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Life
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Development and Use of Photon Knife in Intracranial Disease
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Development and Use of Photon Knife in Intracranial Disease

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Radiobiology and Nuclear Medicine".

Deadline for manuscript submissions: closed (30 November 2022) | Viewed by 10219

Special Issue Editors

Prof. Dr. Hung-Chuan Pan

E-Mail Website
Guest Editor
Department of Neurosurgery, Taichung Veterans General Hospital, Taichung City, Taiwan
Interests: gamma knife; CyberKnife; linear accelerator; radiation injury; stereotactic radiosurgery
Dr. Huai-Che Yang

E-Mail Website
Guest Editor
Department of Neurosurgery, Taipei Veterans General Hospital, Taipei City, Taiwan
Interests: gamma knife radiosurgery; brain imaging; functional neurosurgery; artificial intelligence application

Special Issue Information

Dear Colleagues,

Photon knife is a well-known tool for the treatment of intracranial lesions, including vascular malformation, benign or malignant tumors, as well as functional disorders. The well-established instruments for intracranial radiosurgery include LINAC-based surgery by X-knife, Novalis, gamma knife, and CyberKnife, which have different dose-response curve steepness, homogeneity, accuracy, and feasibility. Recently, the combination of these approaches with imaging techniques, molecular probes, targeted therapy, and artificial intelligence has moved photon knife into a new era. In addition, the new appearance of infectious diseases such as COVID-19 also required several modifications to reduce contact with patients by altering the fraction or frequency of frame-based treatment.

Hence, we invite authors to contribute manuscripts to this Special Issue. Manuscripts on all aspects of the diagnosis and treatment of radiosurgery are welcomed, especially those relating to new imaging techniques, the application of molecular probes, combined targeted therapy, the application of AI, and the alteration of treatment protocol influenced by COVID-19.

Sincerely,
Prof. Dr. Hung-Chuan Pan
Dr. Huai-Che Yang
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Life is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • gamma knife
  • CyberKnife
  • linear accelerator
  • radiation injury
  • stereotactic radiosurgery
  • carotid cavernous sinus fistula
  • intracranial epidermoid cyst
  • brain metastases
  • brain stem metastases carotid-cavernous sinus fistula
  • targeted therapy
  • cavernous malformation
  • deep learning
  • artificial intelligence
  • acoustic schwannoma
  • volumetric analysis
  • trigeminal neuralgia
  • COVID-19
  • decision making
  • hypofractionated radiosurgery
  • nasopharyngeal carcinoma

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Published Papers (5 papers)

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Research

17 pages, 1541 KiB  
Article
Post Surgical Management of WHO Grade II Meningiomas: Our Experience, the Role of Gamma Knife and a Literature Review
by Karol Migliorati, Giorgio Spatola, Lodoviga Giudice, Nine de Graaf, Chiara Bassetti, Cesare Giorgi, Marco Fontanella, Oscar Vivaldi, Mario Bignardi and Alberto Franzin
Life 2023, 13(1), 37; https://doi.org/10.3390/life13010037 - 23 Dec 2022
Cited by 3 | Viewed by 2513
Abstract
Purpose: Grade II meningiomas are rarer than Grade I, and when operated on, bear a higher risk of local recurrence, with a 5-year progression free survival (PFS) ranging from 59 to 90%. Radiotherapy (RT) or radiosurgery, such as Gamma Knife radiosurgery (GKRS) can [...] Read more.
Purpose: Grade II meningiomas are rarer than Grade I, and when operated on, bear a higher risk of local recurrence, with a 5-year progression free survival (PFS) ranging from 59 to 90%. Radiotherapy (RT) or radiosurgery, such as Gamma Knife radiosurgery (GKRS) can reduce the risk of relapse in patients with residual disease, even if their role, particularly after gross total resection (GTR), is still under debate. Main goal of this study was to compare the outcomes of different post-surgical management of grade II meningiomas, grouped by degree of surgical removal (Simpson Grade); next in order we wanted to define the role of GKRS for the treatment of residual disease or relapse. Methods: from November 2016 to November 2020 all patients harboring grade II meningiomas, were divided into three groups, based on post-surgical management: (1) wait and see, (2) conventional adjuvant radiotherapy and (3) stereotactic GKRS radiosurgery. Relapse rate and PFS were registered at the time of last follow up and results were classified as stable, recurrence next to or distant from the surgical cavity. In the second part of the study we collected data of all patients who underwent GKRS in our Centers from November 2017 to November 2020. Results: A total of 37 patients were recruited, including seven patients with multiple meningiomas. Out of 47 meningiomas, 33 (70.2%) were followed with a wait and see strategy, six (12.7%) were treated with adjuvant radiotherapy, and 8 patients (17.0%) with adjuvant GKRS. Follow up data were available for 43 (91.4%) meningiomas. Within the wait and see group, recurrence rates differed based on Simpson grades, lower recurrence rates being observed in three Simpson I cases (30%) compared to twelve relapses (60%) in patients with Simpson grade II/III. Finally, out of the 24 meningiomas undergoing GKRS (8 residual and 16 recurrence), 21 remained stable at follow up. Conclusions: Gross total resection (GTR) Simpson II and III have a significantly worse outcome as compared to Simpson I. The absence of adjuvant treatment leads to significant worsening of the disease progression curve. Adjuvant radiotherapy, especially GKRS, provides good local control of the disease and should be considered as an adjuvant treatment in all cases where Simpson I resection is not possible. Full article
(This article belongs to the Special Issue Development and Use of Photon Knife in Intracranial Disease)
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10 pages, 2077 KiB  
Article
Gamma Knife Radiosurgery as a Salvage Treatment for Nasopharyngeal Carcinoma with Skull Base and Intracranial Invasion (T4b)
by Shao-Ang Chu, Tai-Been Chen, Han-Jung Chen, Kuo-Wei Wang, Jui-Sheng Chen, Fu-Cheng Chuang, Hao-Kuang Wang and Cheng-Loong Liang
Life 2022, 12(11), 1880; https://doi.org/10.3390/life12111880 - 14 Nov 2022
Cited by 1 | Viewed by 1586
Abstract
It is usually difficult to achieve good outcomes with salvage treatment for recurrent nasopharyngeal carcinoma (NPC) because of its deep-seated location, surrounding critical structures, and patient history of high-dose irradiation. Gamma Knife radiosurgery (GKS) is a treatment option for malignancies with skull base [...] Read more.
It is usually difficult to achieve good outcomes with salvage treatment for recurrent nasopharyngeal carcinoma (NPC) because of its deep-seated location, surrounding critical structures, and patient history of high-dose irradiation. Gamma Knife radiosurgery (GKS) is a treatment option for malignancies with skull base and intracranial invasion. We conducted a retrospective, observational, single-center study including 15 patients with recurrent NPC (stage T4b) involving the skull base and intracranial invasion, who underwent GKS as a salvage treatment. Patients were enrolled over 12 years. Per a previous study, the TNM classification T4b was subclassified into T4b1 and T4b2, defined as the involvement of the skull base or cavernous sinus with an intracranial extension of <5 mm and >5 mm, respectively. The effect of prognostic factors, including age, sex, survival period, magnetic resonance imaging (MRI) presentation, presence of other distant metastases, tumor volume, marginal dose, maximal dose, and Karnofsky Performance Status (KPS), on outcomes was analyzed. The patients with T4b1 NPC (p = 0.041), small tumor volume (p = 0.012), higher KPS (p < 0.001), and no other metastasis (p = 0.007) had better outcomes after GKS treatment, suggesting that it is a viable treatment modality for NPC. We also suggest that detailed brain imaging studies may enable the early detection of intracranial invasion. Full article
(This article belongs to the Special Issue Development and Use of Photon Knife in Intracranial Disease)
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12 pages, 2870 KiB  
Article
A Pathophysiological Approach to Reduce Peritumoral Edema with Gamma Knife Radiosurgery for Large Incidental Meningiomas
by Cheng-Siu Chang, Cheng-Wei Huang, Hsi-Hsien Chou, Hsien-Tang Tu, Ming-Tsung Lee and Chuan-Fu Huang
Life 2022, 12(11), 1683; https://doi.org/10.3390/life12111683 - 23 Oct 2022
Cited by 1 | Viewed by 1995
Abstract
Background: Peritumoral edema may be a prohibitive side effect in treating large incidental meningiomas with stereotactic radiosurgery. An approach that limits peritumoral edema and achieves tumor control with SRS would be an attractive management option for large incidental meningiomas. Methods: This is a [...] Read more.
Background: Peritumoral edema may be a prohibitive side effect in treating large incidental meningiomas with stereotactic radiosurgery. An approach that limits peritumoral edema and achieves tumor control with SRS would be an attractive management option for large incidental meningiomas. Methods: This is a retrospective cohort study of patients with large incidental meningiomas (≥2 mL in volume and/or 2 cm in diameter) treated with gamma knife radiosurgery (GKRS) between 2000 and 2019 in Taiwan and followed up for 5 years. The outcomes of a pathophysiological approach targeting the dural feeding artery site with a higher marginal dose (18–20 Gy) to enhance vascular damage and the parenchymal margin of the tumor with a lower dose (9–11 Gy) to reduce parenchymal damage were compared with those of a conventional approach targeting the tumor center with a higher dose and tumor margin with a lower dose (12–14 Gy). Results: A total of 53 incidental meningiomas were identified, of which 23 (43.4%) were treated with a pathophysiological approach (4 cases underwent a two-stage approach) and 30 (56.7%) were treated with a conventional approach. During a median follow-up of 3.5 (range 1–5) years, tumor control was achieved in 19 (100%) incidental meningiomas that underwent a single-stage pathophysiological approach compared with 29 (96.7%) incidental meningiomas that underwent a conventional approach (log-rank test: p = 0.426). Peritumoral edema developed in zero (0%) incidental meningiomas that underwent a single stage pathophysiological approach compared to seven (23.3%) incidental meningiomas that underwent a conventional approach (log-rank test: p = 0.023). Conclusions: Treatment of large incidental meningiomas with a pathophysiological approach with GKRS achieves similar rates of tumor control and reduces the risk of peritumoral edema. GKRS with a pathophysiological approach may be a reasonable management strategy for large incidental meningiomas. Full article
(This article belongs to the Special Issue Development and Use of Photon Knife in Intracranial Disease)
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15 pages, 4086 KiB  
Article
Prognostic Factors Analysis for Intracranial Cavernous Malformations Treated with Linear Accelerator Stereotactic Radiosurgery
by Meng-Wu Chung, Chi-Cheng Chuang, Chun-Chieh Wang, Hsien-Chih Chen and Peng-Wei Hsu
Life 2022, 12(9), 1363; https://doi.org/10.3390/life12091363 - 31 Aug 2022
Cited by 4 | Viewed by 1554
Abstract
Stereotactic radiosurgery (SRS) is generally considered a substitute for cranial cavernous malformations (CCMs). However, prognostic factors for post-radiosurgery CCM rebleeding and adverse radiation effects have not been well evaluated, and the effect of timing and optimal treatment remains controversial. Therefore, this study evaluated [...] Read more.
Stereotactic radiosurgery (SRS) is generally considered a substitute for cranial cavernous malformations (CCMs). However, prognostic factors for post-radiosurgery CCM rebleeding and adverse radiation effects have not been well evaluated, and the effect of timing and optimal treatment remains controversial. Therefore, this study evaluated prognostic factors for post-radiosurgical rebleeding and focal edematous changes in 30 patients who developed symptomatic intracranial hemorrhage due to solitary non-brainstem CCM and received linear accelerator (LINAC) SRS in a single medical center from October 2002 to June 2018. An overall post-radiosurgical annual hemorrhage rate with 4.5% was determined in this study. In addition, a higher marginal dose of >1600 centigray and earlier LINAC SRS intervention were correlated with a significantly lower post-radiosurgical annual hemorrhage rate. A lesion size larger than 3 cm3 and a coexisting developmental venous anomaly were significant risk factors for post-radiosurgical focal brain edema but mostly resulted in no symptoms and were temporary. This study demonstrated the efficacy of LINAC SRS in preventing CCM rebleeding and suggests that earlier radiosurgery treatment with a higher dose for non-brainstem symptomatic CCMs be considered. Full article
(This article belongs to the Special Issue Development and Use of Photon Knife in Intracranial Disease)
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14 pages, 3226 KiB  
Article
Gamma Knife Radiosurgery for Indirect Dural Carotid–Cavernous Fistula: Long-Term Ophthalmological Outcome
by Chiung-Chyi Shen, Yuang-Seng Tsuei, Meng-Yin Yang, Weir-Chiang You, Ming-His Sun, Meei-Ling Sheu, Liang-Yi Pan, Jason Sheehan and Hung-Chuan Pan
Life 2022, 12(8), 1175; https://doi.org/10.3390/life12081175 - 1 Aug 2022
Cited by 2 | Viewed by 1819
Abstract
Objective: The leading treatment option for dural carotid–cavernous sinus fistula is an endovascular approach with immediate improvement. Alternatively, radiosurgery is a slow response for obliterating the fistula and poses a radiation risk to the optic apparatus and the associated cranial nerves and blood [...] Read more.
Objective: The leading treatment option for dural carotid–cavernous sinus fistula is an endovascular approach with immediate improvement. Alternatively, radiosurgery is a slow response for obliterating the fistula and poses a radiation risk to the optic apparatus and the associated cranial nerves and blood vessels. In this study, we retrieved cases from a prospective database to assess the ophthalmological outcomes and complications in treating dural carotid cavernous sinus fistula with gamma knife radiosurgery (GKRS). Material and Methods: We retrieved a total of 65 cases of carotid cavernous sinus fistula treated with GKRS with margin dose of 18–20 Gy from 2003 to 2018 and reviewed the ophthalmological records required for our assessment. Results: The mean target volume was 2 ± 1.43 cc. The onset of symptom alleviated after GKRS was 3.71 ± 7.68 months. There were two cases with residual chemosis, two with cataract, two with infarction, one with transient optic neuropathy, and four with residual cranial nerve palsy, but none with glaucoma or dry eyes. In MRA analysis, total obliteration of the fistula was noted in 64 cases with no detectable ICA stenosis nor cavernous sinus thrombosis. In the Cox regression analysis, post-GKRS residual cranial nerve palsy was highly correlated to targeted volume (p < 0.05) and age (p < 0.05). The occurrence of post-GKRS cataract was related to the initial symptom of chemosis (p < 0.05). Conclusion: GKRS for carotid cavernous sinus fistula offers a high obliteration rate and preserves the cavernous sinus vascular structure while conferring a low risk of treatment complications such as adverse radiation risk to the optic apparatus and adjacent cranial nerves. Full article
(This article belongs to the Special Issue Development and Use of Photon Knife in Intracranial Disease)
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