survival (OS) and the incidence of radionecrosis. RESULTS: A total of 197 lesions (169 FF and 28 MF) were treated in 76 patients (59 FF and 17 MF). 187 lesions were treated with SRS and 10 with FSRT. Median dose was 22 Gy in both groups and median follow-up was 9.3 months. There was a higher local failure rate (HR: 3.69; 95%CI: 1.13-12.0; p = 0.03) with 11 local failures in the FF and none in the MF cohort. No differences were observed between the groups for OS (median: n.r. vs. 16.9 months; HR:1.00; 95%CI: 0.41-2.46; p = 0.999) and PFS (median: 6.9 vs. 8.4 months; HR: 0.92; 95%CI: 0.47-1.79; p = 0.800). Three cases of radionecrosis occurred with FF but none with MF (p = 0.67). CONCLUSIONS: Gamma Knife treatment with MF does not result in worse outcome or increased rates of radionecrosis in this non-randomized study.
Authors: Rodney E Wegner; Zachary D Horne; Yun Liang; Matthew Goss; Alexander Yu; Jonathan Pace; Richard W Williamson; Jody Leonardo; Stephen M Karlovits; Russel Fuhrer Journal: Adv Radiat Oncol Date: 2021-06-06
Authors: Tugce Kutuk; Rupesh Kotecha; Ranjini Tolakanahalli; D Jay J Wieczorek; Yongsook C Lee; Manmeet S Ahluwalia; Matthew D Hall; Michael W McDermott; Haley Appel; Alonso N Gutierrez; Minesh P Mehta; Martin C Tom Journal: Cancers (Basel) Date: 2022-07-13 Impact factor: 6.575
Authors: Maria Jose Perez-Calatayud; Antonio Vicente Menendez; Francisco Javier Celada-Alvarez; Antonio Jose Conde-Moreno; Mariola Bernisz; Françoise Lliso; Vicente Carmona; Jose Gimeno-Olmos; Carlos Botella; Jose Perez-Calatayud Journal: Rep Pract Oncol Radiother Date: 2021-02-25