Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-24T23:25:35.279Z Has data issue: false hasContentIssue false

Early and Late Complications Following Dynamic Stereotactic Radiosurgery and Fractionated Stereotactic Radiotherapy

Published online by Cambridge University Press:  18 September 2015

R. McKenzie Michal*
Affiliation:
Department of Oncology (Division of Radiation Oncology) (M.R.M., L.S., E.B.P.), and the Department of Neurosurgery (J-L.C. A.O., J-G.V.). McGill University, Montreal
Sohami Luis*
Affiliation:
Department of Oncology (Division of Radiation Oncology) (M.R.M., L.S., E.B.P.), and the Department of Neurosurgery (J-L.C. A.O., J-G.V.). McGill University, Montreal
Caron Jean-Louis*
Affiliation:
Department of Oncology (Division of Radiation Oncology) (M.R.M., L.S., E.B.P.), and the Department of Neurosurgery (J-L.C. A.O., J-G.V.). McGill University, Montreal
Oliver Andre*
Affiliation:
Department of Oncology (Division of Radiation Oncology) (M.R.M., L.S., E.B.P.), and the Department of Neurosurgery (J-L.C. A.O., J-G.V.). McGill University, Montreal
Villemure Jean-Guy*
Affiliation:
Department of Oncology (Division of Radiation Oncology) (M.R.M., L.S., E.B.P.), and the Department of Neurosurgery (J-L.C. A.O., J-G.V.). McGill University, Montreal
B. Podgorsak Ervin*
Affiliation:
Department of Oncology (Division of Radiation Oncology) (M.R.M., L.S., E.B.P.), and the Department of Neurosurgery (J-L.C. A.O., J-G.V.). McGill University, Montreal
*
Department of Radiation Oncology, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Qudbec, Canada H3G 1A4
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Between December 1986 and June 1990, 112 patients (116 lesions), underwent treatment with dynamic stereotactic radiosurgery at McGill University. Of the treated lesions, 59 were arteriovenous malformations and 53 were a variety of other neoplastic or non-neoplastic conditions. In 86 lesions, the treatment was delivered in a single fraction and the treatment of the remaining 30 lesions was fractionated. Complications attributed to treatment developed in seven of the 112 patients (6.3%). No relationship was found between complications and prescribed dose, fractionation, collimator diameter, type and anatomical region of the lesion that was treated, or previous irradiation. Although extensive clinical experience will be necessary to determine optimal total doses, the potential role of fractionated treatment, and the tolerance of critical structures to radiosurgery, the relatively low incidence of complications in our series allows us to conclude that radiosurgery is well tolerated by the vast majority of patients.

Type
Research Article
Copyright
Copyright © Canadian Neurological Sciences Federation 1993

References

REFERENCES

1.Leksell, L. A stereotaxic method and radiosurgery of the brain. Acta ChirScand 1951; 102: 316319.Google ScholarPubMed
2.Leksell, L, Larsson, B, Andersson, B, et al. Lesions in the depth of the brain produced by a beam of high energy protons. Acta Radiol 1960; 54: 251264.CrossRefGoogle ScholarPubMed
3.Leksell, L, Cerebral radiosurgery: I Gammathalamotomy in two cases of intractable pain. Acta Chir Scand 1968; 134: 585595.Google Scholar
4.Leksell, DG. Stereotactic radiosurgery: present status and future trends. Neurol Res 1987; 9: 6068.CrossRefGoogle ScholarPubMed
5.Kjellberg, RN, Preston, WM. The use of the Bragg peak of a proton beam for intracerebral lesions. Proceedings of the Second International Congress of Neurological Surgery, Washington, D.C.Excerpt Med 1961; 36: E103.Google Scholar
6.Tobias, CA, Lawrence, JH, Born, JL, et al. Pituitary irradiation with high-energy proton beams: a preliminary report. Cancer Res 1958; 18: 121134.Google Scholar
7.Kjellberg, RN, Hanamura, T, Davis, KR, Lyons, SL, Adams, RD. Bragg peak proton beam therapy for arteriovenous malformations of the brain. N Engl J Med 1983; 309: 269274.Google Scholar
8.Steiner, L. Stereotactic radiosurgery with the Cobalt-60 gamma unit in the surgical treatment of intracranial tumours and arteriovenous malformations. In: Schmidek, HH, Sweet, WH, eds. Operative Neurosurgical Techniques - Indications, Methods, and Results. Philadelphia: WB Saunders, 1988; 515529.Google Scholar
9.Noren, G, Arndt, J, Hindmarsh, T. Stereotactic radiosurgical treatment of acoustic neurinomas. In: Lunsford, LD ed. Modern Stereotactic Neurosurgery. Boston: Martinus Nijhoff, 1988; 481489.Google Scholar
10.Lunsford, LD, Flickinger, J, Coffey, RJ: Stereotactic gamma knife radiosurgery: initial North American experience in 207 patients. Arch Neurol 1990; 47: 169175.CrossRefGoogle ScholarPubMed
11.Walton, L, Bomford, CK, Ramsden, D. The Sheffield Stereotactic Radiosurgery Unit: physical characteristics and principles of operation. Br J Radiol 1987; 60: 897906.CrossRefGoogle ScholarPubMed
12.Betti, OO, Munari, C, Rosler, R. Stereotactic radiosurgery with the linear accelerator: treatment of arteriovenous malformations. Neurosurgery 1989; 24: 311321.CrossRefGoogle ScholarPubMed
13.Colombo, F, Benedetti, A, Pozza, F, et al. External stereotactic irradiation by linear accelerator. Neurosurgery 1985; 16: 154160.Google Scholar
14.Friedman, A. Linac radiosurgery. Neurosurg Clin N Am 1990; 1: 9911008.Google Scholar
15.Hanmann, GH, Schlegel, W, Sturm, V, et al. Cerebral radiation surgery using moving field irradiation at a linear accelerator facility. Int J RadiatOncol Biol Phys 1985; 11: 11851192.Google Scholar
16.Hitchcock, E, Kitchen, G, Dalton, E, Pope, B. Stereotactic linac radiosurgery. Br J Neurosurg 1989; 3: 305312.Google Scholar
17.Loeffler, JS, Alexander, E, Siddon, RL, et al. Stereotactic radiosurgery for intracranial arteriovenous malformations using a standard Iinear accelerator. Int J Radiat Oncol Biol Phys 1989; 17: 672677.CrossRefGoogle Scholar
18.Podgorsak, EB, Olivier, A, Pla, M, Lefebvre, PY, Hazel, J. Dynamic stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 1988; 14: 115126.Google Scholar
19.Gutin, PH, Wilson, CB. Radiosurgery for malignant brain tumours. Clin Onc 1990; 8: 571573.Google Scholar
20.Sheline, GE, Wara, WM, Smith, V. Therapeutic irradiation and brain injury. Int J Radiat Oncol Biol Phys 1980; 6: 12151228.Google Scholar
21.Coffey, RJ, Lunsford, LD. Stereotactic radiosurgery using the 201 Cobalt-60 source gamma knife. Neurosurg Clin N Am 1990; 1: 933953.Google Scholar
22.Kjellberg, RN, Davis, KR, Lyons, S, Butler, W, Adams, RD. Bragg peak proton beam therapy for arteriovenous malformation of the brain. Clin Neurosurg 1983; 31: 248290.Google Scholar
23.Loeffler, JS, Siddon, RL, Wen, PY, Nedzi, LA, Alexander, E. Stereotactic radiosurgery of the brain using a standard linear accelerator: a study of early and late effects. Radiother Oncol 1990; 17: 311321.Google Scholar
24.Steiner, L. Radiosurgery in cerebral arteriovenous malformations. In: Flamm, E, Fein, J, eds. Textbook of Cerebrovascular Surgery. New York: Springer Verlag, 1986; 11611215.Google Scholar
25.Souhami, L, Olivier, A, Podgorsak, EB, et al. Dynamic stereotactic radiosurgery in arteriovenous malformations. Preliminary treatment results. Cancer 1990; 66: 1520.Google Scholar
26.Souhami, L, Olivier, A, Podgorsak, EB, Pla, M, Pike, GB. Radiosurgery of cerebral arteriovenous malformati ons with the dynamic stereotactic irradiation. Int J Radiat Oncol Biol Phys 1990; 19: 775782.CrossRefGoogle Scholar
27.Souhami, L, Olivier, A, Podgorsak, EB, et al. Fractionated stereotactic radiotherapy for intracranial tumours. Cancer 1991; 68: 21012108.Google Scholar
28.Clark, BG, Podgorsak, EB, Souhami, L, et al. A halo-ring technique for fractionated stereotactic radiotherapy. Br J Radiol, 1993; 66: 522527.CrossRefGoogle ScholarPubMed
29.Alexander, E, Siddon, RL, Loeffler, JS. The acute onset of nausea and vomiting following stereotactic radiosurgery: correlation with total dose to area postrema. Surg Neurol 1989; 32: 4044.CrossRefGoogle ScholarPubMed
30.Fliekinger, JC, Lunsford, LD, Coffey, RJ, et al. Radiosurgery of acoustic neurinomas. Cancer 1991; 67: 345353.Google Scholar
31.Arndt, J, Backlund, EO, Larsson, B, et al. Stereotactic irradiation of intracranial structures: physical and biological considerations. In: Szikla, G, ed. Stereotactic Cerebral Irradiation: INSERM Symposium No. 12. Amsterdam: Elsevier/North Holland Biomedical Press, 1979; 8192.Google Scholar
32.Leksell, L, Hemer, T, Leksell, D, Persson, B, Lindquist, C. Visualization of stereotactic radiolesions by nuclear magnetic resonance. J Neurol Neurosurg Psychiatry 1985; 48: 1920.Google Scholar
33.Wennerstrand, J, Ungerstedt, U. Cerebral radiosurgery Il: an anatomical study of gamma radiolesions. Acta Chir Scand 1970; 136: 133137.Google Scholar
34.Nielsen, SL, Kjellberg, RN, Asbury, AK, Koehler, AM. Neuropathologic effects of proton-beam irradiation in man: I Dose-response relationships after treatment of intracranial neoplasms. Acta Neuropathol (Berlin) 1972; 20: 348356.Google Scholar
35.Thompson, BG, Coffey, RJ, Flickinger, JC, Lunsford, LD. Stereotactic radiosurgery of small intracranial tumours: neuropathological correlation in three patients. Surg Neurol 1990; 33: 96104.CrossRefGoogle ScholarPubMed
36.Flickinger, JC, Lunsford, LD, Kondziolka, D, et al. Radiosurgery and brain tolerance: an analysis of neurodiagnostic imaging changes after gamma knife radiosurgery for arteriovenous malformations. Int J Radiat Oncol Biol Phys 1992; 23: 1926.CrossRefGoogle ScholarPubMed
37.Lunsford, LD, Altschuler, E, Flickinger, JC, Wu, A, Martinez, AJ. In vivo radiobiology of stereotactic radiosurgery: a primate model. Neurosurgery 1990; 27: 373382.Google Scholar
38.Steiberg, GK, Fabrikant, JI, Marks, MP, et al. Stereotactic heavy-charged particle Bragg-peak radiation for intracranial arteriovenous malformations. N Engl J Med 1990; 323: 96101.Google Scholar
39.Steiner, L, Greitz, T, Backlund, EO, et al. Radiosurgery in arteriovenous malformations of the brain: undue effects, In: Szikla, G, ed. Stereotactic Cerebral Irradiation: INSERM Symposium No. 12. Amsterdam: Elsevier/North Holland Biomedical Press, 1979; 257269.Google Scholar
40.Nedzi, LA, Kooy, H, Alexander, E, Gelman, RS, Locffler, JS. Variables associated with the development of complications from radiosurgery of intracranial tumours. Int J Radiat Oncol Biol Phys 1991; 21: 591599.Google Scholar
Kjeliberg, RN. Isoeffective dose parameters for brain necrosis in relation to proton radiosurgical dosimetry. In: Szikla, G, ed. Stereotactic Cerebral Irradiation: INSERM Symposium No. 12. Amsterdam: Elsevier/North Holland Biomedical Press, 1979; 157166.Google Scholar
42.Flickinger, JC. An integrated logistic formula for prediction of complications from radiosurgery. Int J Radiat Oncol Biol Phys 1989; 17: 879885.CrossRefGoogle ScholarPubMed
43.Flickinger, JC, Schell, MC, Larson, DA. Estimation of complications for linear accelerator with the integrated logistic formula. Int J Radiat Oncol Biol Phys 1990; 19: 143148.Google Scholar
44.Flickinger, JC, Steiner, L. Radiosurgery and the double logistic product formula. RadiotherOncoI 1990; 17: 229237.Google Scholar
45.Backlund, EO, Bergstrand, G, Hierton-Laurell, U, et al. Tumour changes after single dose irradiation by stereotactic radiosurgery in “non-active” pituitary adenomas and prolactinomas. In: Szikla, G, ed. Stereotactic Cerebral Irradiation: INSERM Symposium No. 12. Amsterdam: Elsevier/North Holland Biomedical Press, 1979; 199206.Google Scholar
46.Kondziolka, D, Lunsford, LD, Coffey, RJ, Flickinger, JC. Stereotactic radiosurgery of meningiomas. J Neurosurg 1991; 74: 552559.CrossRefGoogle ScholarPubMed
47.Gutin, PH, Prados, MD, Phillips, TL, et al. External irradiation followed by an interstitial high activity iodine-125 implant “boost” in the initial treatment of malignant gliomas: NCOG study 6G-82–2. Int J Radiat Biol Phys 1991; 21: 601609.Google Scholar
48.Scharfen, CO, Sneed, PK, Wara, WM, et al. High activity iodine-125 interstitial implant for gliomas. Int J Radiat Oncol Biol Phys 1992; 24: 583591.Google Scholar