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J C Flickinger

Publications and source records attributed to J C Flickinger.

At least 109 records · Page 6Linked to original sources
PubMed1996

Hemorrhage risk after stereotactic radiosurgery of cerebral arteriovenous malformations.

To analyze the effect of stereotactic radiosurgery on the hemorrhage rate of arteriovenous malformations (AVMs), we reviewed the clinical and angiographic characteristics of 315 patients with AVMs before and after radiosurgery. One hundred ninety-six patients sustained 263 bleeds in 10,939 patient-years before radiosurgery, for an annual nonfatal hemorrhage rate of 2.4%. Clinical follow-up after radiosurgery was available in 312 patients (mean, 47 +/- 20 mo); follow-up > or = 24 months was obtained in 295 patients (94%). Twenty-one patients had AVM bleeds at a median of 8 months (range, 1-60 mo) after radiosurgery. Two additional patients had three aneurysmal bleeds (at 5, 27, and 32 mo, respectively) for a 7.4% total risk of hemorrhage per patient. The actuarial hemorrhage rate until AVM obliteration was 4.8% per year (95% confidence interval, 2.4-7.0%) during the first 2 years after radiosurgery and 5.0% per year (95% confidence interval, 2.3-7.3%) for the third to fifth years after radiosurgery. Multivariate analysis of clinical and angiographic factors demonstrated that the presence of an unsecured proximal aneurysm was associated with an increased risk of postradiosurgical hemorrhage (relative risk, 4.56; 95% confidence interval, 1.77-11.70%; P < 0.001). No AVM hemorrhages were observed after radiosurgery in seven patients with intranidal aneurysms. No protective effect against hemorrhage was observed in patients who received an "optimal" radiation dose (> or = 25 Gy to the AVM margin) compared with patients who received < 25 Gy to the AVM margin (P = 0.36). No patient suffered a hemorrhage after angiography had confirmed complete obliteration (n = 140) or suffered from an early draining vein without residual nidus (n = 19). Stereotactic radiosurgery was not associated with a significant change in the hemorrhage rate of AVMs during the latency interval before obliteration. No protective benefit was conferred on patients who had incomplete nidus obliteration in early (< 60 mo) follow-up after radiosurgery. AVM patients with unsecured proximal aneurysms should have aneurysms obliterated either before radiosurgery or at the time of surgical resection of their AVMs.

Cerebral Angiography↗
PubMed1996

Stereotactic radiosurgery for glial neoplasms of childhood.

We evaluated the role of stereotactic radiosurgery (SRS) in 25 children with surgically incurable brain tumors of glial origin. Histological diagnoses were obtained at the time of craniotomy and attempted removal (n = 20) or by stereotactic biopsy (n = 5). Thirteen children had tumors with benign histological characteristics (pilocytic and low-grade astrocytomas), whereas 12 children had tumors with malignant characteristic (malignant astrocytomas and ependymomas). Eleven (10 with malignant tumors) of the 25 children had received fractionated irradiation before SRS. Radiosurgical doses (range to margin, 11-20 Gy) were calculated on the basis of tumor volume and location, with consideration given to prior radiation dose. Follow-up for the 13 children with benign tumors ranged from 6 to 48 months (median, 21 mo). Eleven of the 13 children with "benign" glial neoplasms had tumor control with SRS alone (no evidence of tumor, n = 4; decreased tumor, n = 5; and unchanged tumor, n = 2), and all 13 remain alive. Five children with malignant tumors are alive at 12, 45, 50, 72, and 72 months after radiosurgery. The other seven children with malignant tumors are dead, with a median survival of 6 months after radiosurgery. Three of 12 children with malignant glial neoplasms had tumor control after SRS. Two of these three children received fractionated irradiation as an adjunct to SRS. Complications occurring in four children were transient, associated with peritumoral edema, and responsive to oral glucocorticoids. There was no relationship between tumor volume and local control after radiosurgery. Radiosurgery alone is a safe and effective treatment modality for unresectable benign gliomas of childhood. Radiosurgery may have a role in the adjuvant management of unresectable malignant glial neoplasms of childhood if other therapies (irradiation or chemotherapy) are available.

Adolescent↗
PubMed1996

Radiosurgery: its role in brain metastasis management.

Stereotactic radiosurgery is effective in controlling brain metastasis at presentation and those that recur after radiotherapy. It is the treatment of choice for most patients with small solitary brain metastasis by virtue of its low morbidity, high-effectiveness, and cost.

Brain Neoplasms↗
PubMed1995

Phosphorus-32 intracavitary irradiation of cystic craniopharyngiomas: current technique and long-term results.

PURPOSE: The management of patients with craniopharyngiomas is often multifaceted and multidisciplinary. The purpose of this study was to examine the results of phosphorus-32 intracavitary irradiation in the treatment of patients with predominately cystic craniopharyngiomas. METHODS AND MATERIALS: Thirty patients with cystic craniopharyngiomas underwent phosphorus-32 intracavitary irradiation at our center between 1981 and 1993. The median patient age was 26 years (range, 3-70 years). Thirteen patients had intracavitary irradiation as the primary surgery for their cystic tumors, whereas 17 patients had adjuvant intracavitary irradiation after microsurgical resection, fractionated radiotherapy, or both. Patients in the adjuvant treatment group were more likely to have preoperative anterior pituitary insufficiency (p = 0.008 Fischer exact test) and diabetes insipidus (p = 0.003 Fischer exact test). The median follow-up was 37 months (mean, 46 months, range, 7-116 months). RESULTS: Phosphorus-32 intracavitary irradiation resulted in cyst regression in 28 of 32 treated cysts (88%). Ten patients (33%) have had tumor progression requiring further surgical intervention. Three patients (10%) died: two of tumor progression, and one of unrelated causes. Visual acuity and fields improved or remained stable in 63% of the patients. Fifteen patients had residual anterior pituitary function before intracavitary irradiation and 10 (67%) retained their preoperative endocrine status. New-onset diabetes insipidus occurred in 3 of 17 patients (18%) who had normal posterior pituitary function preoperatively. Fourteen of 20 adult patients (70%) continued to perform at their preoperative functional level; 3 of 5 pediatric patients who were age appropriate at the time of treatment continued to develop normally. No difference was noted between primary and adjuvant treatment patients with respect to cyst control, visual deterioration, or endocrine preservation after phosphorus-32 intracavitary irradiation. CONCLUSION: The goals of craniopharyngioma management should be tumor control with preservation of visual, endocrine, and cognitive function. Phosphorus-32 intracavitary irradiation is an important option that enhances the likelihood of achieving these goals in patients with primarily cystic craniopharyngiomas.

Adolescent↗
PubMed1995

Quality assurance for gamma knife stereotactic radiosurgery.

PURPOSE: This quality assurance program is designed for stereotactic radiosurgical units, gamma knife, to check and maintain the unit to preclude accidents and comply with current regulations. MATERIALS AND METHODS: Over 58 stereotactic radiosurgical units using 201 focused 60Co beams have been installed in the last 7 years and are in use at hospitals throughout the world, with at least 11 additional units being prepared to come on-line in the next year. This system has been in use at the University of Pittsburgh Medical Center (UPMC) for 7 years. A comprehensive quality assurance program has been developed. It includes the physics and dosimetry parameters and safety checks required by regulatory agencies. The program, based on over 7 years of experience in measurements, and used during the treatment of over 1500 patients, is separated into three aspects, namely physics, dosimetry, and safety. The UPMC program hopefully will indicate out-of-tolerance problems. Some quality assurance items are checked on a daily basis prior to patient treatment, while other aspects are checked on a weekly, monthly, and/or annual basis. A complete list of items with their respective time tables and tolerances is provided. RESULTS: Although experience shows very small margins of error, larger values were chosen to account for variations in equipment and techniques. CONCLUSIONS: Items included in this quality assurance program should indicate and/or preclude problems encountered in the use of this unit.

Cobalt Radioisotopes↗
PubMed1995

Node-positive cervical cancer: impact of pelvic irradiation and patterns of failure.

PURPOSE: The roles of postoperative pelvic and prophylactic paraaortic irradiation in pelvic node positive cervical cancer are currently controversial. A retrospective study was undertaken to examine the effect of pelvic irradiation on pelvic control and survival and to analyze the patterns of recurrence to determine whether indications exist for prophylactic paraaortic irradiation. METHODS AND MATERIALS: From 1964 to 1991, 143 cases of FIGO Stage I and II cervical cancer undergoing exploratory laparotomy, pelvic lymph node dissection, and radical hysterectomy had positive pelvic lymph nodes. Postoperatively, 108 cases were treated with whole pelvic irradiation while 35 patients were observed. Prophylactic paraaortic irradiation was not given. RESULTS: Patients who received postoperative whole pelvic irradiation compared with those treated with radical hysterectomy alone had a significantly improved pelvic control rate, disease-free survival (DFS), and overall survival. The 5-year actuarial pelvic control rate was 78% vs. 45% (p = < 0.0001), respectively. The 5-year actuarial DFS was 65% vs. 41% (p = 0.0004). The 5-year actuarial overall survival was 58% vs. 46% (p = 0.02). In multivariate analysis, pelvic irradiation continued to show a positive effect on DFS (p = 0.0001) and overall survival (p = 0.0035). Lymphatic invasion and the total number of positive lymph nodes were the only other independent predictors of overall survival and DFS. The actuarial 5-year pelvic, paraaortic, and distant failure rates were 30%, 10%, and 28%, respectively. An isolated first recurrence in the paraaortic nodes occurred in only three cases. CONCLUSION: Postoperative pelvic irradiation significantly improves pelvic control, DFS, and overall survival, and should be used in patients with early stage cervical cancer and pathologically proven pelvic nodal metastases. The low incidence of isolated paraaortic nodal failure calls into question the value of routine prophylactic paraaortic irradiation in these patients.

Adult↗
PubMed1995

Cranial nerve preservation after stereotactic radiosurgery for small acoustic tumors.

OBJECTIVE: To assess those factors associated with and predictive of cranial nerve preservation after stereotactic radiosurgery in patients with small acoustic tumors identified by magnetic resonance imaging. DESIGN: We performed a retrospective analysis of our experience with 31 patients with preserved hearing and acoustic tumors measuring 10 mm or smaller (pons-to-petrous dimension). All patients underwent clinical and audiologic evaluations varying from 6 to 48 months (mean, 20 months) after stereotactic radiosurgery performed with use of the 201 source cobalt 60 gamma unit. RESULTS: Stabilization or reduction in tumor volume was achieved in 29 of 31 patients. One patient required delayed microsurgical resection. Useful hearing (pure tone average < or = 50 dB and speech discrimination score > or = 50%) preservation was achieved in 10 of 10 patients immediately postoperatively, eight of 10 patients at 6 months, six of 10 patients at 1 year, and five of 10 at 2 years. Preservation of some measurable hearing was possible in all patients immediately after radiosurgery, in 84% and in more than half of patients at 2 years. Preoperative facial nerve function was preserved in 19 of 20 patients at 2 years after radiosurgery. All patients returned to their preoperative employment status within 2 to 5 days after radiosurgery. CONCLUSION: Stereotactic radiosurgery performed with current technology (multiple radiation isocenters and magnetic resonance imaging guidance) is a safe and effective management strategy for patients with small acoustic tumors. The risk of facial and trigeminal neuropathy after gamma knife radiosurgery is low, and useful hearing can be preserved in up to 50% of patients with useful preoperative hearing. Stereotactic radiosurgery is a valuable alternative strategy to surgical removal for many patients with newly diagnosed small acoustic tumors.

Adult↗
PubMed1995

Single-stage stereotactic diagnosis and radiosurgery: feasibility and cost implications.

We compared the efficacy and the hospital charges of either single-stage or two-stage stereotactic diagnosis and radiosurgery procedures. Twelve patients underwent either one-stage or two-stage diagnosis and management of their brain tumors. Both techniques utilize high-resolution intraoperative stereotactic image-guided technology and rapid touch preparation (imprint) cytopathological techniques to confirm the presence of neoplasm. Following this pathologic diagnosis, six patients immediately underwent stereotactic radiosurgery employing the same frame application and dose planning based on preoperative and intraoperative images. Six patients underwent two-stage procedures, i.e., discharge from the hospital after histopathological diagnosis followed by readmission, reapplication of the stereotactic head frame, and repeat neuroradiological imaging prior to radiosurgery. Requirements for success of the single-stage procedure include intraoperative stereotactic high-resolution imaging, a hospital-wide ethernet system for transferring neurodiagnostic images, and expertise in rapid touch-preparation histopathological technique for accurate diagnosis. Intraoperative computed tomography imaging after biopsy confirmed the target accuracy and lack of movement of the target after brain biopsy. The advantages of the single-stage approach include reduced length of overall hospital stay, simultaneous histopathological diagnosis and therapy in a single hospital admission, and reduced total hospital charges. For patients highly suspected of having brain tumors and for whom stereotactic radiosurgery will be utilized in the treatment, single-stage stereotactic diagnosis immediately followed by radiosurgery is an accurate, effective, and potentially less costly management strategy than a two-stage approach.

Adult↗
PubMed1995

Cranial nerve preservation after stereotactic radiosurgery of intracanalicular acoustic tumors.

We reviewed our initial stereotactic radiosurgery experience in 10 patients with intracanalicular acoustic tumors managed by radiosurgery during a 5-year period. These patients constitute 4.7% of acoustic tumor patients who underwent Gamma Knife radiosurgery during this period. Tumor volume stabilization was achieved in 8. Two patients had initial growth followed by delayed growth arrest. Preservation of preoperative hearing was achieved in all patients in the immediate postoperative period and in 8 of 10 at 1 year. No patient had developed facial or trigeminal nerve dysfunction at the last follow-up, which varied from 3 to 64 months (mean 25 months). Tumor growth was delayed in 2 patients, but neither has required delayed microsurgical resection. All patients returned to their preoperative functional status within 3-5 days after radiosurgery. Stereotactic radiosurgery using the Gamma Knife is a safe and effective management strategy for intracanalicular acoustic tumor patients. Our initial results indicate that high cranial nerve preservation rates and a rapid return to previous activity and employment are benefits of radiosurgery.

Adult↗
PubMed1995

Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery.

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.

Adult↗
PubMed1995

Survival after stereotactic biopsy and irradiation of cerebral nonanaplastic, nonpilocytic astrocytoma.

The authors investigated the outcome of stereotactic biopsy and radiotherapy in 35 consecutive adult patients with nonanaplastic, nonpilocytic astrocytomas who were diagnosed between 1982 and 1992. The median patient age at presentation was 32 years. All received fractionated external-beam radiation therapy (median dose 56 Gy) as the initial management strategy. Additional treatment in two patients included intracavitary irradiation with colloidal phosphorus-32. Six patients (17%) had documented tumor progression during the follow-up interval and died. Three others died of causes unrelated to their tumor. Median survival after stereotactic biopsy and irradiation was 118 months (9.8 years). Median survival from the time of onset of neurological symptoms was 148 months (12.3 years). Only three patients required delayed cytoreductive surgery. The outcome of brain astrocytomas, although improved because of earlier diagnosis and therapy, does not substantiate this tumor as having benign behavior; early recognition with neuroimaging, immediate histological diagnosis via stereotactic biopsy, and initial fractionated radiation therapy may provide the potential for longer survival for patients with low-grade astrocytomas. The majority of such surviving patients have a satisfactory quality of life, which is manifested by prolonged normal functional and employment status. The survival data reported in this prospective Phase I-II clinical trial suggest that stereotactic biopsy and radiation therapy are appropriate initial management strategies for astrocytomas.

Adolescent↗
PubMed1995

Reduction of hemorrhage risk after stereotactic radiosurgery for cavernous malformations.

The benefits of radiosurgery for cavernous malformations are difficult to assess because of the unclear natural history of this vascular lesion, the inability to image malformation vessels, and the lack of an imaging technique that defines "cure." The authors selected for radiosurgery 47 patients who harbored a hemorrhagic malformation in a critical intraparenchymal location remote from a pial or ependymal surface. Of these, 44 patients had experienced at least two hemorrhages before radiosurgery. The mean patient age was 39 years; six patients had previously undergone attempted surgical removal. The malformation was located in the pons/midbrain in 24 cases, the medulla in three, the thalamus in nine, the basal ganglia in three, deep in a parietal lobe in four, and deep in a temporal lobe in four. Patients had sustained initial hemorrhages from 0.5 to 12 years prior to radiosurgery (mean 4.12 years). In these patients, who were not typical of the majority of patients with cavernous malformations, there were 109 bleeds before radiosurgery in 193 prior observation-years, for 56.5% annual hemorrhage rate (including the first hemorrhage), or an annual rate of 32% subsequent to the first hemorrhage. The mean follow-up period after radiosurgery was 3.6 years (range 0.33-6.4 years). The proportion of patients with hemorrhage after radiosurgery was significantly reduced (p < 0.0001), as was the mean number of hemorrhages per patient (p = 0.00004). In the first 2 years after radiosurgery, there were seven bleeds in 80 observation-years (8.8% annual hemorrhage rate). In the 2- to 6-year interval after radiosurgery, the annual rate decreased to 1.1% (one bleed). After radiosurgery, 12 patients (26%) sustained neurological worsening that correlated with imaging changes. In eight patients these deficits were temporary; two underwent surgical resection and died. Two patients had new permanent deficits (4%). A significant reduction was observed in the hemorrhage rate after radiosurgery in patients who had deep hemorrhagic cavernous malformations, especially after a 2-year latency interval. This evidence provides further support to the belief that radiosurgery is an effective strategy for cavernous malformations, especially when located within the parenchyma of the brainstem or diencephalon.

Adult↗
PubMed1995

Brain astrocytomas: biopsy, then irradiation.

We believe that every patient who has clinical symptoms and neurodiagnostic imaging signs suggesting a low-grade glial neoplasm should undergo early diagnosis and treatment. Observation is not warranted for a tumor that has a median survival of 5 years. The value of cytoreductive surgery for many patients has yet to be proven. It is incumbent on neurosurgeons who advocate this approach to show that this more aggressive treatment strategy is preferable to minimally invasive techniques, such as stereotactic biopsy followed by radiation therapy. Clearly, some patients who have a glial tumor require early cytoreductive surgery: those with mass effect and significant neurologic deficits. Otherwise, they will not be able to tolerate fractionated radiation therapy. Because the long-term survival rate is very poor, observation is not warranted in patients with suspected glial neoplasm. Early stereotactic biopsy immediately identifies those patients who, in fact, have more anaplastic tumors and a much worse prognosis. Such patients may benefit from early, aggressive treatments such as cytoreductive surgery, chemotherapy, and radiation. Applying this philosophy, we have achieved a median survival of more than 10 years in patients with astrocytoma. Most patients maintain a high KPS rating, and most do not require delayed cytoreductive surgery. Although we believe that the outcomes of future patients with astrocytomas will improve, we must establish whether such improvement is related to better therapeutic options, earlier recognition enabled by advanced neuroimaging, or the availability of corticosteroids (28, 30). We also believe that neurosurgeons and neuro-oncologists should stop arguing over whether cytoreductive surgery is warranted. For some patients it is, and for others it is not. This prolonged controversy indicates the basic impotence with which neurosurgeons approach glial tumors. Our energy and efforts should be devoted toward more concrete and positive goals in terms of glial tumor management. These goals include prolonged and higher-quality survival, reduced surgical and postoperative morbidity, and the development of new surgical, chemotherapeutic, and molecular tools that will allow us to improve clinical outcomes. Needless and senseless arguing over cytoreductive surgery versus biopsy, radiation versus no radiation, or any of these procedures versus observation alone trivialize the issues that face us and our patients: astrocytomas of the brain are neither indolent nor benign. The vast majority of our patients with astrocytomas are dead within 5 years, and almost all within 10. Our papers, our meetings, our approach should encourage us to pursue new basic science and clinical strategies to fight glial neoplasms. Surgery alone cures no patient with a glioma. Radiation therapy cures relatively few, and chemotherapy cures none. New ideas and new approaches are needed to improve the plight of our patients.

Astrocytoma↗
PubMed1995

Stereotactic radiosurgery of anterior skull base tumors.

Stereotactic radiosurgery is an increasingly safe and usually effective method of preventing growth of small to moderate-sized primary tumors of the anterior skull base. Tumor growth control is obtained in more than 90% of patients with skull base tumors having benign histology. Neurologic function is maintained in most patients. The risk of temporary or permanent injury to critical neural and vascular structures is significantly lower than the risk associated with microsurgery. The optic nerves, chiasm, and tracts are structures that appear most sensitive to the radiation doses used during radiosurgery of anterior skull base tumors. The incidence of injury to the optic apparatus is low when the dose to the nerve is less than 8 to 9 Gy (27). The incidence of injury to motor nerves, such as the oculomotor, trochlear, trigeminal, and abducens nerves, is extremely low at the doses used in clinical radiosurgery (27). To date no cases of delayed carotid injuries have been reported. Microsurgical complications (e.g., CSF leak, wound infection, and meningitis) do not occur after radiosurgery. Additional attractive features of radiosurgery are a relatively low, hospital-based cost and a rapid return of the patient of work. In the report of our experience with the first 207 patients treated with the Gamma Knife at the University of Pittsburgh, the average length of hospital stay was 2.24 days for a patient undergoing stereotactic radiosurgery for a skull base tumor and 11.44 days for a patient undergoing craniotomy for the same lesion. The total hospital charges were 30 to 70% lower for patients having radiosurgery (19). The average hospital stay and cost of radiosurgery are even lower now, because most radiosurgery patients are released from the hospital on the same day as their procedure. Patients are usually able to return to a full preoperative functional level and employment within 3 to 5 days. There are patients in certain clinical situations in which microsurgery clearly is required. These include patients experiencing rapidly progressive visual deterioration or who have endocrine-active pituitary tumors. A more rapid reduction in endocrine dysfunction is best achieved by microsurgical tumor excision. In patients in whom a tumor recurs despite "gross total removal," and in cases in which tumor is left behind to preserve critical nerve and vessel integrity, stereotactic radiosurgery is a very effective alternative to additional microsurgical operations. Stereotactic radiosurgery may also be the primary treatment of choice in patients who are unable or unwilling to accept the risk:benefit ratio of microsurgery.

Adult↗
PubMed1994

A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis.

PURPOSE: A multi-institutional experience in radiosurgery for solitary brain metastases was combined to identify factors associated with safety, efficacy, tumor control, and survival. MATERIALS AND METHODS: A review of 116 patients with solitary brain metastases who underwent gamma knife stereotactic radiosurgery at five institutions was performed. The median follow-up was 7 months following radiosurgery and 12 months following diagnosis. Minimum tumor doses varied from 8-30 Gy (mean, 17.5 Gy). Forty-five patients failed prior radiotherapy and 71 had no prior brain irradiation. Fifty-one patients had radiosurgery alone and 65 underwent combined radiosurgery with fractionated large-field radiotherapy (mean dose, 33.8 Gy). RESULTS: Median survival was 11 months after radiosurgery and 20 months after diagnosis. Follow-up documented local tumor control in 99 patients (85%), tumor recurrence in 17 (15%), and documented radiation necrosis in one (1%). The 2-year actuarial tumor control rate was 67 +/- 8%. Tumor histology affected survival (better for breast cancer, p = .004) and local control (better for melanoma and renal cell, p = .0003) in multivariate analyses. Combined fractionated radiotherapy and radiosurgery improved local control (p = 0.111), but not survival in multivariate testing. CONCLUSION: Radiosurgery is effective in controlling solitary brain metastases with low morbidity. Further study is needed to better define optimum treatment parameters for radiosurgery.

Adult↗
PubMed1994

Stereotactic radiosurgery for pituitary adenomas: imaging, visual and endocrine results.

To determine the endocrine, ophthalmologic, and tumor growth control responses after stereotactic radiosurgery using the gamma unit, we reviewed our experience in 35 patients with pituitary adenomas. Twenty-four females and 11 males (mean age 47 years, range 9-81 years) had radiosurgery with average follow-up of 26 months (range 6-60 months). Most patients were refractory to surgical removal. Fifteen patients had Cushing's disease. Prior transsphenoidal resection was performed in 14 patients (6 had two prior operations), fractionated radiotherapy in 3, and adrenalectomy in 2. In 11 evaluable patients, the hormone response was normalized in 8, decreased in 2 and increased in 1. Five patients remained on cortisol suppression. Of 12 patients with imaging follow-up, 4 had decreased tumor size, 6 had no change, and 2 had an increase; these 2 patients underwent subsequent surgery. Ten patients had acromegaly, and 6 had undergone prior surgery. Of 8 evaluable patients, growth hormone secretion has normalized in 3, decreased in 3, and increased in 2. Six tumors decreased in size, and 2 were unchanged. One patient had repeat resection 21 months after radiosurgery and one patient underwent repeat radiosurgery. Ten patients had non-secreting adenomas; all 10 had prior operations (1-4 operations, 6 underwent frontal craniotomy) and 5 had undergone fractionated radiotherapy. Eight patients had panhypopituitarism prior to radiosurgery. Four tumors decreased in size and 6 were without change.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromegaly↗