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John H. Suh - One of the best experts on this subject based on the ideXlab platform.
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Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Spinal Sarcomas.
Technology in cancer research & treatment, 2016Co-Authors: Jacob A. Miller, John H. Suh, Ehsan H. Balagamwala, Lilyana Angelov, Toufik Djemil, Anthony Magnelli, T. Zhuang, Andrew Godley, Samuel T. ChaoAbstract:Purpose:Despite advancements in local and systemic therapy, metastasis remains common in the natural history of sarcomas. Unfortunately, such metastases are the most significant source of morbidity and mortality in this heterogeneous disease. As a classically radioresistant histology, Stereotactic Radiosurgery has emerged to control spinal sarcomas and provide palliation. However, there is a lack of data regarding pain relief and relapse following Stereotactic Radiosurgery.Methods:We queried a retrospective institutional database of patients who underwent spine Stereotactic Radiosurgery for primary and metastatic sarcomas. The primary outcome was pain relief following Stereotactic Radiosurgery. Secondary outcomes included progression of pain, radiographic failure, and development of toxicities following treatment.Results:Forty treatment sites were eligible for inclusion; the median prescription dose was 16 Gy in a single fraction. Median time to radiographic failure was 14 months. At 6 and 12 months, radi...
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Stereotactic Radiosurgery for the Management of Brain Metastases
The New England journal of medicine, 2010Co-Authors: John H. SuhAbstract:A 50-year-old man with a history of lung cancer presents with headaches and right-arm numbness; he is found to have a single brain metastasis. Stereotactic Radiosurgery is recommended as part of his care. Stereotactic Radiosurgery uses multiple narrowly focused beams of radiation to treat one or a few focal lesions while minimizing effects on the surrounding tissue.
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Stereotactic Radiosurgery and radiation therapy for spinal tumors
Expert review of neurotherapeutics, 2007Co-Authors: Eric L. Chang, Yoshiya Yamada, Andrew E. Sloan, John H. Suh, Ehud MendelAbstract:Spinal tumors constitute 15% of all CNS neoplasms. Radiation therapy can be administered for palliation of pain and spinal cord compression. However, the amount of radiation that can be administered is often limited by the tolerance of the spinal cord, especially in cases where prior radiation therapy has been given. Stereotactic Radiosurgery and radiotherapy allow the delivery of a higher dose of radiation to spinal lesions, while limiting the spinal cord dose to below the tolerance level. These are technically demanding procedures and should be performed only when proper equipments and expertise are available. Data on spinal Stereotactic Radiosurgery and radiotherapy have emerged in recent years. This review summarizes the clinical applications of Stereotactic Radiosurgery and radiotherapy for spinal tumors.
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Update of Stereotactic Radiosurgery for brain tumors.
Current opinion in neurology, 2004Co-Authors: John H. Suh, Michael A. Vogelbaum, Gene H. BarnettAbstract:Purpose of review This paper will review the recent publications of Stereotactic Radiosurgery for brain tumors. Recent advances Despite its controversial beginning, Stereotactic Radiosurgery has rapidly gained acceptance among neurosurgeons, radiation oncologists, and neuro-oncologists as a valuable treatment option for patients with certain benign and malignant brain tumors. Over the past year, a number of publications have confirmed the efficacy and safety of this treatment modality as the sole treatment modality or as part of the multimodality management of brain tumor patients. These publications ranged from the first multi-institutional phase III trial of Radiosurgery for patients with brain metastases to numerous retrospective papers about treatment outcomes. Also, a number of these publications have explored the use of newer imaging modalities to improve treatment outcomes while others reported on the rare complication of radiation-associated second tumors. Summary Recent publications of Stereotactic Radiosurgery have increased our understanding of the use of this technology. Future studies are needed to further improve outcomes, minimize toxicities and increase our understanding of this treatment modality.
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Stereotactic Radiosurgery for brain tumors in pediatric patients.
Technology in cancer research & treatment, 2003Co-Authors: John H. Suh, Gene H. BarnettAbstract:Brain tumors represent the most common solid tumor in children. Fractionated radiation therapy has been an important treatment modality in the multi-disciplinary management of these tumors. Stereotactic Radiosurgery is the precise delivery of a single fraction of radiation and has been an important treatment option for adult brain tumor patients. Although the use of Stereotactic Radiosurgery in pediatric brain tumors is much less frequent, it represents an important alternative for patients with recurrent, surgically inaccessible or radioresponsive tumors. This article will review the results and logistical issues of this modality in the management of pediatric brain tumors.
Matthias Guckenberger - One of the best experts on this subject based on the ideXlab platform.
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Stereotactic Radiosurgery for Multiple Brain Metastases
Current treatment options in neurology, 2019Co-Authors: Johannes Kraft, Jaap D. Zindler, Giuseppe Minniti, Matthias Guckenberger, Nicolaus AndratschkeAbstract:To give an overview on the current evidence for Stereotactic Radiosurgery of brain metastases with a special focus on multiple brain metastases. While the use of Stereotactic Radiosurgery in patients with limited brain metastases has been clearly defined, its role in patients with multiple lesions (> 4) is still a matter of controversy. Whole-brain radiation therapy (WBRT) has been the standard treatment approach for patients with multiple brain lesions and is still the most commonly used treatment approach worldwide. Although distant brain failure is improved by WBRT, the overall survival is not readily impacted. As WBRT is associated with significant neurocognitive decline compared to Stereotactic Radiosurgery (SRS), SRS has been explored and increasingly utilized for selected patients with multiple brain metastases. Recent clinical data indicated the feasibility of Stereotactic Radiosurgery to multiple brain metastases with a similar survival in patients with more than 4 brain metastases versus patients with a maximum of 4 brain metastases. Also, neurocognitive function and quality of life was maintained after Stereotactic Radiosurgery which is essential in a palliative setting. The application of Stereotactic Radiosurgery with Gamma Knife, Cyberknife, or LINAC-based equipment has emerged as an effective and widely available treatment option for patients with limited brain metastases. Although not formally proven in prospective studies, SRS may also be considered as a safe and effective treatment option in selected patients with multiple brain metastases. Especially in patients with a favorable prognosis, survival over several years is observed also in the setting of multiple BM. For these patients, avoidance of the neurocognitive damage of WBRT is desirable, and SRS is often a more appropriate treatment in the current multimodality treatment of BM in which systemic treatment is often the cornerstone of the treatment. For patients with an intermediate (3–12 months) and poor prognosis (
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Stereotactic Radiosurgery for treatment of brain metastases
Strahlentherapie Und Onkologie, 2014Co-Authors: Martin Kocher, Matthias Guckenberger, Andrea Wittig, Marc D Piroth, Harald Treuer, Heinrich Seegenschmiedt, Maximilian I Ruge, Ancaligia GrosuAbstract:Background This report from the Working Group on Stereotaktische Radiotherapie of the German Society of Radiation Oncology (Deutsche Gesellschaft fur Radioonkologie, DEGRO) provides recommendations for the use of Stereotactic Radiosurgery (SRS) on patients with brain metastases. It considers existing international guidelines and details them where appropriate.
John C. Flickinger - One of the best experts on this subject based on the ideXlab platform.
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Stereotactic Radiosurgery for Epilepsy and Functional Disorders
Neurosurgery clinics of North America, 2013Co-Authors: Douglas Kondziolka, John C. Flickinger, L. Dade LunsfordAbstract:Stereotactic Radiosurgery is used for many indications. In functional neurosurgery, it is used to modulate the function of axons, neurons, and related brain circuits. In this article, indications, current techniques, and outcomes are discussed.
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Stereotactic Radiosurgery for residual neurocytoma. Report of four cases.
Journal of neurosurgery, 2001Co-Authors: Elizabeth C. Tyler-kabara, Douglas Kondziolka, John C. Flickinger, L. Dade LunsfordAbstract:✓ The purpose of this report was to review the results of Stereotactic Radiosurgery in the management of patients with residual neurocytomas after initial resection or biopsy procedures. Four patients underwent Stereotactic Radiosurgery for histologically proven neurocytoma. Clinical and imaging studies were performed to evaluate the response to treatment. Radiosurgery was performed to deliver doses to the tumor margin of 14, 15, 16, and 20 Gy, depending on tumor volume and proximity to critical adjacent structures. More than 3 years later, imaging studies revealed significant reductions in tumor size. No new neurological deficits were identified at 53, 50, 42, and 38 months of follow up. The authors' initial experience shows that Stereotactic Radiosurgery appears to be an effective treatment for neurocytoma.
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Stereotactic Radiosurgery for Hemangioblastomas of the Brain
Acta neurochirurgica, 2000Co-Authors: A. Jawahar, Bruce E. Pollock, Douglas Kondziolka, John C. Flickinger, Y. I. Garces, L. Dade LunsfordAbstract:Objective. To assess the effectiveness of Stereotactic Radiosurgery in achieving tumor control and improving survival in patients with hemangioblastoma, we evaluated results from patients who were managed at the University of Pittsburgh and the Mayo Clinic.
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Adjuvant Stereotactic Radiosurgery for anaplastic ependymoma.
Stereotactic and functional neurosurgery, 1999Co-Authors: A. Jawahar, Douglas Kondziolka, John C. FlickingerAbstract:Object: The purpose of this retrospective study is to evaluate the role of Stereotactic Radiosurgery using the Gamma Knife as an adjuvant to other modalities used in the treatment o
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outcome analysis of acoustic neuroma management a comparison of microsurgery and Stereotactic Radiosurgery
Neurosurgery, 1995Co-Authors: Bruce E. Pollock, Douglas Kondziolka, John C. Flickinger, Dade L Lunsford, David J Bissonette, Sheryl F Kelsey, Peter J JannettaAbstract:Currently, microsurgical resection of acoustic neuromas by an experienced, multidisciplinary team is thought to be the treatment of choice. During the past 20 years Stereotactic Radiosurgery has been used as an alternative to surgical removal. To compare the results of both microsurgery and Stereotactic Radiosurgery, we conducted a study of 87 patients with unilateral, previously unoperated acoustic neuromas with an average diameter less than 3 cm treated by the neurosurgical service during 1990 and 1991. Preoperative patient characteristics and average tumor size were similar between the treatment groups. State of the art microsurgical or radiosurgical techniques were used by experienced surgeons in both treatment groups. The treatment groups were compared based on cranial nerve preservation, tumor control, postoperative complications, patient symptomatology, length of hospital stay, total management charges, effect on employment status, and overall patient satisfaction. Stereotactic Radiosurgery was more effective in preserving normal postoperative facial function (P < 0.05), and hearing preservation (P < 0.03) with less treatment associated morbidity (P < 0.01). Effect on preoperative symptoms were similar between the treatment groups. Postoperative functional outcomes and patients' satisfaction of their tumor management were greater after Stereotactic Radiosurgery when compared to the microsurgical group, although they did not reach statistical significance (P = 0.07 and P = 0.10, respectively). Patients returned to independent functioning sooner after Stereotactic Radiosurgery (P < 0.001). Hospital length of stay and total management charges were less in the radiosurgical group (P < 0.001). When compared to microsurgical removal, Stereotactic Radiosurgery proved to be an effective and less costly management strategy of unilateral acoustic neuromas less than 3 cm in diameter. For many acoustic neuroma patients, Stereotactic Radiosurgery should be offered as an alternative management strategy.
Steven D. Chang - One of the best experts on this subject based on the ideXlab platform.
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Stereotactic Radiosurgery for Benign Spinal Tumors.
Neurosurgery clinics of North America, 2020Co-Authors: Antonio Meola, Peter C. Gerszten, Scott G. Soltys, Adam M. Schmitt, Steven D. ChangAbstract:Benign spinal tumors are rare clinical conditions, including meningiomas, schwannomas, and neurofibromas. Although these tumors are usually treated with open surgical resection, spinal Stereotactic Radiosurgery may be a safe and effective alternative to surgery in selected patients.
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Hemangioblastoma: Stereotactic Radiosurgery
Tumors of the Central Nervous System Volume 5, 2011Co-Authors: Anand Veeravagu, Bowen Jiang, Steven D. ChangAbstract:CNS hemangioblastomas are rare, vascular neoplasms that arise primarily in the posterior cranial fossa. Prognosis is generally favorable, with a recurrence rate of fewer than 25% in multiple surgical series. Although current standard of care for CNS hemangioblastomas is surgical resection, other treatment modalities including endovascular embolization and Stereotactic Radiosurgery (CyberKnife, LINAC, Gamma Knife) are bing applied. Increasing evidence has suggested the effectiveness of Stereotactic Radiosurgery in managing CNS hemangioblastomas. Herewithin, we review the indications and multi-institutional experiences in using such a treatment modality.
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Stereotactic Radiosurgery for hemangiomas and ependymomas of the spinal cord
Neurosurgical focus, 2003Co-Authors: Stephen I. Ryu, Daniel H. Kim, Steven D. ChangAbstract:Object. The optimal treatment for intramedullary spinal tumors is controversial, because both resection and conventional radiation therapy are associated with potential morbidity. Stereotactic Radiosurgery can theoretically deliver highly conformal, high-dose radiation to surgically untreatable lesions while simultaneously mitigating radiation exposure to large portions of the spinal cord. The purpose of this study was to evaluate the authors’ initial experience with frameless Stereotactic Radiosurgery for intramedullary spinal tumors. Methods. Between 1998 and 2003, 10 intramedullary spinal tumors were treated with Stereotactic Radiosurgery at the authors’ institution. Seven hemangioblastomas and three ependymomas were treated in four men and three women. These patients either had recurrent tumors, had undergone several previous surgeries, had medical contraindications to surgery, or had declined open resection. Conformal treatment planning delivered a prescribed dose of 1800 to 2500 cGy (mean 2100 cGy) to the lesions in one to three stages. No significant treatment-related complications have been recorded. The mean radiographic and clinical follow-up duration was 12 months (range 1–24 months). One ependymoma and two hemangioblastomas were smaller on follow-up neuroimaging. The remaining tumors were stable at the time of follow-up imaging. Conclusions. Stereotactic Radiosurgery for intramedullary spinal tumors is feasible and safe in selected cases and may prove to be another therapeutic option for these challenging lesions.
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Stereotactic Radiosurgery in patients with multiple brain metastases
Neurosurgical focus, 2000Co-Authors: Steven D. Chang, Elizabeth Lee, Gordon T. Sakamoto, Nalani P. Brown, John R. AdlerAbstract:Object Patients with multiple brain metastases are often treated primarily with fractionated whole-brain radiation therapy (WBRT). In previous reports the authors have shown that patients with four or fewer brain metastases can benefit from Stereotactic Radiosurgery in addition to fractionated WBRT. In this paper the authors review their experience using linear accelerator Stereotactic Radiosurgery to treat patients with multiple brain metastases. Methods Fifty-three patients with 149 brain metastases underwent Stereotactic Radiosurgery. The mean age of patients was 53.1 years (range 20–78 years). There were 23 men and 30 women. The primary tumor location was lung (27 patients), melanoma (10), breast (six), ovary (six), and other (four). All patients harbored at least two metastatic tumors treated with Radiosurgery; 27 patients (51%) harbored two lesions, 17 (32%) three lesions, eight (15%) four lesions, and one patient (2%) harbored five lesions. The mean radiation dose administered was 19.6 Gy (range 14...
L. Dade Lunsford - One of the best experts on this subject based on the ideXlab platform.
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Stereotactic Radiosurgery for Epilepsy and Functional Disorders
Neurosurgery clinics of North America, 2013Co-Authors: Douglas Kondziolka, John C. Flickinger, L. Dade LunsfordAbstract:Stereotactic Radiosurgery is used for many indications. In functional neurosurgery, it is used to modulate the function of axons, neurons, and related brain circuits. In this article, indications, current techniques, and outcomes are discussed.
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Stereotactic Radiosurgery guideline for the management of patients with intracranial arteriovenous malformations.
Progress in neurological surgery, 2012Co-Authors: Ajay Niranjan, L. Dade LunsfordAbstract:Our objective was to provide guidelines about the use of Stereotactic Radiosurgery in symptomatic patients with imaging-identified arteriovenous malformations (AVMs) of the brain. We reviewed evidence-based medicine and clinical experience with Radiosurgery for AVM of the brain to develop guidelines and provide scientific foundation for patients and physicians. Major recommendations include the definition of AVM patients suitable for various management strategies ranging from observation to surgical excision to endovascular embolization and Stereotactic Radiosurgery. The optimal dose range for volumetric conformal AVM Stereotactic Radiosurgery has been largely established based on location and volume of the AVM. The relationship to prior embolization or prior surgery has been evaluated. The role of repeat Radiosurgery has been assessed for those patients with incomplete obliteration of their AVM after 3 years have elapsed. The causes of failure of Stereotactic Radiosurgery have also been identified. A clinical algorithm for the potential role of Stereotactic Radiosurgery for a symptomatic brain AVM was defined. The guidelines provide a framework for professional judgment and treatment selection alternatives.
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Stereotactic Radiosurgery guidelines for the management of patients with intracranial cavernous malformations.
Progress in neurological surgery, 2012Co-Authors: Ajay Niranjan, L. Dade LunsfordAbstract:Treatment options for cavernous malformations (CMs) have expanded with the application of Stereotactic Radiosurgery. In this report, we provide guidelines about the use of Stereotactic Radiosurgery in CM patients who had 2 documented symptomatic hemorrhages. We reviewed the evidence-based medicine and clinical experience with Radiosurgery for CM of the brain and developed guidelines and provided a scientific foundation for patients and physicians. We also reviewed the controversy surrounding CM Radiosurgery and discussed its origin and validity. Our recommendations include the selection of CM patients suitable for various management strategies ranging from observation to surgical excision and Stereotactic Radiosurgery. Radiosurgery is an effective management strategy that reduces the risk of additional hemorrhages from CMs that repeatedly bleed. The marginal dose ranges from 12 to 18 Gy (median 16 Gy). A clinical algorithm for the potential role of Stereotactic Radiosurgery for CM patients with 2 or more symptomatic hemorrhages is defined. These guidelines provide a framework for professional judgment and assessment of management alternatives for selected intracranial CMs.
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The development of the international Stereotactic Radiosurgery society.
Journal of radiosurgery and SBRT, 2011Co-Authors: L. Dade LunsfordAbstract:In this report the origins of the International Stereotactic Radiosurgery Society (ISRS) are described from the viewpoint of one of the early organizers and first president. The value of the society, the subsequent leadership, and the Jacob Fabrikant Award winners are also presented. A brief and incomplete timeline for the field of Stereotactic Radiosurgery is shown. The goals and mission of the ISRS continue to be met via the sponsorship of biennial meetings and publications.
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A Call to Define Stereotactic Radiosurgery
Neurosurgery, 2004Co-Authors: Bruce E. Pollock, L. Dade LunsfordAbstract:Stereotactic Radiosurgery IS the single-session, precise delivery of a therapeutically effective radiation dose to an imaging-defined target. Conceived and developed during the pass 5 decades, Stereotactic Radiosurgery has involved significant advances, which have improved patient outcomes and made it a critical component of modern neurosurgical practice and training. In this article, a short history of Stereotactic surgery and Radiosurgery are presented, and Radiosurgery is contrasted to radiation therapy. Adherence to accepted, descriptive terms in defining Stereotactic Radiosurgery and radiation therapy permits a clear distinction among the results of the different radiation delivery techniques for patients, physicians, and other interested parties.
