Changes in treatment paradigm for neurosurgical patients in the era of stereotactic irradiation. By the 15th anniversary of the Neuroradiosurgery in Russia

Abstract

Stereotactic method and new irradiation techniques ensured radiosurgical treatment with high precision and conformity and significantly expanded the indications for stereotactic irradiation in neurosurgery. Over 15-year period, 29 976 patients underwent irradiation in various modes of fractionation on linear accelerators and Gamma Knife system at the first national radiosurgery center. Stereotactic radiotherapy and radiosurgery are followed by minimal number of complications and side reactions. At the same time, 5-year control of tumor growth for skull base meningioma was 96.8%, neuroma - 97%, glomus tumor - 94%, pituitary adenoma - 96-98%, craniopharyngioma - 95% in overall 10-year survival 86%, pilocytic astrocytoma - 97.5% in overall 5-year survival 99%. In intracranial metastases, median overall survival after radiosurgery was 10.1 months, 24- and 36-month overall survival - 25.9% and 19.2%, respectively. In patients with recurrent high-grade glioma, overall survival was 27.4 months. In case of metastatic spine lesions, control of tumor growth within 1 year was achieved in 90% of patients, pain relief - in more than 50% of cases. Obliteration of AVM and dural fistula was found in more than 80% of patients in years after treatment. Reduction or disappearance of pain was also observed in 80% of patients with trigeminal neuralgia. Stereotactic irradiation is effective and safe in patients with various pathologies of the central nervous system and characterized by high socio-economic indicators. Our own data indicate more significant role of stereotactic irradiation in the treatment of neurosurgical patients and make it possible to revise the existing treatment standards.