• Journal of Korean Neurosurgical Society
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• 제64권1호
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• pp.13-22
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• 2021

Objective : High precision and accuracy are expected in gamma knife radiosurgery treatment. Because of the requirement of clinically applying complex radiation and dose gradients together with a rapid radiation decline, a dedicated quality assurance program is required to maintain the radiation dosimetry and geometric accuracy and to reduce all associated risk factors. This study investigates the validity of Leksell Gamma plan (LGP)10.1.1 system of 5th generation Gamma Knife Perfexion as modified variable ellipsoid modeling technique (VEMT) method. Methods : To verify LGP10.1.1 system, we compare the treatment plan program system of the Gamma Knife Perfexion, that is, the LGP, with the calculated value of the proposed modified VEMT program. To verify a modified VEMT method, we compare the distributions of the dose of Gamma Knife Perfexion measured by Gafchromic EBT3 and EBT-XD films. For verification, the center of an 80 mm radius solid water phantom is placed in the center of all sectors positioned at 16 mm, 4 mm and 8 mm; that is, the dose distribution is similar to the method used in the x, y, and z directions by the VEMT. The dose distribution in the axial direction is compared and analyzed based on Full-Width-of-Half-Maximum (FWHM) evaluation. Results : The dose profile distribution was evaluated by FWHM, and it showed an average difference of 0.104 mm for the LGP value and 0.130 mm for the EBT-XD film. Conclusion : The modified VEMT yielded consistent results in the two processes. The use of the modified VEMT as a verification tool can enable the system to stably test and operate the Gamma Knife Perfexion treatment planning system.

• 대한방사선치료학회지
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• 제9권1호
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• pp.50-55
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• 1997

The optimal management of uveal melanoma is still a matter of controversy. To determine the effect of Gamma Knife surgery for patients with uveal malanoma. the authors reviewed the results of 5 patients underwent Gamma Knife sugery between Sep. 1993 and Dec. 1996. The mean age was 60.7 years ranging from 42.5 to 76.5 years. Median follow-up was 13.29 months and the patient with follow up period more than 6 months was 4. The mean tumor volume was $3442 mm^3$(mean diameter 15.3 mm) and all patients were irradiated with a mean maximum dose of 74Gy(range $60\~80\;Gy$), using the $50\%$ isodose. After Gamma Knife surgery. one pateint showed complete disapperance in tumor size with follow-up 32 months, one enucleation due to progression, and 2 no interval change. In regard to vision, one patient blind. one enucleation, and 2 patients had no interval change. According to our experiences, Gamma Knife surgery for uveal melanoma be able to achieve local tumor control, spare the eyeball, and have possibility of save vision.

• Journal of International Society for Simulation Surgery
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• 제2권2호
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• pp.58-63
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• 2015

Image-guided neurosurgery (IGN) is a technique for localizing objects of surgical interest within the brain. In the past, its main use was placement of electrodes; however, the advent of computed tomography has led to a rebirth of IGN. Advances in computing techniques and neuroimaging tools allow improved surgical planning and intraoperative information. IGN influences many neurosurgical fields including neuro-oncology, functional disease, and radiosurgery. As development continues, several problems remain to be solved. This article provides a general overview of IGN with a brief discussion of future directions.

• 한국의학물리학회지:의학물리
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• 제18권4호
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• pp.194-201
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• 2007

감마나이프는 한 번에 수 Gy의 선량을 조사하는 일반 방사선 치료에 비하여 훨씬 많은 수십 Gy의 고선량을 한 번에 조사하기 때문에 조사되는 방사선량의 절대값 측정이 매우 중요하다. 그러나, 감마나이프의 물흡수선량 절대 측정값을 검증하는 연구는 많지 않다. 더욱이, 물팬텀 사용을 규정한 국제원자력기구(International Atomic Energy Agency: IAEA) TRS-398 프로토콜을 적용하여 물흡수선량을 측정한 연구는 보고되고 있지 않다. 본 연구에서는 IAEA TRS- 398 프로토콜을 이용하여 감마나이프 C모델의 물흡수선량을 측정하는 실험을 하였다. 본 실험에서는 IAEA TRS-398에 규정한 바를 최대한 따르면서 물팬텀을 제작하여 감마나이프 C모델의 물흡수선량을 측정하고, 감마나이프 제작사에서 제공하는 플라스틱 팬텀에서 측정한 값과 비교하였다. 이온함으로는 Capintec 사의 PR-05P mini-chamber 두 개를 사용하였고, 전리계로는 PTW사의 UNIDOS를 사용하였다. 측정 결과 물팬텀에서 측정한 감마나이프 모델C의 물흡수선량은 제작사의 플라스틱팬텀에서 측정한 값에 비하여 1.38% 크게 나타났다- 따라서, 현재 국내 감마나이프센터에서 사용하고 있는 제작사에서 제공하고 물흡수선량 측정 프로토콜에는 물팬텀 대신 플라스틱팬텀을 사용하는 데 따른 기온적인 문제점이 있는 것으로 판단된다. 결론적으로 IAEA TRS-398프로토콜을 직접적으로 감마나이프 물흡수선량 측정에 적용하는 것은 기준조건을 만족시킬 수 없기 때문에 불가능한 것으로 판단되며, 새로운 프로토콜을 작성하거나, 물팬텀과 기존의 플라스틱 팬텀으로 측정한 값 사이의 변환계수를 제공하는 것이 현실적인 대안이 될 것이다.

• Journal of Korean Neurosurgical Society
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• 제67권5호
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• pp.560-567
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• 2024

Objective : We investigated how treating large brain metastasis (LBM) using 2-day fraction Gamma Knife radiosurgery (GKRS) affects tumor control and patient survival. A prescription dose of 10.3 Gy was applied for 2 consecutive days, with a biologically effective dose equivalent to a tumor single-fraction dose of 16.05 Gy and a brain single-fraction dose of 15.12 Gy. Methods : Between November 2017 and December 2021, 42 patients (mean age, 68.3 years; range, 50-84 years; male, 29 [69.1%]; female, 13 [30.9%]) with 44 tumors underwent 2-day fraction GKRS to treat large volume brain metastasis. The main cancer types were non-small cell lung cancer (n=16), small cell lung cancer (n=7), colorectal cancer (n=7), breast cancer (n=3), gastric cancer (n=2), and other cancers (n=7). Twenty-one patients (50.0%) had a single LBM, 19 (46.3%) had a single LBM and other metastases, and two had two (4.7%) large brain metastases. At the time of the 2-day fraction GKRS, the tumors had a mean volume of 23.1 mL (range, 12.5-67.4). On each day, radiation was administered at a dose of 10.3 Gy, mainly using a 50% isodose-line. Results : We obtained clinical and magnetic resonance imaging follow-up data for 34 patients (81%) with 35 tumors, who had undergone 2-day fraction GKRS. These patients did not experience acute or late radiation-induced complications during follow-up. The median and mean progression-free survival (PFS) periods were 188 and 194 days, respectively. The local control rates at 6, 9, and 12 months were 77%, 40%, and 34%, respectively. The prognostic factors related to PFS were prior radiotherapy (p=0.019) and lung cancer origin (p=0.041). Other factors such as tumor volumes, each isodose volumes, and peri-GKRS systemic treatment were not significantly related to PFS. The overall survival period of the 44 patients following repeat stereotactic radiosurgery (SRS) ranged from 15-878 days (median, 263±38 days; mean, 174±43 days) after the 2-day fraction GKRS. Eight patients (18.2%) were still alive. Conclusion : Considering the unsatisfactory tumor control, a higher prescription dose should be needed in this procedure as a salvage management. Moreover, in the treatment for LBM with fractionated SRS, using different isodoses and prescription doses at the treatment planning for LBMs should be important. However, this report might be a basic reference with the same fraction number and prescription dose in the treatment for LBMs with frame-based SRS.

• Journal of Korean Neurosurgical Society
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• 제50권3호
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• pp.179-184
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• 2011

Objective : The aim of this study is to evaluate the therapeutic effects of gamma knife radiosurgery (GKRS) in patients with multiple brain metastases and to investigate prognostic factors related to treatment outcome. Methods : We retrospectively reviewed clinico-radiological and dosimetric data of 36 patients with 4-14 brain metastases who underwent GKRS for 264 lesions between August 2008 and April 2011. The most common primary tumor site was the lung (n=22), followed by breast (n=7). At GKRS, the median Karnofsky performance scale score was 90 and the mean tumor volume was 1.2 cc (0.002-12.6). The mean prescription dose of 17.8 Gy was delivered to the mean 61.1% isodose line. Among 264 metastases, 175 lesions were assessed for treatment response by at least one imaging follow-up. Results : The overall median survival after GKRS was $9.1{\pm}1.7$ months. Among various factors, primary tumor control was a significant prognostic factor ($11.1{\pm}$1.3 months vs. $3.3{\pm}2.4$ months, p=0.031). The calculated local tumor control rate at 6 and 9 months after GKRS were 87.9% and 84.2%, respectively. Paddick's conformity index (>0.75) was significantly related to local tumor control. The actuarial peritumoral edema reduction rate was 22.4% at 6 months. Conclusion : According to our results, GKRS can provide beneficial effect for the patients with multiple (4 or more) brain metastases, when systemic cancer is controlled. And, careful dosimetry is essential for local tumor control. Therefore, GKRS can be considered as one of the treatment modalities for multiple brain metastase.

• Journal of Korean Neurosurgical Society
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• 제43권1호
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• pp.26-30
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• 2008

Objective : The authors developed a stereotactic device for irradiation of small animals with Leksell Gamma Knife Model C. Development and verification procedures were described in this article. Methods : The device was designed to satisfy three requirements. The mechanical accuracy in positioning was to be managed within 0.5 mm. The strength of the device and structure were to be compromised to provide enough strength to hold a small animal during irradiation and to interfere the gamma ray beam as little as possible. The device was to be used in combination with the Leksell G-$frame^{(R)}$ and $KOPF^{(R)}$ rat adaptor. The irradiation point was determined by separate imaging sequences such as plain X-ray images. Results : The absolute dose rate with the device in a Leksell Gamma Knife was 3.7% less than the value calculated from Leksell Gamma $Plan^{(R)}$. The dose distributions measured with $GAFCHROMIC^{(R)}$ MD-55 film corresponded to those of Leksell Gamma $Plan^{(R)}$ within acceptable range. The device was used in a series of rat experiments with a 4 mm helmet of Leksell Gamma Knife. Conclusion : A stereotactic device for irradiation of small animals with Leksell Gamma Knife Model C has been developed so that it fulfilled above requirements. Absorbed dose and dose distribution at the center of a Gamma Knife helmet are in acceptable ranges. The device provides enough accuracy for stereotactic irradiation with acceptable practicality.

• Journal of Korean Neurosurgical Society
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• 제37권1호
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• pp.48-53
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• 2005

Objective: The purpose of this study is to elucidate in vitro responses to combined gamma knife irradiation and p53 gene transfection on human malignant glioma cell lines. Methods: Two malignant human glioma cell lines, U87MG (p53-wild type) and U373MG (p53-mutant) were transfected with an adenoviral vector containing p53 (MOI of 50) before and after applying 20Gy of gamma irradiation. Various assessments were performed, including, cell viability by MTT assay; apoptosis by annexin assay; and cell cycle by flow cytometry, for the seven groups: mock, p53 only, gamma knife (GK) only, GK after LacZ, LacZ after GK, GK after p53, p53 after GK. Results: Cell survival decreased especially, in the subgroup transfected with p53 after gamma irradiation. Apoptosis tended to increase in p53 transfected U373 MG after gamma irradiation (apoptotic rate, 38.9%). The G2-M phase cell cycle arrest markedly increased by transfecting with p53, 48 hours after gamma knife irradiation in U373 MG (G2-M phase, 90.8%). Conclusion: These results suggest that the in vitro effects of combined gamma knife irradiation and p53 gene transfection is an augmentation of apoptosis and G2-M phase cell cycle arrest, which are more exaggerated in U373 MG with p53 transfection after gamma knife irradiation.

• Journal of Korean Neurosurgical Society
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• 제30권sup2호
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• pp.289-293
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• 2001

Objectives : The optimal treatment of craniopharyngioma is controversial. Despite recent advances in microsurgical management, complete surgical removal of craniopharyngioma remains very difficult. Radiation added to surgery is effective, but radiation therapy resulted in untoward side effect in young patient. Gamma knife radiosurgery offers the theoretical advantage of a reduced radiation dose to surrounding structures during the treatment of residual or recurrent craniopharyngioma compared with fractionated radiotheraphy. We described retrospective analysis of tumor size and clinical symptoms of patients after gamma knife radiosurgery in residual or recurrent craniopharyngioma were performed. Material and Methods : From September 1990 to January 2000, 18 patients of craniopharyngioma were treated by gamma knife radiosurgery. All patient had undergone surgery, but residual or recurrent tumor was found and all of them treated postoperative gamma knife radiosurgery. The mean age was 19(from 6 to 66) and male to female ratio was 10 to 8 and 8 patients were below 15 years old. In young age group(below age 15), the average volume of the tumor was $2904.8mm^3$ and mean maximal gamma knife dose was 34.9Gy. In old age group(older than 15), the average volume of the tumor was $2590.4mm^3$ and mean maximal gamma knife dose was 45.2Gy. The size of the tumor was average $2730.1mm^3$($88-12000mm^3$), mean average radiation dose was 40.7Gy and the mean prescription dose was 17.6 Gy(4-35Gy) delivered to a median prescription 50.7% isodose. Results : The follow up was from 1 year to 9 years(mean 59.1 months) after gamma knife radiosurgery. The tumor was controlled in 13(72.2%) patients. The tumor decreased in 9 patients and not changed in 4 patients. The tumor size increased in 4(22.2%) patients during follow up period. In two cases the tumor size increased because of its cystic portion was increased, but their solid portion of the tumor was not changed. In another two patients, the solid portion of the tumor was increased. So, one patient underwent reoperation and the other patient underwent operation and repeated gamma knife radiosurgery. The tumor recurred in one case(5.6%) that is a outside of irradiated site. The presenting symptoms were improved in 4 patients(improved visual acuity in 1, controlled increased intracranial presure sign in 3 patients). In one case, visual acuity decreased after gamma knife radiosurgery. The endocrine symptoms were not influenced by gamma knife radiosurgery. Conclusion : Craniopharyngioma can be treated successfully by gamma knife radiosurgery. Causes of the tumor regrowth are inadequate dose planning because of postoperatively poor margination of the tumor, close approximation of optic nerve and residual tumors outside the target lesion. Recurrence can develop 4 years after gamma knife radiosurgery. Volume is important, but the accurate targeting is more important to prevent tumor recurrence. If the tumor definition is not clear during planning gamma knife surgery, long-term image follow up is required.

• 한국의학물리학회지:의학물리
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• 제14권3호
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• pp.184-188
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• 2003

감마나이프는 일회에 대용량의 방사선량을 조사하여 뇌정위 방사선 수술을 하기 때문에, 주기적인 정도 관리가 매우 중요하다. 그러나 국내의 경우 학회 및 규제기관 차원에서 권고되고 있는 표준화된 정도관리 절차서가 없이, 각 기관별로 독자적인 정도관리 절차서를 개발하여 시행되고 있어, 기관별로 상호 비교하기가 어려운 실정이다. 따라서 본 연구에서는 국내 실정에 적합한 감마나이프 정도관리 프로그램을 개발하기 위해, 제조사, 미국 및 일본에서 권고하고 있는 정도관리 절차서를 수집하여 비교 분석하였다 또한 감마나이프에 대한 주기적인 정도관리 검사항목을 선량관련 검사항목, 기계적인 검사항목 및 안전 관리적인 측면으로 분류하였다. 미국의 경우 제조사 보다 엄격하게 권고 및 규제하고 있으며, 일본의 경우 미국의 절차서를 토대로 검사항목 및 주기를 권고하고 있다. 이를 토대로 국내 실정에 적합한 감마나이프 정도관리 절차를 제시하고자 한다.