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Adaptive radiosurge...
Adaptive radiosurgery based on two simultaneous dose prescriptions in the management of large renal cell carcinoma brain metastases in critical areas: Towards customization
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- Sinclair, Georges (author)
- Departments of Neurosurgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden;Department of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey,;Department of Oncology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom.
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- Stenman, M. (author)
- Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden,
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- Benmakhlouf, H. (author)
- Departments of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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- Johnstone, P. (author)
- Department of Oncology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom.
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- Wersäll, P. (author)
- Department of Oncology-Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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- Lindskog, M. (author)
- Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden,
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- Hatiboglu, M. A. (author)
- Department of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey,
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- Harmenberg, U. (author)
- Department of Oncology-Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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Departments of Neurosurgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden;Department of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey,;Department of Oncology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden, (creator_code:org_t)
- 2020-02-14
- 2020
- English.
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In: Surgical Neurology International. - : Scientific Scholar. - 2229-5097 .- 2152-7806. ; 11, s. 21-21
- Related links:
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https://surgicalneur...
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https://urn.kb.se/re...
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https://doi.org/10.2...
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Abstract
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- The long-term benefits of local therapy in metastatic renal cell carcinoma (mRCC) have been widely documented. In this context, single fraction gamma knife radiosurgery (SF-GKRS) is routinely used in the management of brain metastases. However, SF-GKRS is not always feasible due to volumetric and regional constraints. We intend to illustrate how a dose-volume adaptive hypofractionated GKRS technique based on two concurrent dose prescriptions termed rapid rescue radiosurgery (RRR) can be utilized in this particular scenario.Case Description:A 56-year-old man presented with left-sided hemiparesis; the imaging showed a 13.1 cc brain metastasis in the right central sulcus (Met 1). Further investigation confirmed the histology to be a metastatic clear cell RCC. Met 1 was treated with upfront RRR. Follow-up magnetic resonance imaging (MRI) at 10 months showed further volume regression of Met 1; however, concurrently, a new 17.3 cc lesion was reported in the boundaries of the left frontotemporal region (Met 2) as well as a small metastasis (<1 cc) in the left temporal lobe (Met 3). Met 2 and Met 3 underwent RRR and SF-GKRS, respectively.Results:Gradual and sustained tumor ablation of Met 1 and Met 2 was demonstrated on a 20 months long follow- up. The patient succumbed to extracranial disease 21 months after the treatment of Met 1 without evidence of neurological impairment post-RRR.Conclusion:Despite poor prognosis and precluding clinical factors (failing systemic treatment, eloquent location, and radioresistant histology), RRR provided optimal tumor ablation and salvage of neurofunction with limited toxicity throughout follow-up.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Keyword
- Oncology
- Onkologi
Publication and Content Type
- ref (subject category)
- for (subject category)
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