Clinical Efficacy of CyberKnife Radiosurgery for Adult Brainstem Glioma: 10 Years Experience at Tianjin CyberKnife Center and Review of the Literature.

Jiaqi Zhang,Ping Wang,Qun Liu,Xiaoguang Wang,Zhiyong Yuan,Lujun Zhao

doi:10.3389/fonc.2019.00257

Jiaqi Zhang, Ping Wang + Show 4 more

Open Access

https://doi.org/10.3389/fonc.2019.00257

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Abstract

Background: Brainstem glioma is a rare brain tumor with poor prognosis and difficulty for surgical resection. We sought to retrospectively analyze and evaluate the clinical efficacy of CyberKnife for brainstem gliomas.Methods: From 2006 to 2015, a total of 21 brainstem gliomas patients who received CyberKnife radiosurgery treatment enrolled in this study and 18 patients with follow up. CyberKnife image-guided radiosurgical system were applied consecutively with the median prescribed total dose of 26 Gy (14–33 Gy) at two to six fractions on days utilizing CyberKnife system, and the median biological equivalent doses of 59.8 Gy (33.6–76.56 Gy). The clinic pathlogical features, survival were analyzed to explore the efficacy of CyberKnife radiosurgery in treatment of brainstem glioma.Results: With median follow-up of 54.5 months, patients with brainstem gliomas had median overall survival of 19 months, five patients still alive. The primary endpoints of the 1- and 2-year overall survival rates were 87.5 and 52.4%, respectively. During the treatment course, six patients were observed to have pseudoprogression with mass effect on MRI. Four patients developed radiation complications. Grade 2 radiation-related toxicity were observed in three patients and one patient with grade 3.Conclusion: The efficacy of brainstem gliomas—treated with CyberKnife is efficacious with mild toxicity.

Highlights

Brainstem gliomas (BSGs) account for 5–15% of brain tumors and more likely happen in children [1]
The patient inclusion criteria were as follows: [1] all patients were received the cranial computed tomography (CT) and magnetic resonance imaging (MRI), MRI sequence including T1-weighted, T2-weighted, contrast-enhanced T1-weighted MRI and FLAIR, [2] the tumors were diagnosed as glioma by two or more medical specialists in diagnostic radiology based on the typical CT and MRI findings of such lesions, [3] the epicenter of the tumor was located in the brainstem
We considered the reason of these side effect was brain edema which caused by CyberKnife treatment

Summary

Introduction

Brainstem gliomas (BSGs) account for 5–15% of brain tumors and more likely happen in children [1]. BSGs is rare in the adult population and account for only 1.5–2.5% of brain glioma, with a peak age of 40–70 years [1]. Diffuse intrinsic pontine glioma(DIPG) was the most common type of BSG is that could invade the whole brainstem including midbrain, pons as well as CyberKnife for Adult Brainstem Glioma medulla, surgery resection has the most challenges and may not be taken as the appropriate approach. There is a much more broad pathology spectrum in adult brainstem glioma, which squint toward be more radiographically and clinically diversified. Brainstem glioma is a rare brain tumor with poor prognosis and difficulty for surgical resection. We sought to retrospectively analyze and evaluate the clinical efficacy of CyberKnife for brainstem gliomas

Methods

Results

Conclusion