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Adaptive radiosurge...
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Sinclair, GeorgesDepartments 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.
(författare)
Adaptive radiosurgery based on two simultaneous dose prescriptions in the management of large renal cell carcinoma brain metastases in critical areas: Towards customization
- Artikel/kapitelEngelska2020
Förlag, utgivningsår, omfång ...
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2020-02-14
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Scientific Scholar,2020
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printrdacarrier
Nummerbeteckningar
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LIBRIS-ID:oai:DiVA.org:uu-464972
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-464972URI
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https://doi.org/10.25259/sni_275_2019DOI
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Språk:engelska
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Sammanfattning på:engelska
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Ämneskategori:ref swepub-contenttype
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Ämneskategori:for swepub-publicationtype
Anmärkningar
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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.
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Biuppslag (personer, institutioner, konferenser, titlar ...)
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Stenman, M.Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden,
(författare)
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Benmakhlouf, H.Departments of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
(författare)
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Johnstone, P.Department of Oncology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom.
(författare)
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Wersäll, P.Department of Oncology-Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
(författare)
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Lindskog, M.Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden,
(författare)
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Hatiboglu, M. A.Department of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey,
(författare)
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Harmenberg, U.Department of Oncology-Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
(författare)
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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)
Sammanhörande titlar
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Ingår i:Surgical Neurology International: Scientific Scholar11, s. 21-212229-50972152-7806
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