Highlights
- •Re-irradiation spans a range of repeat-treatment and mixed-treatment modality scenarios.
- •Re-irradiation involving SRS is becoming more common.
- •Minimizing treatment uncertainty is critical for SRS in re-irradiation situations.
- •Multi-session GKRS supports many re-irradiation situations.
- •The GKRS platform design works to minimize beam-delivery uncertainties.
Abstract
Stereotactic radiosurgery (SRS) involves the focal delivery of large, cytotoxic doses
of radiation to small targets within the brain, often located in close proximity to
radiosensitive normal tissue structures and requiring very low procedural uncertainties
to perform safely. Historically, neurosurgeons considered SRS as a one-time, single
session procedure. However therapeutic advances and a better understanding of the
clinical response to SRS have caused a renewal of interest in a variety of re-irradiation
scenarios; including re-irradiation of the same target after prior SRS, SRS treatments
after prior broad-field radiation, hypofractionated treatments, and volume-staged
treatments. Re-irradiation may in some cases require even greater effort towards minimizing
treatment uncertainties as compared to one-time-only treatments. Gamma Knife radiosurgery
(GKRS) has evolved over time in ways that directly supports many re-irradiation scenarios
while helping to minimize overall procedural uncertainty.
Keywords
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References
- The stereotaxic method and radiosurgery of the brain.Acta Chir Scand. 1951; 102: 316-319
- Analysis of repeat stereotactic radiosurgery for progressive primary and metastatic CNS tumors.Int J Radiat Oncol Biol Phys. 2002; 53: 527-532https://doi.org/10.1016/S0360-3016(02)02784-0
- Re-irradiation as salvage treatment in recurrent glioblastoma: a comprehensive literature review to provide practical answers to frequently asked questions.Crit Rev Oncol Hematol. 2018; 126: 80-91https://doi.org/10.1016/j.critrevonc.2018.03.024
- Clinical outcomes following salvage gamma knife radiosurgery for recurrent glioblastoma.World J Clin Oncol. 2014; 5: 142https://doi.org/10.5306/wjco.v5.i2.142
- Follow-up results of brain metastasis patients undergoing repeat Gamma Knife radiosurgery.J Neurosurg. 2016; 125: 2-10https://doi.org/10.3171/2016.6.GKS161404
- Long-term outcomes after salvage stereotactic radiosurgery (SRS) following in-field failure of initial SRS for brain metastases.Front Oncol. 2017; 7: 279https://doi.org/10.3389/fonc.2017.00279
- Repeat stereotactic radiosurgery as salvage therapy for locally recurrent brain metastases previously treated with radiosurgery.J Neurosurg. 2017; 127: 148-156https://doi.org/10.3171/2016.5.JNS153051
- Repeat stereotactic radiosurgery for locally recurrent brain metastases.World Neurosurg. 2017; 104: 589-593https://doi.org/10.1016/j.wneu.2017.04.103
- Repeated in-field radiosurgery for locally recurrent brain metastases: Feasibility, results and survival in a heavily treated patient cohort.PLoS ONE. 2018; 13: 12-28https://doi.org/10.1371/journal.pone.0198692
- Repeat radiosurgery for intracranial arteriovenous malformations.Neurosurgery. 2012; 70: 150-154https://doi.org/10.1227/NEU.0b013e31822c5740
- Emerging indications for fractionated Gamma knife radiosurgery.Neurosurgery. 2017; 80: 210-216https://doi.org/10.1227/NEU.0000000000001227
- Multistaged volumetric management of large arteriovenous malformations.Prog Neurol Surg. 2012; 27: 73-80https://doi.org/10.1159/000341629
- Volume-staged stereotactic radiosurgery for large intracranial arteriovenous malformations.J Clin Neurosci. 2017; 43: 202-207https://doi.org/10.1016/j.jocn.2017.04.020
- How to improve obliteration rates during volume-staged stereotactic radiosurgery for large arteriovenous malformations.J Neurosurg. 2018; : 1-8https://doi.org/10.3171/2018.2.JNS172964
- Staged gamma knife radiosurgery for large critically located benign meningiomas: evaluation of a series comprising 20 patients.J Neurol Neurosurg Psychiatry. 2009; 80: 1172-1175https://doi.org/10.1136/jnnp.2008.156745
- Wowra B. Quality assurance in stereotactic space. A system test for verifying the accuracy of aim in radiosurgery.Med Phys. 2002; 29: 561-568
- American College of Radiology (ACR) and American Society for Radiation Oncology (ASTRO) Practice Guideline for the Performance of Stereotactic Radiosurgery (SRS).Am J Clin Oncol. 2013; 36: 310-315https://doi.org/10.1097/COC.0b013e31826e053d
Schell MC, Bova FJ, Larson DA, Leavitt DD, Lutz WR, Podgorsak EB, et al. Stereotactic Radiosurgery; Report of Task Group 42 Radiation Therapy Committee. 1995.
- Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia.Neurosurgery. 2012; 70: 295-305https://doi.org/10.1227/NEU.0b013e318230218e
- Repeat radiosurgery for trigeminal neuralgia.Neurosurgery. 2015; 77: 755-761https://doi.org/10.1227/NEU.0000000000000915
- Repeat Gamma Knife surgery for vestibular schwannomas.Surg Neurol Int. 2015; 6 (SNI-6-153 [pii]): 153https://doi.org/10.4103/2152-7806.166173
- Three or more courses of stereotactic radiosurgery for patients with multiply recurrent brain metastases.Clin Neurosurg. 2017; 80: 871-879https://doi.org/10.1093/neuros/nyw147
- Repeat stereotactic radiosurgery for Cushing’s disease: outcomes of an international, multicenter study.J Neurooncol. 2018; 138: 519-525https://doi.org/10.1007/s11060-018-2817-5
- Reirradiation of recurrent meningioma.J Clin Neurosci. 2012; 19: 1261-1264https://doi.org/10.1016/j.jocn.2012.01.023
- Radiologic response and disease control of recurrent intracranial meningiomas treated with reirradiation.Int J Radiat Oncol Biol Phys. 2018; 102: 194-203https://doi.org/10.1016/j.ijrobp.2018.05.011
- Repeat Gamma Knife surgery for regrowth of vestibular schwannomas.Neurosurgery. 2009; 64: 48-55https://doi.org/10.1227/01.NEU.0000327692.74477.D5
- Repeat Gamma Knife surgery for recurrent trigeminal neuralgia: long-term outcomes and systematic review.J Neurosurg. 2014; 121: 210-221https://doi.org/10.3171/2014.8.GKS141487
- Volume-staged stereotactic radiosurgery for intracranial arteriovenous malformations: Outcomes based on an 18-year experience.Clin Neurosurg. 2017; 80: 543-549https://doi.org/10.1093/neuros/nyw107
- Analysis of the results of recurrent intracranial meningiomas treated with re-radiosurgery.Clin Neurol Neurosurg. 2017; 153: 93-101https://doi.org/10.1016/j.clineuro.2016.12.014
- Repeat stereotactic radiosurgery for progressive or recurrent vestibular schwannomas.Neurosurgery. 2018; https://doi.org/10.1093/neuros/nyy416
- Repeat Gamma-Knife radiosurgery for refractory or recurrent Trigeminal Neuralgia with consideration about the optimal second dose.World Neurosurg. 2016; 86: 371-383https://doi.org/10.1016/j.wneu.2015.08.056
- Repeat Gamma Knife radiosurgery versus microvascular decompression following failure of GKRS in trigeminal neuralgia: a systematic review and meta-analysis.J Neurosurg. 2018; : 1-10https://doi.org/10.3171/2018.5.JNS18583
- Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial.Lancet. 2004; 363: 1665-1672https://doi.org/10.1016/S0140-6736(04)16250-8
- Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial.Lancet Oncol. 2009; 10: 1037-1044https://doi.org/10.1016/S1470-2045(09)70263-3
- Phase 3 trials of stereotactic radiosurgery with or without whole-brain radiation therapy for 1 to 4 brain metastases: individual patient data meta-analysis.Int J Radiat Oncol. 2015; 91: 710-717https://doi.org/10.1016/j.ijrobp.2014.10.024
- Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases.JAMA. 2006; 295: 2483https://doi.org/10.1001/jama.295.21.2483
- Radiosurgery for recurrent brain metastases after whole-brain radiotherapy: factors affecting radiation-induced neurological dysfunction.J Korean Neurosurg Soc. 2009; 45: 275-283https://doi.org/10.3340/jkns.2009.45.5.275
- Salvage stereotactic radiosurgery for multiple brain recurrences: how much is enough?.Cureus. 2017; 9e1835https://doi.org/10.7759/cureus.1835
- Impact of the number of metastatic tumors treated by stereotactic radiosurgery on the dose to normal brain: implications for brain protection.Stereotact Funct Neurosurg. 2017; 95: 352-358https://doi.org/10.1159/000480666
- Timing and risk factors for new brain metastasis formation in patients initially treated only with Gamma Knife surgery.J Neurosurg. 2011; 114: 763-768https://doi.org/10.3171/2010.2.JNS091539
- Expert consensus on re-irradiation for recurrent glioma.Radiat Oncol. 2017; 12: 1-10https://doi.org/10.1186/s13014-017-0928-3
- Repeated courses of radiosurgery for new brain metastases to defer whole brain radiotherapy: feasibility and outcome with validation of the new prognostic metric brain metastasis velocity.Front Oncol. 2018; 8: 551https://doi.org/10.3389/fonc.2018.00551
- Report on a randomized trial comparing two forms of immobilization of the head for fractionated stereotactic radiotherapy.Med Phys. 2008; 36: 12-17https://doi.org/10.1118/1.3030950
- Repositioning accuracy of a commercially available thermoplastic mask system.Radiother Oncol. 2004; 71: 339-345https://doi.org/10.1016/j.radonc.2004.03.003
- Evaluation of stability of stereotactic space defined by cone-beam CT for the Leksell Gamma Knife Icon.J Appl Clin Med Phys. 2017; 18: 67-72https://doi.org/10.1002/acm2.12073
- Impact of 2-staged stereotactic radiosurgery for treatment of brain metastases ≥ 2 cm.J Neurosurg. 2017; 129: 1-17https://doi.org/10.3171/2017.3.JNS162532
- Impact of target point deviations on control and complication probabilities in stereotactic radiosurgery of AVMs and metastases.Radiother Oncol. 2006; 81: 25-32https://doi.org/10.1016/j.radonc.2006.08.022
- Inter-and intrafractional dose uncertainty in hypofractionated Gamma Knife radiosurgery.J Appl Clin Med Phys. 2016; 17
- Single-isocenter multiple-target stereotactic radiosurgery: risk of compromised coverage.Int J Radiat Oncol Biol Phys. 2015; 93: 540-546https://doi.org/10.1016/j.ijrobp.2015.07.2262
- Errors and margins in radiotherapy.Semin Radiat Oncol. 2004; 14: 52-64https://doi.org/10.1053/j.semradonc.2003.10.003
Measurements IC on RU and. ICRU Report 50. Prescribing, recording, and reporting photon beam therapy. Bethesda, MD: 1993.
Measurements IC on RU and. ICRU Report 62. Prescribing, recording, and reporting photon beam therapy (Supplement to ICRU Report 50). Bethesda, MD: 1999.
- Geometrical uncertainties, radiotherapy planning margins, and the ICRU-62 report.Radiother Oncol. 2002; 64: 75-83
- The probability of correct target dosage: dose-population histograms for deriving treatment margins in radiotherapy.Int J Radiat Oncol Biol Phys. 2000; 47: 1121-1135
- Convolution method and CTV-to-PTV margins for finite fractions and small systematic errors.Phys Med Biol. 2007; 52: 1967-1990https://doi.org/10.1088/0031-9155/52/7/013
- Fractionated stereotactic radiotherapy with the Leksell Gamma Knife: feasibility study.Radiother Oncol. 1995; 37: 108-116https://doi.org/10.1016/0167-8140(95)01632-Q
- The talon removable head frame system for stereotactic radiosurgery/radiotherapy: measurement of the repositioning accuracy.Int J Radiat Oncol Biol Phys. 2001; 51: 555-562https://doi.org/10.1016/S0360-3016(01)01670-4
- Inter- and intrafraction patient positioning uncertainties for intracranial radiotherapy: A study of four frameless, thermoplastic mask-based immobilization strategies using daily cone-beam CT.Int J Radiat Oncol Biol Phys. 2011; 80: 281-290https://doi.org/10.1016/j.ijrobp.2010.06.022
- A non-invasive, relocatable stereotactic frame for fractionated radiotherapy and multiple imaging.Radiother Oncol. 1991; 21: 60-62https://doi.org/10.1016/0167-8140(91)90342-E
- An intraoral positioning appliance for stereotactic radiotherapy.J Prosthet Dent. 1998; 79: 226-228https://doi.org/10.1016/S0022-3913(98)70221-5
- Fractionated stereotactic radiotherapy for skull base tumors: analysis of treatment accuracy using a stereotactic mask fixation system.Radiat Oncol. 2010; 5: 1https://doi.org/10.1186/1748-717X-5-1
- Initial clinical experience with frameless stereotactic radiosurgery: analysis of accuracy and feasibility.Int J Radiat Oncol. 2001; 51: 1152-1158https://doi.org/10.1016/S0360-3016(01)01756-4
- Performance of a novel repositioning head frame for gamma knife perfexion and image-guided linac-based intracranial stereotactic radiotherapy.Int J Radiat Oncol Biol Phys. 2010; 78: 306-313https://doi.org/10.1016/j.ijrobp.2009.11.001
- Validity of the use of nose tip motion as a surrogate for intracranial motion in mask-fixated frameless Gamma Knife®IconTM therapy.J Radiosurgery SBRT. 2017; 4: 289-301
- A clinical comparison of patient setup and intra-fraction motion using frame-based radiosurgery versus a frameless image-guided radiosurgery system for intracranial lesions.Radiother Oncol. 2010; 95: 109-115https://doi.org/10.1016/j.radonc.2009.12.030
- A computerized record and verify system for radiation treatments.Int J Radiat Oncol Biol Phys. 1984; 10: 1975-1985
- Universal survival curve and single fraction equivalent dose: useful tools in understanding potency of ablative radiotherapy.Int J Radiat Oncol Biol Phys. 2008; 70: 847-852https://doi.org/10.1016/j.ijrobp.2007.10.059
USA Nuclear Regulatory Commission. Quality Assurance for Gamma Knives 1995.
Seuntjens J, McEwen M. The Calibration Chain: Role of BIPM, PSDLs, and ADCLs. In: (AAPM) AA of P in M, editor. Med. Phys. Monogr. No. 34 Clin. Dosim. Meas. Radiother., Madison, WI: 2009, p. 567–76.
- Long-term stability of the Leksell Gamma Knife® PerfexionTM patient positioning system (PPS).Med Phys. 2014; 41https://doi.org/10.1118/1.4866225
Elekta Instrument AB. Leksell Gamma Knife Icon Planned Maintenance Manual 2015.
- The use of cone beam computed tomography for image guided Gamma Knife stereotactic radiosurgery: initial clinical.Evaluation. 2016; 96: 214-220https://doi.org/10.1016/j.ijrobp.2016.04.011
- Stereotactic shifts during frame-based image-guided stereotactic radiosurgery: clinical measurements.Radiat Oncol Biol. 2018; 102: 895-902https://doi.org/10.1016/j.ijrobp.2018.05.042
- Initial experience with the eXtend System: a relocatable frame system for multiple-session Gamma Knife radiosurgery.World Neurosurg. 2011; 75https://doi.org/10.1016/j.wneu.2010.12.051
- Whole-procedural radiological accuracy for delivering multi-session Gamma Knife radiosurgery with a relocatable frame system.Technol Cancer Res Treat. 2014; 13: 403-408https://doi.org/10.7785/tcrtexpress.2013.600259
- Interfraction and intrafraction performance of the Gamma Knife Extend system for patient positioning and immobilization.J Neurosurg. 2012; 117 Suppl
- Commissioning of the Leksell Gamma Knife® IconTM.Med Phys. 2017; 44: 355-363https://doi.org/10.1002/mp.12052
- Repositioning accuracy of two different mask systems-3D revisited: comparison using true 3D/3D matching with cone-beam CT.Int J Radiat Oncol Biol Phys. 2006; 66: 1568-1575https://doi.org/10.1016/j.ijrobp.2006.08.054
- The continuous assessment of cranial motion in thermoplastic masks during CyberKnife radiosurgery for trigeminal neuralgia.Cureus. 2016; 8e607https://doi.org/10.7759/cureus.607
- Prolonged treatment time deteriorates positioning accuracy for stereotactic radiosurgery.PLoS ONE. 2015; 10e0123359https://doi.org/10.1371/journal.pone.0123359
Elekta Instrument AB. Geometric Quality Assurance for Leksell Gamma Knife® IconTM (White Paper). Stockholm: 2015.
Article info
Publication history
Published online: November 21, 2019
Accepted:
November 1,
2019
Received in revised form:
September 16,
2019
Received:
February 5,
2019
Identification
Copyright
© 2019 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
