The Experts below are selected from a list of 312 Experts worldwide ranked by ideXlab platform
Dwight E. Heron - One of the best experts on this subject based on the ideXlab platform.
-
Clinical Application of Stereotactic Body Radiotherapy (SBRT): Cranium to Prostate - Clinical Application of Stereotactic Body Radiotherapy (SBRT): Cranium to Prostate
Frontiers Research Topics, 2016Co-Authors: Dwight E. Heron, John A. VargoAbstract:Stereotactic radiosurgery is a relatively recent radiation technique initially developed using a frame-based system in 1949 by a Swedish neurosurgeon, Lars Leksell, for lesions not amendable to surgical resection. Radiosurgery is founded on principles of extreme radiation dose escalation, afforded by precise dose delivery with millimeter accuracy. Building upon the success of frame-based radiosurgery techniques, which were limited to cranial tumors and invasive head-frame placement, advances in radiation delivery and image-guidance have lead to the development of stereotactic body radiotherapy (SBRT). SBRT allows for frameless delivery of dose distributions akin to frame-based cranial stereotactic radiosurgery to both cranial and extra-cranial sites and has emerged as a important treatment strategy for a variety of cancers from the cranium to prostate. Herein we highlight ongoing investigations for the clinical application of SBRT for a variety of primary and recurrence cancers aimed at examining the growing clinical evidence supporting emerging roles for SBRT in the ever growing oncologic armamentarium
-
Clinical Application of Stereotactic Body Radiotherapy (SBRT): Cranium to Prostate
Frontiers Media SA, 2016Co-Authors: John A. Vargo, Dwight E. HeronAbstract:Stereotactic radiosurgery is a relatively recent radiation technique initially developed using a frame-based system in 1949 by a Swedish neurosurgeon, Lars Leksell, for lesions not amendable to surgical resection. Radiosurgery is founded on principles of extreme radiation dose escalation, afforded by precise dose delivery with millimeter accuracy. Building upon the success of frame-based radiosurgery techniques, which were limited to cranial tumors and invasive head-frame placement, advances in radiation delivery and image-guidance have lead to the development of stereotactic body radiotherapy (SBRT). SBRT allows for frameless delivery of dose distributions akin to frame-based cranial stereotactic radiosurgery to both cranial and extra-cranial sites and has emerged as a important treatment strategy for a variety of cancers from the cranium to prostate. Herein we highlight ongoing investigations for the clinical application of SBRT for a variety of primary and recurrence cancers aimed at examining the growing clinical evidence supporting emerging roles for SBRT in the ever growing oncologic armamentarium
-
Editorial: Clinical Application of Stereotactic Body Radiotherapy (SBRT): Cranium to Prostate.
Frontiers in oncology, 2015Co-Authors: John A. Vargo, Dwight E. HeronAbstract:Stereotactic radiosurgery is a relatively recent radiation technique initially developed using a frame-based system in 1949 by a Swedish neurosurgeon, Lars Leksell, for lesions not amendable to surgical resection. Radiosurgery is founded on principles of extreme radiation dose escalation, afforded by precise dose delivery with millimeter to submillimeter accuracy. Building upon the success of frame-based radiosurgery techniques, which were limited to cranial tumors and invasive head-frame placement, advances in radiation delivery and image guidance have led to the development of stereotactic body radiotherapy (SBRT). SBRT allows for frameless delivery of dose distributions akin to frame-based cranial stereotactic radiosurgery to both cranial and extracranial sites and has emerged as an important treatment strategy for a variety of cancers from the cranium to prostate. In this research topic, we present a compendium of scientific papers that highlight the forefront of clinical applications of SBRT. This collection of papers showcase the wide application of SBRT for primary cancers often in patient populations in whom conventional treatment strategies are either not possible anatomically, fraught with risk due to medical comorbidities, or present significant threats to patient quality of life. This includes the primary treatment for elderly patients with inoperable head and neck cancers, medically inoperable early-stage non-small cell lung cancer, adrenal metastases, and early-stage organ confined prostate cancer. Through stereotaxy, SBRT limits the volume of tissue that is irradiated which is especially important when considering reirradiation for recurrent tumors; this is highlighted through the collection with papers discussing SBRT for reirradiation of primary brain tumors, skull-base, and parenchymal brain metastases, and gynecologic tumors. Finally, as a number of papers herein highlight, SBRT both due to its short overall treatment time, minimal acute side effects, and unique underlying radiobiological effects, holds the potential for integration with novel systemic therapies aimed at improving outcomes and even potentially engaging the immune system in the oncologic armamentarium. This collection could, thus, serve as an invaluable resource for the growing breadth of SBRT application as physicians continue the relentless pursuit of tackling some of the most challenging cases in oncology.
Jason P. Sheehan - One of the best experts on this subject based on the ideXlab platform.
-
The evolution of stereotactic radiosurgery in neurosurgical practice
Journal of Neuro-Oncology, 2021Co-Authors: Daniel M. Trifiletti, Henry Ruiz-garcia, Alfredo Quinones-hinojosa, Rohan Ramakrishna, Jason P. SheehanAbstract:Introduction Stereotactic radiosurgery (SRS) was born in an attempt to treat complex intracranial pathologies in a fashion whereby open surgery would create unnecessary or excessive risk. To create this innovation, it was necessary to harness advances in other fields such as engineering, physics, radiology, and computer science. Methods We review the history of SRS to provide context to today’s current state, as well as guide future advancement in the field. Results Since time of Lars Leksell, the young Swedish neurosurgeon who pioneered the development of the SRS, the collegial and essential partnership between neurosurgeons, radiation oncologists and physicists has given rise to radiosurgery as a prominent and successful tool in neurosurgical practice. Conclusion We examine how neurosurgeons have helped foster the SRS evolution and how this evolution has impacted neurosurgical practice as well as that of radiation oncology and neuro-oncology.
-
Cranial Stereotactic Radiosurgery: Current Status of the Initial Paradigm Shifter
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014Co-Authors: Jason P. Sheehan, Chun-po Yen, Cheng-chia Lee, Jay S. LoefflerAbstract:The concept of stereotactic radiosurgery (SRS) was first described by Lars Leksell in 1951. It was proposed as a noninvasive alternative to open neurosurgical approaches to manage a variety of conditions. In the following decades, SRS emerged as a unique discipline involving a collegial partnership among neurosurgeons, radiation oncologists, and medical physicists. SRS relies on the precisely guided delivery of high-dose ionizing radiation to an intracranial target. The focused convergence of multiple beams yields a potent therapeutic effect on the target and a steep dose fall-off to surrounding structures, thereby minimizing the risk of collateral damage. SRS is typically administered in a single session but can be given in as many as five sessions or fractions. By providing an ablative effect noninvasively, SRS has altered the treatment paradigms for benign and malignant intracranial tumors, functional disorders, and vascular malformations. Literature on extensive intracranial radiosurgery has unequivocally demonstrated the favorable benefit-to-risk profile that SRS affords for appropriately selected patients. In a departure from conventional radiotherapeutic strategies, radiosurgical principles have recently been extended to extracranial indications such as lung, spine, and liver tumors. The paradigm shift resulting from radiosurgery continues to alter the landscape of related fields.
-
A perspective on radiosurgery: creativity, elegance, simplicity, and flexibility to change.
World Neurosurgery, 2013Co-Authors: Jason P. Sheehan, Ladislau SteinerAbstract:adiosurgery is aminimally invasive technique designed by Lars Leksell to deliver a destructive amount of radiation to R intracranial lesions that may be inaccessible or unsuitable for open surgery. Undoubtedly, the experiences of delivering ether anesthesia to neurosurgical patients for Dr. Olivecrona motivated Leksell to develop a techniquewith fewer complications than open surgery. A passage from Leksell’s autobiography proved the idea of a minimally invasive neurosurgical approach as on his mind for some time. At the first Scandinavian neurosurgical meeting held in Oslo, Leksell left the conference room during a less-than-exciting presentation and decided to walk in a garden. While on this walk, Leksell met Sir HughCairns. Leksell confessed to Cairns his doubts concerning the state of neurosurgical techniques available at the time and was convinced that something new had to be developed. He explained his plans to mechanically direct a probe into the brain using perhaps the brain’s own electrical activity and ablate pain pathways. He also mused about the idea of using narrow-beam X-ray or ultrasound as the physical agent and doing away with the probe entirely. His enthusiasm and ideas were given a warm reception by Cairns, and the encouraged young Leksell beganwork that led to the development of an “arc-radius” type stereotactic system. Leksell wrote, “I was born under the sign of the ‘archer’ and looked forward to sharpshoot into the brain” (39).
-
Transcranial ultrasound for arteriovenous malformations: something old is new again.
World neurosurgery, 2011Co-Authors: Jason P. SheehanAbstract:The concept of ionizing radiation to treat arteriovenous malformations was devised in 1914 (3). At that time, Vilhelm Magnus, a neurosurgeon from Norway, used radium therapy to treat a patient with a large arteriovenous malformation (AVM) located in the motor cortex. Two years later, Magnus found that the patient’s seizures ceased. He remarked that “In this case radiotherapy was more lenient than the knife” (3). Since then, thousands of patients with cerebral arteriovenous malformations (AVM and dural arteriovenous fistulae [dAVF]) have undergone stereotactic radiosurgery. Most of the vascular malformations obliterate within 3 to 4 years after radiosurgery. In the interim, patients are typically followed with serial magnetic resonance imaging (MRI) performed at 6-month intervals. Once the vascular malformation seems to have disappeared on the MRI, a diagnostic angiogram is usually performed to confirm obliteration. The interval between radiosurgery and angiographically confirmed obliteration is filled with some degree of uncertainty and anxiety for patients and clinicians alike. The risk of hemorrhage appears unchanged until complete obliteration is achieved. However, from a clinical perspective, we know that hemodynamic changes are occurring during the timeframe between treatment and obliteration. Favorable hemodynamic changes may be accompanied by improvements in symptoms such as tinnitus for patients with dAVF or seizures in patients with AVM. Unfavorable hemodynamic changes may be accompanied by clinical worsening. Dr. Jo and colleagues are to be commended for their research using transcranial Doppler (TCD) evaluations to track hemodynamic changes in AVMs treated with Gamma Knife radiosurgery. They demonstrated favorable hemodynamic changes and eventual obliteration of unruptured AVMs fed by the middle cerebral artery or its major branches. Standard TCD technology would likely confine this approach to middle cerebral artery fed AVMs and, thus, prevent its use for AVMs with anterior cerebral artery, posterior cerebral artery, or posterior circulation feeding vessels. In those AVMs studied, they observed a decrease in the mean blood flow velocity and an increase in the mean pulsatility index correlated with diminished flow and, later, complete obliteration. Although TCD evaluation should not be used in place of MRI or cerebral angiography, it can be used as an adjunct to the postoperative radiographic follow-up of selected patients with AVM. It may also provide valuable data for modeling of AVM and dAVF hemodynamics before and after stereotactic radiosurgery. Such hemodynamic measurements could be useful for development of predictive modeling related to the treatment of patients with AVMs and dAVFs undergoing radiosurgery, with or without embolization. Ultrasound has long played a role in neurosurgery. In fact, Lars Leksell was introduced to high frequency ultrasound by a neurosurgical colleague, Peter Aron Lindstrom. In 1954, Lindstrom explored the use of high frequency ultrasound for lesioning as an alternative to the then popular lobotomy procedure (2). Leksell went so far as to develop a specifically adapted frame to mount an ultrasound transducer (2). Unfortunately, Leksell could not circumvent the intact cranium and sufficiently focus the ultrasound as a therapeutic tool. He abandoned this energy source and eventually turned to ionizing radiation from the Gamma Knife to treat intracranial pathology including AVMs. He did continue to use ultrasound to perform evaluations of patients in the emergency department in an attempt to identify a mass lesion or intracranial hematoma (2).
-
Gamma knife surgery for low-grade gliomas.
Neurosurgery, 2008Co-Authors: Peter A Heppner, Jason P. Sheehan, Ladislau E SteinerAbstract:Data regarding the long-term efficacy of Gamma knife surgery on a large series of patients with low-grade gliomas is lacking. We aimed to review the outcome of patients with low-grade gliomas undergoing Gamma knife surgery at the Lars Leksell Gamma Knife Center at the University of Virginia to clarify its role in the management of these lesions. A retrospective review of 49 patients treated between 1989 and 2003 was conducted. The median follow up was 63 months. Gamma knife surgery was generally performed for tumors in eloquent brain, residual tumor post-surgery or for late progression after surgery. Median clinical progression free survival was 44 months and median radiological progression free survival was 37 months. Five-year radiological progression free survival was 37% while clinical progression free survival was 41%. Mortality due to tumor progression occurred in 7 patients (14%). Complete radiological remission was seen in 14 patients (29%). Complications due to Gamma surgery were seen in 4 patients (8%). Of these, two resolved without sequelae, one required surgery for neurological decline and associated radiation induced changes, and one patient suffered a permanent neurological deficit from treatment. Gamma knife radiosurgery is a safe treatment for low-grade gliomas and may be considered in patients with residual or recurrent disease.
Lauri V. Laitinen - One of the best experts on this subject based on the ideXlab platform.
-
Personal memories of the history of stereotactic neurosurgery.
Neurosurgery, 2004Co-Authors: Lauri V. LaitinenAbstract:: This article summarizes the author's personal memories of the first 50 years of stereotactic neurosurgery. The author provides a short summary of his education and his introduction to stereotactic neurosurgery. Some great pioneers of the field who played an important role in his training, including John F. Gillingham, Jean Talairach, Guillaume Guiot, Edvard Kandel, Hirotaro Narabayashi, Irving Cooper, Henry Wycis, and Lars Leksell, are described in detail. The author then discusses his own work in the treatment of movement disorders, chronic pain, epilepsy, and intractable psychiatric disorders. For his contributions to the field, the author received the Spiegel-Wycis Medal of the World Society for Stereotactic and Functional Neurosurgery in 2001.
-
My 50 years of interest in stereotactic and functional neurosurgery.
Stereotactic and functional neurosurgery, 2001Co-Authors: Lauri V. LaitinenAbstract:The author describes his personal reflections over the last 50 years. Special attention is drawn to Jean Talairach and Lars Leksell, who greatly influenced his work in stereotactic neurosurgery.
-
Leksell's unpublished pallidotomies of 1958-1962.
Stereotactic and functional neurosurgery, 2000Co-Authors: Lauri V. LaitinenAbstract:Lars Leksell performed posteroventral pallidotomies in 123 parkinsonian patients from 1958 through 1962. This previously unpublished series was analyzed by the present author 40 years later. The analysis was based on a number of old radiographs that were found accidentally as well as the available hospital notes. After pallidotomy, Leksell had left metal markers in the brain to illustrate the lesion site. Superimposition of the markers on modern MRI scans of patients with similar-sized heads shows a high degree of accuracy of Leksell's pallidotomy.
-
Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease
Journal of neurosurgery, 1992Co-Authors: Lauri V. Laitinen, Marwan HarizAbstract:Between 1985 and 1990, the authors performed stereotactic posteroventral pallidotomies on 38 patients with Parkinson's disease whose main complaint was hypokinesia. Upon re-examination 2 to 71 months after surgery (mean 28 months), complete or almost complete relief of rigidity and hypokinesia was observed in 92% of the patients. Of the 32 patients who before surgery also suffered from tremor, 26 (81%) had complete or almost complete relief of tremor. The L-dopa-induced dyskinesias and muscle pain had greatly improved or disappeared in most patients, and gait and speech volume also showed remarkable improvement. Complications were observed in seven patients: six had a permanent partial homonymous hemianopsia (one also had transient dysphasia and facial weakness) and one developed transitory hemiparesis 1 week after pallidotomy. The results presented here confirm the 1960 findings of Svennilson, et al., that parkinsonian tremor, rigidity, and hypokinesia can be effectively abolished by posteroventral pallidotomy, an approach developed in 1956 and 1957 by Lars Leksell. The positive effect of posteroventral pallidotomy is believed to be based on the interruption of some striopallidal or subthalamopallidal pathways, which results in disinhibition of medial pallidal activity necessary for movement control.
-
Leksell's posteroventral pallidotomy in the treatment of
1992Co-Authors: Lauri V. Laitinen, A. Tommy Bergenheim, Marwan HarizAbstract:v Between 1985 and 1990, the authors performed stereotactic posteroventral pallidotomies on 38 patients with Parkinson's disease whose main complaint was hypokinesia. Upon re-examination 2 to 71 months after surgery (mean 28 months), complete or almost complete relief of rigidity and hypokinesia was observed in 92% of the patients. Of the 32 patients who before surgery also suffered from tremor, 26 (81 %) had complete or almost complete relief of tremor. The L-dopa-induced dyskinesias and muscle pain had greatly improved or disappeared in most patients, and gait and speech volume also showed remarkable improvement. Complications were observed in seven patients: six had a permanent partial homonymous hemianopsia (one also had transient dysphasia and facial weakness) and one developed transitory hemiparesis I week after pallidotomy. The results presented here confirm the 1960 findings of Svennilson, et al., that parkinsonian tremor, rigidity, and hypokinesia can be effectively abolished by posteroventral pallidotomy, an approach developed in 1956 and 1957 by Lars Leksell. The positive effect of posteroventral pallidotomy is believed to be based on the interruption of some striopallidal or subthalamopallidal pathways, which results in disinhibition of medial pallidal activity necessary for movement control.
Ladislau Steiner - One of the best experts on this subject based on the ideXlab platform.
-
A perspective on radiosurgery: creativity, elegance, simplicity, and flexibility to change.
World Neurosurgery, 2013Co-Authors: Jason P. Sheehan, Ladislau SteinerAbstract:adiosurgery is aminimally invasive technique designed by Lars Leksell to deliver a destructive amount of radiation to R intracranial lesions that may be inaccessible or unsuitable for open surgery. Undoubtedly, the experiences of delivering ether anesthesia to neurosurgical patients for Dr. Olivecrona motivated Leksell to develop a techniquewith fewer complications than open surgery. A passage from Leksell’s autobiography proved the idea of a minimally invasive neurosurgical approach as on his mind for some time. At the first Scandinavian neurosurgical meeting held in Oslo, Leksell left the conference room during a less-than-exciting presentation and decided to walk in a garden. While on this walk, Leksell met Sir HughCairns. Leksell confessed to Cairns his doubts concerning the state of neurosurgical techniques available at the time and was convinced that something new had to be developed. He explained his plans to mechanically direct a probe into the brain using perhaps the brain’s own electrical activity and ablate pain pathways. He also mused about the idea of using narrow-beam X-ray or ultrasound as the physical agent and doing away with the probe entirely. His enthusiasm and ideas were given a warm reception by Cairns, and the encouraged young Leksell beganwork that led to the development of an “arc-radius” type stereotactic system. Leksell wrote, “I was born under the sign of the ‘archer’ and looked forward to sharpshoot into the brain” (39).
-
The role of the Gamma Knife in the management of cerebral astrocytomas.
Progress in neurological surgery, 2007Co-Authors: György T. Szeifert, Dheerendra Prasad, Toshifumi Kamyrio, Melita Steiner, Ladislau SteinerAbstract:The aim of this study was to assess the role of Gamma Knife radiosurgery in the complex management of cerebral astrocytomas. Out of a series with more than 1,000 brain tumor cases treated at the Lars Leksell Center for Gamma Knife Surgery, UVA, 74 astrocytomas were selected for the present review. The tumor either disappeared or decreased in 60% of grade 1 astrocytomas (n = 15), and 71% tumor control was achieved in grade 2 astrocytomas (n = 17) following radiosurgery. In the high-grade glioma group (grades 3 and 4; n = 42) median survival time was 14 (range 2-58) months, and 25% of the patients were alive at 5 years after the treatment. The best results were presented by the subgroup wherein previous craniotomy and debulking of the tumor were followed by radiosurgery (n = 7) with a median survival period of 24 (range 2-53) months. Results of the present analysis suggest that stereotactic radiosurgery represents an alternative or supplementary treatment modality to conventional surgery in small-volume low-grade astrocytomas especially in deep-seated critical locations. There is also evidence for the beneficial effect of radiosurgery on the survival of patients with high-grade gliomas; however, the limitations of a focused irradiation technique on a malignant infiltrative process are obvious.
-
Gamma Knife surgery for trigeminal schwannoma
Journal of neurosurgery, 2007Co-Authors: Jason P. Sheehan, Chun-po Yen, Yasser Arkha, David Schlesinger, Ladislau SteinerAbstract:Object. Trigeminal schwannomas are rare intracranial tumors. In the past, resection and radiation therapy were the mainstays of their treatment. More recently, neurosurgeons have begun to use radiosurgery in the treatment of trigeminal schwannomas because of its successful use in the treatment of vestibular schwannomas. In this article the authors evaluate the radiological and clinical outcomes in a series of patients in whom Gamma Knife surgery (GKS) was used to treat trigeminal schwannomas. Methods. Twenty-six patients with trigeminal schwannomas underwent GKS at the University of Virginia Lars Leksell Gamma Knife Center between 1989 and 2005. Five of these patients had neurofibromatosis and one patient was lost to follow up. The median tumor volume was 3.96 cm 3 , and the mean follow-up period was 48.5 months. The median prescription radiation dose was 15 Gy, and the median prescription isodose configuration was 50%. There was clinical improvement in 18 patients (72%), a stable lesion in four patients (16%), and worsening of the disease in three patients (12%). On imaging, the schwannomas shrank in 12 patients (48%), remained stable in 10 patients (40%), and increased in size in three patients (12%). These results were comparable for primary and adjuvant GKSs. No tumor growth following GKS was observed in the patients with neurofibromatosis. Conclusions. Gamma Knife surgery affords a favorable risk-to-benefit profile for patients harboring trigeminal schwannomas. Larger studies with open-ended follow-up review will be necessary to determine the long-term results and complications of GKS in the treatment of trigeminal schwannomas.
-
gamma surgery in the treatment of nonsecretory pituitary macroadenoma
Journal of Neurosurgery, 2006Co-Authors: Vincenzo Mingione, Jason P. Sheehan, Chun-po Yen, Melita Steiner, Mary Lee Vance, Edward R Laws, Ladislau SteinerAbstract:Object. The authors report on a retrospective analysis of the imaging and clinical outcomes following gamma surgery in 100 patients with nonsecretory pituitary macroadenoma. Methods. Between June 1989 and March 2004, 100 consecutive patients with nonsecretory pituitary macroadenoma were treated at the Lars Leksell Center for Gamma Surgery, University of Virginia Health System (Charlottesville, VA). Ninety-two patients had residual or recurrent macroadenoma following one or more surgical procedures. In eight patients, gamma surgery was the primary treatment. Ten patients received conventional fractionated radiotherapy before the gamma surgery. Sixty-nine patients required hormone replacement therapy for one or more deficits before gamma knife treatment. Peripheral doses between 5 and 25 Gy (mean 18.5 Gy) were administered. Imaging and endocrinological follow-up evaluations were performed in 90 patients; these studies ranged from 6 to 142 months (mean 44.9 months) and 6 to 127 months (mean 47.9 months), respectively. Tumor volume decreased in 59 patients (65.6%), remained unchanged in 24 (26.7%), and increased in seven (7.8%). The minimal effective peripheral dose was 12 Gy; peripheral doses greater than 20 Gy did not seem to provide additional benefit. Of 61 patients with a partially or fully functioning pituitary gland and follow-up data, 12 (19.7%) suffered new hormone deficits following gamma surgery. In patients with endocrinological follow-up data that had been collected over more than 2 years, the rate of new deficits was 25%. No neurological morbidity or death was related to treatment. Conclusions. Current experience suggests that gamma surgery is an appropriate means of managing recurrent or residual nonsecretory pituitary macroadenoma following microsurgery and a primary treatment in selected patients. To evaluate definite rates of recurrence and new endocrine deficiencies, long-term follow-up studies are needed.
-
Stereotactic radiosurgery for pituitary adenomas: a review of the literature and our experience.
Frontiers of hormone research, 2006Co-Authors: Jason P. Sheehan, Jay Jagannathan, Nader Pouratian, Ladislau SteinerAbstract:Lars Leksell Gamma Knife Center, Department of Neurological Surgery, Health Sciences Center, University of Virginia, Charlottesville, Va., USA
John A. Vargo - One of the best experts on this subject based on the ideXlab platform.
-
Clinical Application of Stereotactic Body Radiotherapy (SBRT): Cranium to Prostate - Clinical Application of Stereotactic Body Radiotherapy (SBRT): Cranium to Prostate
Frontiers Research Topics, 2016Co-Authors: Dwight E. Heron, John A. VargoAbstract:Stereotactic radiosurgery is a relatively recent radiation technique initially developed using a frame-based system in 1949 by a Swedish neurosurgeon, Lars Leksell, for lesions not amendable to surgical resection. Radiosurgery is founded on principles of extreme radiation dose escalation, afforded by precise dose delivery with millimeter accuracy. Building upon the success of frame-based radiosurgery techniques, which were limited to cranial tumors and invasive head-frame placement, advances in radiation delivery and image-guidance have lead to the development of stereotactic body radiotherapy (SBRT). SBRT allows for frameless delivery of dose distributions akin to frame-based cranial stereotactic radiosurgery to both cranial and extra-cranial sites and has emerged as a important treatment strategy for a variety of cancers from the cranium to prostate. Herein we highlight ongoing investigations for the clinical application of SBRT for a variety of primary and recurrence cancers aimed at examining the growing clinical evidence supporting emerging roles for SBRT in the ever growing oncologic armamentarium
-
Clinical Application of Stereotactic Body Radiotherapy (SBRT): Cranium to Prostate
Frontiers Media SA, 2016Co-Authors: John A. Vargo, Dwight E. HeronAbstract:Stereotactic radiosurgery is a relatively recent radiation technique initially developed using a frame-based system in 1949 by a Swedish neurosurgeon, Lars Leksell, for lesions not amendable to surgical resection. Radiosurgery is founded on principles of extreme radiation dose escalation, afforded by precise dose delivery with millimeter accuracy. Building upon the success of frame-based radiosurgery techniques, which were limited to cranial tumors and invasive head-frame placement, advances in radiation delivery and image-guidance have lead to the development of stereotactic body radiotherapy (SBRT). SBRT allows for frameless delivery of dose distributions akin to frame-based cranial stereotactic radiosurgery to both cranial and extra-cranial sites and has emerged as a important treatment strategy for a variety of cancers from the cranium to prostate. Herein we highlight ongoing investigations for the clinical application of SBRT for a variety of primary and recurrence cancers aimed at examining the growing clinical evidence supporting emerging roles for SBRT in the ever growing oncologic armamentarium
-
Editorial: Clinical Application of Stereotactic Body Radiotherapy (SBRT): Cranium to Prostate.
Frontiers in oncology, 2015Co-Authors: John A. Vargo, Dwight E. HeronAbstract:Stereotactic radiosurgery is a relatively recent radiation technique initially developed using a frame-based system in 1949 by a Swedish neurosurgeon, Lars Leksell, for lesions not amendable to surgical resection. Radiosurgery is founded on principles of extreme radiation dose escalation, afforded by precise dose delivery with millimeter to submillimeter accuracy. Building upon the success of frame-based radiosurgery techniques, which were limited to cranial tumors and invasive head-frame placement, advances in radiation delivery and image guidance have led to the development of stereotactic body radiotherapy (SBRT). SBRT allows for frameless delivery of dose distributions akin to frame-based cranial stereotactic radiosurgery to both cranial and extracranial sites and has emerged as an important treatment strategy for a variety of cancers from the cranium to prostate. In this research topic, we present a compendium of scientific papers that highlight the forefront of clinical applications of SBRT. This collection of papers showcase the wide application of SBRT for primary cancers often in patient populations in whom conventional treatment strategies are either not possible anatomically, fraught with risk due to medical comorbidities, or present significant threats to patient quality of life. This includes the primary treatment for elderly patients with inoperable head and neck cancers, medically inoperable early-stage non-small cell lung cancer, adrenal metastases, and early-stage organ confined prostate cancer. Through stereotaxy, SBRT limits the volume of tissue that is irradiated which is especially important when considering reirradiation for recurrent tumors; this is highlighted through the collection with papers discussing SBRT for reirradiation of primary brain tumors, skull-base, and parenchymal brain metastases, and gynecologic tumors. Finally, as a number of papers herein highlight, SBRT both due to its short overall treatment time, minimal acute side effects, and unique underlying radiobiological effects, holds the potential for integration with novel systemic therapies aimed at improving outcomes and even potentially engaging the immune system in the oncologic armamentarium. This collection could, thus, serve as an invaluable resource for the growing breadth of SBRT application as physicians continue the relentless pursuit of tackling some of the most challenging cases in oncology.
