Low Dose Gamma-knife Radiosurgery for Diffuse Brainstem Gliomas

Abstract

Introduction: Diffuse brainstem glial tumors remain a challenge. Despite many advances in neurosurgical techniques, no effective treatment is currently available. Recently, some authors showed beneficial results with gamma-knife radiosurgery (GK) for focal brainstem tumors. Objective: to analyze safety and effectiveness of GK in patients with diffuse brainstem gliomas. Methods: Eleven patients with diffuse brainstem gliomas treated with Gamma-knife from November 2001 to June 2009 were included. Complete data such as age, gender, symptoms, tumor size, prescription dose, adverse radiation effects and an early late follow-up were analyzed. Results: The mean age was 28.7 years (ranging from 1y 7m to 62y). Six patients were female and 5 were male. The gamma-knife prescription dose ranged from 6 to 7 Gy. All patients had clinical and imaging improvement at an early follow-up, although in 6, there was a late increase in tumor size and death. The others remained clinically stable or better. Larger tumors had a direct relationship with a poorer prognosis. No patient developed complications related to the radiosurgical treatment. Conclusion: Gamma-Knife is a safe and effective treatment for selected patients with diffuse brainstem tumors. The authors propose lower doses. Further studies are mandatory in order to analyze which patients could benefit from this treatment.