The role of Gamma Knife Radiosurgery in the management of unresectable gross disease or gross residual disease after surgery in ependymoma

Simon S. Lo, Ramzi Abdulrahman, Paul M. DesRosiers, Achilles J. Fakiris, Thomas C. Witt, Robert M. Worth, Phil H. Dittmer, Colleen M. DesRosiers, Stephanie Frost, Robert D. Timmerman

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Purpose/Objective: To evaluate the efficacy and the toxicity of Gamma Knife (GK)-based stereotactic radiosurgery (SRS) in the management of gross disease in ependymoma. Materials and methods: Eight patients with 13 ependymomas were treated with GK-based SRS in our institution for gross disease. Five patients were treated for recurrent disease that developed after surgery and external beam radiotherapy (EBRT), two received SRS to the gross disease after surgery and EBRT, and one received SRS alone (in a 1.3 year old child). Median EBRT dose was 54.4 Gy (range 50-55.8 Gy). Median SRS dose was 14 Gy (range 12-20 Gy). Seven of eight (87.5%) patients had SRS to a single lesion and one of eight (12.5%) patients had treatment to six tumors in three different sessions. Results: The median follow up was 3 0.2 months (range 8-65.4 months). Out of the eight patients treated with SRS, six (75%) were alive, four (50%) were alive with no recurrence, two (25%) were alive with recurrence, and two (25%) died of recurrent disease. Both patients treated with SRS as a boost were alive and without recurrence. Out of the five patients who received SRS as salvage treatment, three (60%) were alive, two (40%) were alive without recurrence, two (40%) developed distant failure, and three (60%) had in-field control. Two patients who received SRS to their brainstem lesions developed symptoms related to radionecrosis and were successfully treated with steroid with good control of symptoms. Conclusions: GK-based SRS appears to be a feasible and safe treatment modality for patients with ependymoma with unresectable gross disease or gross residual disease after surgery. SRS provides reasonable local control but out-of-field tumor progression remains an issue. For patients who receive SRS as a boost, the local control appears to be excellent.

Original languageEnglish (US)
Pages (from-to)51-56
Number of pages6
JournalJournal of Neuro-Oncology
Volume79
Issue number1
DOIs
StatePublished - Aug 2006

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Ependymoma
Radiosurgery
Recurrence
Radiotherapy
Salvage Therapy
Disease Management
Brain Stem
Neoplasms

Keywords

  • Ependymoma
  • Gross disease
  • Radiosurgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Cancer Research
  • Oncology
  • Neuroscience(all)

Cite this

The role of Gamma Knife Radiosurgery in the management of unresectable gross disease or gross residual disease after surgery in ependymoma. / Lo, Simon S.; Abdulrahman, Ramzi; DesRosiers, Paul M.; Fakiris, Achilles J.; Witt, Thomas C.; Worth, Robert M.; Dittmer, Phil H.; DesRosiers, Colleen M.; Frost, Stephanie; Timmerman, Robert D.

In: Journal of Neuro-Oncology, Vol. 79, No. 1, 08.2006, p. 51-56.

Research output: Contribution to journalArticle

Lo, Simon S. ; Abdulrahman, Ramzi ; DesRosiers, Paul M. ; Fakiris, Achilles J. ; Witt, Thomas C. ; Worth, Robert M. ; Dittmer, Phil H. ; DesRosiers, Colleen M. ; Frost, Stephanie ; Timmerman, Robert D. / The role of Gamma Knife Radiosurgery in the management of unresectable gross disease or gross residual disease after surgery in ependymoma. In: Journal of Neuro-Oncology. 2006 ; Vol. 79, No. 1. pp. 51-56.
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abstract = "Purpose/Objective: To evaluate the efficacy and the toxicity of Gamma Knife (GK)-based stereotactic radiosurgery (SRS) in the management of gross disease in ependymoma. Materials and methods: Eight patients with 13 ependymomas were treated with GK-based SRS in our institution for gross disease. Five patients were treated for recurrent disease that developed after surgery and external beam radiotherapy (EBRT), two received SRS to the gross disease after surgery and EBRT, and one received SRS alone (in a 1.3 year old child). Median EBRT dose was 54.4 Gy (range 50-55.8 Gy). Median SRS dose was 14 Gy (range 12-20 Gy). Seven of eight (87.5{\%}) patients had SRS to a single lesion and one of eight (12.5{\%}) patients had treatment to six tumors in three different sessions. Results: The median follow up was 3 0.2 months (range 8-65.4 months). Out of the eight patients treated with SRS, six (75{\%}) were alive, four (50{\%}) were alive with no recurrence, two (25{\%}) were alive with recurrence, and two (25{\%}) died of recurrent disease. Both patients treated with SRS as a boost were alive and without recurrence. Out of the five patients who received SRS as salvage treatment, three (60{\%}) were alive, two (40{\%}) were alive without recurrence, two (40{\%}) developed distant failure, and three (60{\%}) had in-field control. Two patients who received SRS to their brainstem lesions developed symptoms related to radionecrosis and were successfully treated with steroid with good control of symptoms. Conclusions: GK-based SRS appears to be a feasible and safe treatment modality for patients with ependymoma with unresectable gross disease or gross residual disease after surgery. SRS provides reasonable local control but out-of-field tumor progression remains an issue. For patients who receive SRS as a boost, the local control appears to be excellent.",
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AU - Lo, Simon S.

AU - Abdulrahman, Ramzi

AU - DesRosiers, Paul M.

AU - Fakiris, Achilles J.

AU - Witt, Thomas C.

AU - Worth, Robert M.

AU - Dittmer, Phil H.

AU - DesRosiers, Colleen M.

AU - Frost, Stephanie

AU - Timmerman, Robert D.

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N2 - Purpose/Objective: To evaluate the efficacy and the toxicity of Gamma Knife (GK)-based stereotactic radiosurgery (SRS) in the management of gross disease in ependymoma. Materials and methods: Eight patients with 13 ependymomas were treated with GK-based SRS in our institution for gross disease. Five patients were treated for recurrent disease that developed after surgery and external beam radiotherapy (EBRT), two received SRS to the gross disease after surgery and EBRT, and one received SRS alone (in a 1.3 year old child). Median EBRT dose was 54.4 Gy (range 50-55.8 Gy). Median SRS dose was 14 Gy (range 12-20 Gy). Seven of eight (87.5%) patients had SRS to a single lesion and one of eight (12.5%) patients had treatment to six tumors in three different sessions. Results: The median follow up was 3 0.2 months (range 8-65.4 months). Out of the eight patients treated with SRS, six (75%) were alive, four (50%) were alive with no recurrence, two (25%) were alive with recurrence, and two (25%) died of recurrent disease. Both patients treated with SRS as a boost were alive and without recurrence. Out of the five patients who received SRS as salvage treatment, three (60%) were alive, two (40%) were alive without recurrence, two (40%) developed distant failure, and three (60%) had in-field control. Two patients who received SRS to their brainstem lesions developed symptoms related to radionecrosis and were successfully treated with steroid with good control of symptoms. Conclusions: GK-based SRS appears to be a feasible and safe treatment modality for patients with ependymoma with unresectable gross disease or gross residual disease after surgery. SRS provides reasonable local control but out-of-field tumor progression remains an issue. For patients who receive SRS as a boost, the local control appears to be excellent.

AB - Purpose/Objective: To evaluate the efficacy and the toxicity of Gamma Knife (GK)-based stereotactic radiosurgery (SRS) in the management of gross disease in ependymoma. Materials and methods: Eight patients with 13 ependymomas were treated with GK-based SRS in our institution for gross disease. Five patients were treated for recurrent disease that developed after surgery and external beam radiotherapy (EBRT), two received SRS to the gross disease after surgery and EBRT, and one received SRS alone (in a 1.3 year old child). Median EBRT dose was 54.4 Gy (range 50-55.8 Gy). Median SRS dose was 14 Gy (range 12-20 Gy). Seven of eight (87.5%) patients had SRS to a single lesion and one of eight (12.5%) patients had treatment to six tumors in three different sessions. Results: The median follow up was 3 0.2 months (range 8-65.4 months). Out of the eight patients treated with SRS, six (75%) were alive, four (50%) were alive with no recurrence, two (25%) were alive with recurrence, and two (25%) died of recurrent disease. Both patients treated with SRS as a boost were alive and without recurrence. Out of the five patients who received SRS as salvage treatment, three (60%) were alive, two (40%) were alive without recurrence, two (40%) developed distant failure, and three (60%) had in-field control. Two patients who received SRS to their brainstem lesions developed symptoms related to radionecrosis and were successfully treated with steroid with good control of symptoms. Conclusions: GK-based SRS appears to be a feasible and safe treatment modality for patients with ependymoma with unresectable gross disease or gross residual disease after surgery. SRS provides reasonable local control but out-of-field tumor progression remains an issue. For patients who receive SRS as a boost, the local control appears to be excellent.

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KW - Gross disease

KW - Radiosurgery

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