Journal of Korean Neurosurgical Society

  • 제39권2호
  • /
  • Pages.102-108
  • /
  • 2006
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지

The Role of Gamma Knife Radiosurgery for Diffuse Astrocytomas

  • Kim, Kyung-Hyun (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Park, Yong-Sook (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Chang, Jong-Hee (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Chang, Jin-Woo (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Park, Yong-Gou (Department of Neurosurgery, Yonsei University College of Medicine)
  • 발행 : 2006.02.28
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : The management of diffuse astrocytomas is one of the most controversial areas in clinical neurooncology. There are numerous reviews and editorials outlining the difficulties in the management of these lesions. In this study, we assess the role of Gamma Knife radiosurgery[GKS] for diffuse astrocytomas. Methods : Twenty-three patients with a diffuse astrocytoma were treated with GKS as a primary or adjuvant method from February 1995 to October 2003. The mean marginal dose was $13.6\;[8.5{\sim}17.5]Gy$ and the mean maximal dose was $27.3\;[17.0{\sim}35.0]Gy$. Local control and the pattern of radiologic response were evaluated. The probable factors affecting local control, such as tumor volume, margin dose, previous history of craniotomy or stereotactic biopsy, and the presence or absence of previous radiotherapy were statistically analyzed. The average duration of follow-up was 39.7 [$11.3{\sim}101.5$] months after GKS. Results : Of the 23 lesions treated, 16 lesions [69.6%] were controlled during the follow-up period. The mean progression-free interval was 57.4 months and the 5-year progression-free rate was 68%. Only tumor volume was found to be a statistically significant factor for local control. Smaller tumors were better controlled by GKS; it was significantly effective in tumors with less than $10cm^3$ volume. Conclusion : GKS could be a valuable therapeutic modality both as a primary treatment and as a postoperative adjuvant therapy in some selected cases.

키워드

참고문헌

  1. Baker DG, Krochak RJ : The response of the microvascular system to radiation : a review. Cancer Invest 7 : 287-294, 1989 https://doi.org/10.3109/07357908909039849
  2. Barcia JA, Barcia-Salorio JL, Ferrer C, Ferrer E, Algas R, Hernandez G : Stereotactic radiosurgery of deeply seated low grade gliomas. Acta Neurochir Suppl 62 : 58-61, 1994
  3. Buatti JM, Bova FJ, Friedman WA, Bova FJ : Preliminary experience with frameless stereotactic radiotherapy. Int J Radiat Oncol Biol Phys 42 : 591-599, 1998 https://doi.org/10.1016/S0360-3016(98)00276-4
  4. Chun SM, Lim YJ, Leem W, Kim TS, Kim GK, Rhee BA : Gamma Knife Radiosurgery for low grade glioma. J Korean Neurosurg Soc (Suppl II) 30 : s273-s280, 2001
  5. Collet-Solberg PF, Sernyak H, Satin-Smith M, Katz LL, Molloy P, Moshang T Jr : Endocrine outcome in long-term survivors of low-grade hypothalamic/chiasmatic glioma. Clin Endocrinol (Oxf) 47 : 79-85, 1997 https://doi.org/10.1046/j.1365-2265.1997.2211032.x
  6. Duffner PK : Long-term effects of radiation therapy on cognitive and endocrine function in children with leukemia and brain tumors. Neurologist 10 : 293-310, 2004 https://doi.org/10.1097/01.nrl.0000144287.35993.96
  7. Fischman AJ, Thornton AF, Frosch MP, Swearinger B, Gonzalez RG, Alpert NM : FDG hypermetabolism associated with inflammatory necrotic changes following radiation of meningioma. J Nucl Med 38 : 1027-1029, 1997
  8. Fiveash JB, Spencer SA : Role of radiation therapy and radiosurgery in glioblastoma multiforme. Cancer J 9 : 222-229, 2003 https://doi.org/10.1097/00130404-200305000-00010
  9. Hadjipanayis CG, Kondziolka D, Flickinger JC, Lunsford LD : The role of stereotactic radiosurgery for low-grade astrocytomas. Neurosurg Focus 14 : e15, 2003
  10. Herholz K, Wienhard K, Heiss WD : Validity of PET studies in brain tumors. Cerebrovasc Brain Metab Rev 2 : 240-265, 1990
  11. Kamada K, Houkin K, Abe H, Sawamura Y, Kashiwaba T : Differentiation of cerebral radiation necrosis from tumor recurrence by proton magnetic resonance spectroscopy. Neurol Med Chir (Tokyo) 37 : 250- 256, 1997 https://doi.org/10.2176/nmc.37.250
  12. Khoo VS, Oldham M, Adams EJ, Bedford JL, Webb S, Brada M : Comparison of intensity-modulated tomotherapy with stereotactically guided conformal radiotherapy for brain tumors. Int J Radiat Oncol Biol Phys 45 : 415-425, 1999 https://doi.org/10.1016/S0360-3016(99)00213-8
  13. Kida Y, Kobayashi T, Mori Y : Gamma knife radiosurgery for low-grade astrocytomas : results of long-term follow up. J Neurosurg 93(Suppl 3) : 42-46, 2000
  14. Kim MS, Lee SI, Sim SH : Brain tumors with cysts treated with Gamma Knife radiosurgery : is microsurgery indicated?. Stereotact Funct Neurosurg 72(Suppl 1) : 38-44, 1999 https://doi.org/10.1159/000056437
  15. Kortmann RD, Timmermann B, Taylor RE, Scarzello G, Plasswilm L, Jeremic B, et al : Current and future strategies in radiotherapy of childhood low-grade glioma of the brain. Part II : Treatment-related late toxicity. Strahlenther Onkol 179 : 585-597, 2003 https://doi.org/10.1007/s00066-003-8104-0
  16. Kreth FW, Faist M, Warnke PC, Rossner R, Volk B, Ostertag CB : Interstitial radiosurgery of low-grade gliomas. J Neurosurg 82 : 418- 429, 1995 https://doi.org/10.3171/jns.1995.82.3.0418
  17. Mansur DB, Hekmatpanah J, Wollman R, Macdonald L, Nicholas K, Beckmann E, et al : Low grade gliomas treated with adjuvant radiation therapy in the modern imaging era. Am J Clin Oncol 23 : 222-226, 2000
  18. McDermott MW, Berger MS, Kunwar S, Parsa AT, Sneed PK, Larson DA : Stereotactic radiosurgery and interstitial brachytherapy for glial neoplasms. J Neurooncol 69 : 83-100, 2004 https://doi.org/10.1023/B:NEON.0000041873.42938.13
  19. Meeks SL, Buatti JM, Bova FJ, Friedman WA, Mendenhall WM, Zlotecki RA : Potential clinical efficacy of intensity-modulated conformal therapy. Int J Radiat Oncol Biol Phys 40 : 483-495, 1998 https://doi.org/10.1016/S0360-3016(97)00819-5
  20. Park YG, Kim EY, Chang JW, Chung SS : Volume changes following gamma knife radiosurgery of intracranial tumors. Surg Neurol 48 : 488- 493, 1997 https://doi.org/10.1016/S0090-3019(97)00186-9
  21. Plathow C, Schulz-Ertner D, Thilman C, Zuna I, Lichy M, Weber MA, et al : Fractionated stereotactic radiotherapy in low-grade astrocytomas : long-term outcome and prognostic factors. Int J Radiat Oncol Biol Phys 57 : 996-1003, 2003 https://doi.org/10.1016/S0360-3016(03)00738-7
  22. Rabinov JD, Brisman JL, Cole AJ, Lee PL, Bussiere MR, Chapman PH, et al : MRI changes in the rat hippocampus following proton radiosurgery. Stereotact Funct Neurosurg 82 : 156-164, 2004 https://doi.org/10.1159/000081639
  23. Remler MP, Marcussen WH, Tiller-Borsich J : The late effects of radiation on the blood brain barrier. Int J Radiat Oncol Biol Phys 12 : 1965-1969, 1986 https://doi.org/10.1016/0360-3016(86)90133-1
  24. Saran FH, Baumert BG, Khoo VS, Adams EJ, Garre ML, Warrington AP, et al : Stereotactically guided conformal radiotherapy for progressive low-grade gliomas of childhood. Int J Radiat Oncol Biol Phys 53 : 43-51, 2002 https://doi.org/10.1016/S0360-3016(02)02734-7
  25. Sarkar A, Pollock BE, Brown PD, Gorman DA : Evaluation of gamma knife radiosurgery in the treatment of oligodendrogliomas and mixed oligodendroastrocytomas. J Neurosurg 97 : 653-656, 2002
  26. Shaw EG, Daumas-Duport C, Scheithauer BW, Gilbertson DT, O'Fallon JR, Earle JD, et al : Radiation therapy in the management of lowgrade supratentorial astrocytomas. J Neurosurg 70 : 853-861, 1989 https://doi.org/10.3171/jns.1989.70.6.0853
  27. Shuto T, Inomori S, Fusino H, Nagano H, Hasegawa N, Kakuta Y : Cyst formation following gamma knife surgery for intracranial meningioma. J Neurosurg 102(Suppl) : 134-139, 2005 https://doi.org/10.3171/jns.2005.102.s_supplement.0134
  28. Warnke PC, Kopitzki K, Ostertag CB : Interstitial stereotactic radiosurgery. Acta Neurochir Suppl 88 : 45-50, 2003
  29. Kida Y, Kobayashi T, Mori Y : Gamma knife radiosurgery for low-grade astrocytoma ; Results of long-term follow up. J Neurosurg (Suppl 3) 93 : 42-46, 2000
  30. Marcus KJ, Goumnerova L, Billett AL, Lavally B, Scott RM, Bishop K, et al : Stereotactic radiotherapy for localized low-grade gliomas in children ; Final results of a prospective trial. Int J Radiat Oncol Biol Phys 61 : 374-379, 2005 https://doi.org/10.1016/j.ijrobp.2004.06.012
  31. Plathow C, Schulz-Ertner D, Thilman C, Zuna I, Lichy M, Weber MA : Fractionated stereotactic radio-therapy in low-grade astrocytoma ; Longterm outcome and prognostic factors. Int J Radiat Oncol Biol Phys 57 : 996-1003, 2003 https://doi.org/10.1016/S0360-3016(03)00738-7