Efficacy Of Gamma Knife Radiosurgery Research Articles

Gamma Knife radiosurgery for central neurocytoma: a quantitative systematic review and metanalysis.

Central neurocytomas (CN) are rare tumors within the central nervous system. Originating from the septum pellucidum and subependymal cells, they are typically found in the third and lateral ventricles. For this reason, they may lead to hydrocephalus and increased intracranial pressure. CNs are generally benign lesions that exhibit locally aggressive behavior and a high recurrence rate. Complete surgical resection is the preferred treatment; however, due to their anatomical location, this is often not feasible. Based on these findings, Gamma Knife radiosurgery (GKRS) has been introduced for managing both residual and recurrent tumors and as an initial therapy in selected cases. This study aimed to systematically review the available knowledge regarding GKRS for CN. A systematic investigation of the scientific literature was undertaken through an exhaustive search across prominent databases, including PubMed, Web of Science, and Google Scholar, by employing precise MeSH terms such as "Central neurocytoma," "Radiosurgery," "Gamma Knife," and "Stereotactic Radiosurgery." A comprehensive quantitative systematic review and meta-analysis were meticulously conducted, focusing on cases of CN treated with GKRS for a thorough evaluation of outcomes and efficacy. Seventeen articles, including 289 patients, met the inclusion criteria. Random effects meta-analysis estimates for disease control and local tumor control were 90% (95% CI 87-93%; I2 = 0%, p < 0.74) and 94% (95% CI 92-97%; I2 = 0%, p < 0.98), respectively. When considering only studies with at least 5years of follow-up, progression-free survival was 89% (95% CI 85-94%; I2 = 0.03%, p < 0.74). The mean clinical control rate was 96%. This systematic review and meta-analysis confirmed the safety and efficacy of GKRS in managing CN.

Efficacy and indications of gamma knife radiosurgery for recurrent low-and high-grade glioma

PurposeTo investigate the indications and efficacy of gamma knife radiosurgery (GKRS) as a salvage treatment for recurrent low-and high-grade glioma.MethodsThis retrospective study of 107 patients with recurrent glioma treated with GKRS between 2009 and 2022, including 68 high-grade glioma (HGG) and 39 low-grade glioma (LGG) cases. The Kaplan-Meier method was used to calculate the overall survival (OS) and progression-free survival (PFS). The log-rank test was used to analyze the multivariate prognosis of the Cox proportional hazards model. Adverse reactions were evaluated according to the Common Terminology Criteria for Adverse Events version 4.03. The prognostic value of main clinical features was estimated, including histopathology, Karnofsky performance status (KPS), recurrence time interval, target location, two or more GKRS, surgery for recurrence, site of recurrence, left or right side of the brain and so on.ResultsThe median follow-up time was 74.5 months. The median OS and PFS were 17.0 months and 5.5 months for all patients. The median OS and PFS were 11.0 months and 5.0 months for HGG, respectively. The median OS and PFS were 49.0 months and 12.0 months for LGG, respectively. Multivariate analysis showed that two or more GKRS, left or right side of the brain and brainstem significantly affected PFS. Meanwhile, the KPS index, two or more GKRS, pathological grade, and brainstem significantly affected OS. Stratified analysis showed that surgery for recurrence significantly affected OS and PFS for LGG. KPS significantly affected OS and PFS for HGG. No serious adverse events were noted post-GKRS.ConclusionGKRS is a safe and effective salvage treatment for recurrent glioma. Moreover, it can be applied after multiple recurrences with tolerable adverse effects.

Concomitant radiosurgical and targeted oncological treatment improves the outcome of patients with brain metastases from gastrointestinal cancer

BackgroundSo far, only limited studies exist that evaluate patients with brain metastases (BM) from GI cancer and associated primary cancers who were treated by Gamma Knife Radiosurgery (GKRS) and concomitant immunotherapy (IT) or targeted therapy (TT).MethodsSurvival after GKRS was compared to the general and specific Graded Prognostic Assessment (GPA) and Score Index for Radiosurgery (SIR). Further, the influence of age, sex, Karnofsky Performance Status Scale (KPS), extracranial metastases (ECM) status at BM diagnosis, number of BM, the Recursive Partitioning Analysis (RPA) classes, GKRS1 treatment mode and concomitant treatment with IT or TT on the survival after GKRS was analyzed. Moreover, complication rates after concomitant GKRS and mainly TT treatment are reported.ResultsMultivariate Cox regression analysis revealed IT or TT at or after the first Gamma Knife Radiosurgery (GKRS1) treatment as the only significant predictor for overall survival after GKRS1, even after adjusting for sex, KPS group, age group, number of BM at GKRS1, RPA class, ECM status at BM diagnosis and GKRS treatment mode. Concomitant treatment with IT or TT did not increase the rate of adverse radiation effects. There was no significant difference in local BM progression after GKRS between patients who received IT or TT and patients without IT or TT.ConclusionGood local tumor control rates and low rates of side effects demonstrate the safety and efficacy of GKRS in patients with BM from GI cancers. The concomitant radiosurgical and targeted oncological treatment significantly improves the survival after GKRS without increasing the rate of adverse radiation effects. To provide local tumor control, radiosurgery remains of utmost importance in modern GI BM management.

Efficacy of Gamma Knife Radiosurgery In The Treatment of Metastatic Parapharyngeal Acinic Cell Adenocarcinoma In The Cavernous Sinus: A Case Report

Efficacy of Gamma Knife Radiosurgery In The Treatment of Metastatic Parapharyngeal Acinic Cell Adenocarcinoma In The Cavernous Sinus: A Case Report

Safety and Efficacy of Gamma Knife Radiosurgery for the Management of Trigeminal Neuralgia: A Retrospective and Cross-Sectional Study.

Medical management is the first line of care for patients with trigeminal neuralgia (TN), and carbamazepine is the drug of choice used alone or in combination with other drugs. Gamma knife radiosurgery (GKRS) has been an established option in the management of refractory TN based on its noninvasiveness and robust safety profile. Our study aims to confirm the safety and assess the efficacy of GKRS in the management of TN. A retrospective review of the patients with refractory TN treated with GKRS from 1997 to March 2019 by the senior author was carried out. Out of 194 eligible patients, detailed clinical information was not available in 41 patients. The remaining 153 patients' case files (post-GKRS cohort) were reviewed, and data obtained were collated, computed, and analyzed. An additional cross-sectional analysis was carried out telephonically in the post-GKRS cohort in January 2021 using Barrow Neurological Institute (BNI) pain scoring, to obtain the long-term efficacy of GKRS in TN. The majority of the patients (96.1%) received a radiation dose of 80 Gy. At 6 months, 94.8% of patients had satisfactory response to GKRS. Follow-up ranged between 1 and 7.5 years. The recurrence rate was 9.2% and the complication rate was 4.6%. Facial numbness was the commonest complication. No mortality was reported. The cross-sectional arm of the study had a response rate of 39.2% (60 patients). Adequate pain relief (BNI I/II/IIIa/IIIb) was reported in 85% of patients. GKRS is a safe and effective modality of treatment for TN without any major complications. Both short-term and long-term efficacies are excellent.

Gamma knife radiosurgery versus transcatheter arterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a propensity score matching study

BackgroundThe optimal locoregional treatment for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) is unclear. This study aimed to investigate the efficacy of Gamma knife radiosurgery (GKR) versus transcatheter arterial chemoembolization (TACE) in HCC patients with PVTT.MethodsThis retrospective study included 544 HCC patients with PVTT (GKR, 202; TACE, 342). Propensity score matching (PSM) analysis identified 171 matched pairs of patients. The primary endpoint was overall survival (OS).ResultsBefore PSM, the GKR group exhibited longer median OS (mOS) than the TACE group (17.2 vs. 8.0 months, p < 0.001). We followed the Cheng’s classification for PVTT. In the subgroup analysis, GKR was associated with significantly longer mOS for patients with PVTT II-IV (17.5 vs. 8.7 months, p < 0.001; 17.2 vs. 7.8 months, p = 0.001; 14.5 vs. 6.5 months, p = 0.001, respectively) and comparable OS for patients with PVTT I. After PSM, the GKR group had also a longer mOS than the TACE group (15.8 vs. 10.4 months, p < 0.001). In the subgroup analysis, the GKR group demonstrated superior mOS for patients with PVTT II-IV (all p < 0.05) and comparable OS for patients with PVTT I.ConclusionsGKR was associated better OS than TACE in HCC patients with PVTT, especially for patients with PVTT II-IV.Clinical Trials RegistrationThe study was registered in the Chinese Clinical Trials Registry under the registration number ChiCTR2100051057.

Long-term Efficacy of Gamma Knife Radiosurgery on Pain Control in Trigeminal Neuralgia.

Gamma Knife is an essential treatment alternative for treatment-resistant trigeminal neuralgia (TN). This study investigated the efficacy of Gamma Knife radiosurgery (GKRS) in patients with Burchiel type 1 and 2 TN. A retrospective analysis of prospectively collected data of 163 patients who underwent GKRS between December 2006 and December 2021 was performed. The median follow-up was 37 (range, 6-168) months. The target was the cisternal portion of the trigeminal nerve, and the median prescribed dose was 85 (range, 75-90) Gy. Pain severity was evaluated using the Barrow Neurological Institute (BNI) pain intensity score. All patients had BNI IV or V before GKRS. BNI IIIb or better was defined as adequate pain relief. Logistic regression analysis was conducted to determine the prognostic significance of different pretreatment and treatment variables. The initial pain relief rate was 85%, with a median period of 25 (range, 1-90) days. At the final follow-up, 62.5% of patients had adequate pain relief. BNI I was achieved in 8% of patients within the first 24 h after GKRS; this rate was 22% at the final follow-up. The predicted adequate pain relief rates at the 3rd and 6th month and 1st, 3rd, 5th, and 7th year were 84%, 79%, 76%, 67%, 59%, and 55%, respectively. The complication rate was 8%, with disturbing facial sensorial dysfunction in four patients, decreased corneal reflex in three patients, and masseter dysfunction in six patients. Univariate and multivariate logistic regression analyses revealed Burchiel type 1 TN (p = 0.001) and male gender (p = 0.037) as predictors of increased initial pain relief rate and shorter time to initial pain relief day, respectively. Appropriate patient selection is the key to successful TN treatment. GKRS can be recommended, especially for patients with Burchiel type 1 TN, with low complication rates and effective long-term pain relief.

Efficacy of Gamma Knife Radiosurgery in Refractory Obsessive-Compulsive Disorder: An Indian Experience

Background Obsessive-compulsive disorder (OCD) is a chronic debilitating psychiatric condition with adverse impact on patient's sociooccupational health. Refractoriness to pharmacotherapy and psychotherapy is not uncommon. Gamma Knife radiosurgery (GKRS) is the comprehensively used and reviewed treatment modality in refractory OCD worldwide. In India, the past two decades of increasing GKRS availability has failed to create the necessary local awareness of its usefulness in refractory OCD. Limited native literature deepens the problem. Objective To analyze our experience with GKRS in refractory OCD, and report the safety and efficacy/long-term outcome in patients using the Yale–Brown Obsessive-Compulsive Scale (Y-BOCS). Materials and Methods A retrospective review of patients receiving GKRS for refractory OCD between 2000 and 2020 was carried out. Case files of the eligible ( n = 9) patients were reviewed for clinical, radiotherapeutic, and outcome data. Additionally, patients were contacted via telephone to enquire about their experiences, and to obtain retroactive consent for GKRS in June 2021. Information obtained was collated, computed, and analyzed. Results Male-to-female sex ratio was 8:1. Mean age at the time of GKRS and mean duration of OCD prior to GKRS was 30.1 ± 9.4 and 10.2 ± 5.8 years, respectively. Mean baseline Y-BOCS score was 29.6 ± 4.7. Our first patient received cingulotomy, while the rest underwent anterior capsulotomy. Median margin dose (50% isodose) was 70 Gy. Also, 23.8 ± 7.7 was the mean Y-BOCS score at the last follow-up (median = 30 months). Overall, 44.4% patients showed full/partial response (≥25% reduction in Y-BOCS score) at the last follow-up. In anterior capsulotomy (eight patients), patients with moderate/severe OCD showed better response (4/5 responders) than those with extreme OCD (0/3 responders). Single case of cingulotomy resulted in no response (<25% reduction in Y-BOCS score). No adverse radiation effects were noted. Also, 55.6% patients gave retroactive consent telephonically. Conclusion GKRS is a safe and effective noninvasive treatment modality for refractory OCD. Ventral anterior capsule is the preferred target. Maximum radiation doses of 120 to 160 Gy are well tolerated. Extremely severe OCD cases fared poorer. Proper awareness about the availability and efficacy of GKRS in refractory OCD is required in India.

Radiologic and Clinical Outcomes of Stereotactic Radiosurgery for Intraventricular Metastases

The optimal management of intraventricular metastases remains debatable. The aim of this study is to define the safety and efficacy of Gamma-Knife radiosurgery in the treatment of intraventricular metastases. This retrospective, single-center study involved patients that were treated with stereotactic radiosurgery (SRS) for intraventricular metastases. The study end points included SRS-related toxicity, local and distal intracranial tumor control, as well as the incidence of post-treatment hydrocephalus and leptomeningeal dissemination. Factors associated with radiologic and clinical outcomes were also analyzed. The cohort included 17 consecutive patients who underwent stereotactic radiosurgery for treatment of 41 intracranial metastases, of which 23 were primary intraventricular (intraventricular metastasis). Median overall survival from primary tumor diagnosis and from SRS treatment were 28 and 5 months, respectively. With a median radiological follow-up of 3 (interquartile range 3) months, 7 patients (41.18%) experienced overall intracranial disease progression, whereas 7 (27.27%) intraventricular metastases progressed radiologically. Four (23.53%) and 3 (17.65%) patients developed hydrocephalus and leptomeningeal dissemination post-SRS, respectively. Four patients (23.53%) died due to intracranial disease progression. SRS offers a reasonable chance of local tumor control for patients with intraventricular brain metastasis. However, the risk of hydrocephalus and leptomeningeal spread of disease is not inconsequential and merits close follow-up for patients with brain metastasis involving the ventricular system.

Efficacy of Gamma Knife radiosurgery in the management of pituitary prolactinoma.

Background: Gamma Knife radiosurgery (GKR) has been widely used in the management of a variety of intracranial tumors, including pituitary adenomas. Pituitary prolactinoma (Prs) is one of the most common types of these adenomas.Methods: This prospective study included 50 patients with pituitary Prs over a period from June 2017 to June 2018 at the Neurosciences Hospital, Baghdad/Iraq. The GKR procedure was performed using the Leksell Gamma Knife® Perfexion™, 192 beams of Cobalt 60 radiation were delivered through the intact skull to the pituitary Prs.Results: There is a significant female predominance 32 (72%). The results after 6 months of GKR showed significant improvement regarding the size of adenoma, prolactin hormone level, contrast enhancement on MRI, and medical treatment.Conclusion: The study showed that the GKR is a safe and effective modality of treatment in the management of pituitary Prs.

Gamma Knife Radiosurgery for High-Grade Gliomas: Single-Center Experience of Six Years in China

Objective: The aim of this study was to evaluate the efficacy of Gamma Knife radiosurgery (GKRS) as a salvage therapy for high-grade glioma in our center. Methods: A total of 167 patients with malignant glioma were treated with GKRS in our Gamma Knife Center between January 2013 and December 2017; 140 patients (85 males and 55 females) were followed up and enrolled in our study. A single lesion was found in 110 cases, and multiple lesions were found in 30 cases; 108 cases received a single therapy, and in 32 cases, at least 2 GKRSs were performed. The median tumor volume was 13.5 cm³. The mean radiation dosage was 14.35 Gy (range, 6–18 Gy). MRI was performed regularly. The RANO criteria and Cox analysis were used to evaluate the therapeutic efficiency. Results: Follow-up MRI showed the local control rate was 61.4% at 3 months after GKRS, 25.0% at 6 months, and 7.1% at 12 months. The mean and median progression-free survival (PFS) periods were 8.6 (95% CI, 6.3–11.0) and 4 (95% CI, 3.5–4.5) (range, 1–60) months, respectively. The overall survival (OS) after GKRS was 3–62 months, with a mean of 16.7 (95% CI, 14.6–18.9) months, and the median survival was 13 (95% CI, 12.1–13.9) months. The 1-, 2-, and 5-year survival rates were 51.4, 10.0, and 2.9%, respectively. No severe complications occurred. Cox regression showed that glioma pathology was closely related to prognosis (p < 0.05). The Karnofsky Performance Score had little influence on PFS (p > 0.05) but influenced OS significantly (p < 0.05). Conclusion: GKRS can be used to effectively treat malignant brain glioma and can therefore be used as an alternative treatment option.

Efficacy of Gamma Knife radiosurgery in the management of multiple sclerosis-related trigeminal neuralgia: a systematic review and meta-analysis

Trigeminal neuralgia (TN) is the most frequent craniofacial pain condition, which commonly affects patients suffering from multiple sclerosis (MS). Stereotactic radiosurgery, especially Gamma Knife radiosurgery (GKRS), represents a safe and effective treatment for TN, and it has been adopted also for MS-TN, with a lower success rate. Therefore, we aimed to analyze the outcome of GKRS for MS-TN. PubMed, Web of Science, and Google Scholar and the reference list of relevant articles were searched for GKRS in MS-TN. Two investigators independently identified the articles, assessed the study quality, and extracted the data. Endpoints of interest were initial pain responders, successful treatments at the end of follow-up, and factors influencing the outcome. Data analyses were performed using R software. Twelve articles involving 646 patients met our inclusion criteria. Pooled proportion of patients who experienced an initial response to GKRS treatment was 83% (CI 74-90%). The cumulative proportion of successful treatments at the end of follow-up was 47% (CI 33-60%). No variables were found to have a significant contribution to heterogeneity regarding the initial response outcome. The only variable significantly explaining the heterogeneity found in the proportion of successful treatments was the length of the follow-up, with a negative b coefficient (- 0.0051, p value = 0.0047). Regarding the efficacy of GKRS in MS-TN, the initial pain response rate was 83%, which dramatically decreases to 47% during follow-up. GKRS still represents a valuable option for MS-TN; however, its long-term efficacy should be always considered.

Choroidal melanoma treatment in times of coronavirus disease 2019.

Choroidal melanoma treatment in times of coronavirus disease 2019.

Efficacy of Gamma-Knife Radiosurgery in Grade 2 and Grade 3 Meningioma: A Single-Center, Long-Term Follow-Up Study

Efficacy of Gamma-Knife Radiosurgery in Grade 2 and Grade 3 Meningioma: A Single-Center, Long-Term Follow-Up Study

Long-term results of gamma knife radiosurgery for foramen magnum meningiomas.

Outcomes of 37 patients of foramen magnum meningioma (FMM) were evaluated, and the related literature was reviewed to determine the efficacy of Gamma Knife radiosurgery (GKRS) for treating patients with FMM. We present the largest series reported from a single institution with the longest follow-up to date. The database of patients who underwent GKRS for FMM between 2007 and 2019 was evaluated retrospectively. A total of 37 patients with radiological and pathological features consistent with FMM were included in this series. Thirty-three patients were female, and 4 were male. The median age was 58years (range, 23-74years). The most common symptom at diagnosis was headache (64.9%). Twelve patients had a history of microsurgical resection. The median duration from the initial onset of symptoms to GKRS was 12months (range 1-140months). Among the 37 tumors, eight (21.6%) were located ventrally, 24 (64.9%) laterally, and five (13.5%) dorsally. The median target volume was 3.30cm3 (range, 0.6-17.6cm3). Thirty-five patients (95%) were treated with single fraction GKRS, and two patients (5%) were treated with hypofractionated GKRS. The median clinical follow-up was 80months (range, 18-151months), while the median radiological follow-up was 84months (range, 18-144months). At the last clinical follow-up after GKRS, 27 patients (73%) had improved symptoms, and none had worsened pre-GKRS symptoms. At the last radiological follow-up after GKRS, 23 tumors (62.2%) remained stable, 13 (35.1%) decreased in size, and 1 (2.7%) increased in size. Tumor control, including stable and regressed tumors, was achieved in 97.3% of patients. Our cohort demonstrates that GKRS is an effective and safe treatment for patients with either primary or recurrent/residual FMM.

Gamma knife radiosurgery for uveal melanomas and metastases: a systematic review and meta-analysis.

Gamma knife radiosurgery is regarded as the gold-standard stereotactic radiosurgery modality for the treatment of intracranial tumours, and its use has been expanded for the treatment of intraocular malignancies. The aim of this study was to systematically evaluate the efficacy, outcomes, and complications of gamma knife radiosurgery for uveal melanomas and metastases. We did a systematic review and meta-analysis to aggregate the clinical outcomes of patients with uveal melanomas or intraocular metastases treated primarily with gamma knife radiosurgery. We searched MEDLINE and Embase for studies published between Sept 1, 1960, and Feb 1, 2020, reporting the use of gamma knife radiosurgery as primary treatment for uveal melanoma or uveal metastases. The search was restricted to clinical studies and relevant grey literature published in English. Studies reporting treatment of benign tumours, extraocular tumours, or other forms of stereotactic radiosurgery were excluded to reduce heterogeneity. No restrictions were placed on participant criteria. Local tumour control and tumour regression were extracted as the primary outcomes and analysed via a random-effects meta-analysis of proportions using the DerSimonian and Laird method with a Freeman-Tukey double arcsine transformation. This study is registered with PROSPERO, CRD42019148165. Our search returned 454 studies, of which 109 were assessed for full-text eligibility. 52 studies, reporting on 1010 patients with uveal melanoma and 34 intraocular metastases, were eligible for systematic review. 28 studies were included in the meta-analysis. 840 of 898 patients (0·96, 95% CI 0·94-0·97; I2=16%) from 19 studies had local control, and 378 of 478 patients (0·81, 0·70-0·90; I2=83%) from 16 studies experienced tumour regression. Gamma knife radiosurgery is an efficacious primary method of treating uveal melanomas and intraocular metastases, with reliable tumour control rates. Randomised controlled trials should further evaluate the safety and efficacy of gamma knife radiosurgery in this setting. The Rhodes Trust and the Howard Brain Sciences Foundation.

Efficacy of gamma knife radiosurgery in the treatment of intraventricular meningiomas

Intraventricular meningiomas (IVMs) are notably limited tumors and express one of the most challenging tumors in neurosurgery. Gamma Knife radiosurgery (GKRS) as an alternative for IVMs has been reported only in a few case series. We aimed to present six patients with IVMs who were treated with GKRS and do a literature review. The data of patients were retrospectively reviewed. All patients underwent a single session of GKRS with a median marginal dose of 12 Gy (range, 11–13). Target volume ranged from 1.2 to 9.5 cc. Routine imaging with contrast-enhanced MRI scans was performed every six months initially and thereafter yearly. New neurological deficits and symptoms stated or observed during follow-up were recorded and investigated. The mean age was 41.3 years (range, 30–71). GKRS was used as a primary treatment in five patients and as adjunctive treatment in one patient. The most common presenting symptom was a headache. The median duration of symptoms was 30 months (range, 5–240). Four tumors (67%) were located in the left lateral ventricle, and two were in the right lateral ventricle. During a median follow-up of 71.5 months (range, 23–139), tumor volume was noted to have shrunk (median = 59.6%) in all patients (100%). One patient experienced post-GKRS peritumoral edema that resolved after a short course of steroids. The mean progression-free survival was 117.5 months (95% CI, 81–154 months). Neurologic symptoms and signs improved in all patients. GKRS may be a feasible treatment alternative in patients with small IVMs with low morbidity.

Long-term results of Gamma Knife radiosurgery for facial nerve schwannomas

ABSTRACT Objective Long-term outcomes of eleven cases of facial nerve schwannoma were evaluated and the related literature was reviewed to determine the efficacy of Gamma Knife radiosurgery for treating patients with facial nerve schwannoma. Methods Eleven patients with facial nerve schwannoma (7 women and 4 men; mean age, 44.2 years; range, 19–73 years) underwent Gamma Knife radiosurgery. The most common symptoms were facial palsy (n = 10) and hearing loss (n = 7). Five patients presented with headache. Two patients had undergone prior resection. The patients’ clinical and radiographic data were evaluated retrospectively. Results For the 11 cases of facial nerve schwannoma, mean tumor volume was 3.1 cm3 (range, 0.4–7.4 cm3) and the mean marginal dose applied was 11.9 Gy (range, 11–13 Gy). The mean follow-up period was 84.3 months (range, 66–117 months). Tumor control was achieved in all patients. At the time of writing, four patients experienced tumor volume regression and the other seven were in stable condition. During follow-up, nine patients experienced no change in their facial function, two experienced deteriorated facial function, and none developed new facial palsy. Ten patients who had serviceable hearing prior to Gamma Knife radiosurgery retained their hearing. Conclusions Gamma Knife radiosurgery achieves excellent results with respect to tumor control for 7 years on average. In addition, Gamma Knife radiosurgery provides good results in facial nerve and hearing function at long term. Our series demonstrates that Gamma Knife radiosurgery is an effective and safe treatment for patients with either primary or residual facial nerve schwannoma.

Long-term endocrinological outcomes of gamma knife radiosurgery in acromegaly patients

Gamma knife radiosurgery (GKS) is a treatment option for recurrent or persistent disease in patients with acromegaly. ObjectiveWe aimed to retrospectively evaluate acromegaly patients who had undergone GKS in terms of pituitary hormone status, efficacy of GKS, and prognostic factors. MethodOne-hundred and ten acromegaly patients who underwent GKS, and who were referred to our outpatient endocrinology clinic between 2007 and 2017, were included in the study. Anterior pituitary hormones and radiology imaging during follow-up were recorded. Remission for acromegaly was defined as a normal insulin-like growth factor 1 (IGF-1) level adjusted for age and gender, and a random growth hormone (GH) level < 1 ng/ml. Endocrine control was defined as normal GH and IGF-1 levels under medication. ResultsAfter a mean follow-up of 6.5 ± 4.7 years; remission, endocrine control, and uncontrolled status was observed in 16.4%, 60%, and 23.6% of patients; respectively. Adenoma volume was decreased after GKS (P < .0001). Remnant adenoma diameter was higher in the uncontrolled group compared to the remission and endocrine control group. The presence of tumor extension was associated with disease status (P = .03) and higher initial GH and IGF-1 levels. The mean time after GKS to remission was 26.5 months. Six (5.4%) patients had new-onset pituitary deficiency after GKS. In the multivariate analysis, pre-GKS IGF-1 levels and patient's age were associated with disease status. ConclusionGKS is an effective adjuvant treatment with minimal side effects to control GH and IGF-1 levels, increase remission rates, endocrine control, and reduce tumor diameter in persistent acromegaly patients after surgery.

Toxicity and efficacy of Gamma Knife radiosurgery for brain metastases in melanoma patients treated with immunotherapy or targeted therapy-A retrospective cohort study.

BackgroundFew safety data of concurrent stereotactic radiosurgery and targeted therapy (TT) or immunotherapy (IT) are available. The aim of the study was to evaluate the outcome of melanoma patients with brain metastases (MBM) after Gamma Knife Radiosurgery (GKRS) in relation to IT/TT.MethodsWe evaluated 182 MBM patients, who were treated with GKRS in the modern radiosurgical and oncological era.ResultsThe median time between the initial melanoma diagnosis and occurrence of MBM was 2.4 years. The median overall survival time was 5.4 years after melanoma diagnosis. The estimated median survival after the initial diagnosis of MBM was 1.0 year (95% CI = 0.7‐1.2 years). Patients treated with anti‐PD‐1 or a combination of anti‐CTLA‐4/PD‐1 showed a significantly longer survival after first GKRS compared to all other forms of treatment. In addition, patients treated with anti‐PD‐1, anti‐CTLA‐4, or a combination of anti‐CTLA‐4/PD‐1 showed a significantly longer time to new MBM after GKRS1 compared to patients treated with other forms and combinations of the oncological therapy. The occurrence of hemorrhage or radiation reaction/necrosis after GKRS did not show any statistically significant differences in relation to IT/TT.ConclusionIn MBM patients, complications after GKRS are not significantly increased if IT/TT treatment is performed at the time of or after radiosurgery. Further, a clear benefit in distant control and survival is seen in MBM patients treated with GKRS and checkpoint inhibitors. Thus, concomitant treatment of MBM with GKRS and IT/TT seems to be a safe and powerful treatment option although further prospective studies should be conducted.