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KMID : 0942820090080010029
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Journal of Korean Brain Tumor Society
2009 Volume.8 No. 1 p.29 ~ p.34
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Fractionated Gamma Knife Radiosurgery for Intracranial Tumors Located Near Radiosensitive Organs
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Cho Won-Jin
Jung Shin
Moon Kyung-Sub
Kim In-Young
Jung Tae-Young
Park Seung-Jin
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Abstract
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Objective: This study was performed to investigate the radiological and functional outcomes after fractionated gamma knife radiosurgery in the patients with intracranial tumors located near radiosensitive structures.
Materials and Methods: A total of 19 patients performed fractionated GKRS from 2006 to 2008. Among these patients, 12 patients followed at least 6 month were retrospectively reviewed. Fractionated GKS was performed because of old age, higher surgical risk, large size and adjacent to critical structures. There were 4 male & 8 female patients(mean age 59.3, range 37-80). GKRS performed as a primary technique in 8 patients and adjuvant treatment following open surgery and chemotherapy in 4 patients. The mean tumor volume was 12.4(range 1.2-30.9). The dose delivered at the tumor margin ranged 5 to 12 Gy(mean dose 6.9 Gy) and fraction time was 2.5(range 2-3).
Results: The locations were maxilla in one case, suprasellar in one case, hypothalamus & suprasella in one case, clinoid in two cases, frontal lobe in one case, tuberculum sellae in one case, sphenopetoclival in one case, multiple in two cases and petroclivocavernous in two cases. The presumptive diagnosis of the lesion were maxillary cancer in one case, craniopharyngioma in two cases, multiple metastatic cancer in two cases, meningioma in seven cases. The critical structures, should be spared from high dose radiation were optic apparatus and brain stem in our patients. Among the 12 cases, 2 (16.7%) cases showed a tumor response as shrunken, static in 8(66.7%) of the cases and none of the case showed enlarged. Pre-operative neurological deficits were found in 6 cases, 4 cases(66.7%) showed a clinical improvement and 2 cases showed no changes. There were no specific complications & no delayed worsening or new cranial nerve deficits after fractionated GKRS.
Conclusion: The fractionated GKRS were usefully used in near critical structure, large volume, surgically high risk patients and provided good tumor controls in some cases without any adverse effects.
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KEYWORD
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Brain tumor, Complication, Fractionation, Gamma knife radiosurgery
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