Linac radiosurgery as a tool in neurosurgery.
Stereotactic radiosurgery is a radiation technique that uses a high radiation dose focused on a stereotactic defined intracranial target in single fraction with high precision. In the 1980s, linear accelerators were introduced as a tool for radiosurgery beneath the already accepted gamma unit. Technique and mechanical precision of LINACs have become equal to the gamma unit and LINAC radiosurgery became more and more used recently. From January 1996 to August 2003 we have treated 237 patients with LINAC radiosurgery. A combination of the University of Florida system and the X Knife System, developed by Radionics, was used in all patients. A number of 110 patients had 161 brain metastases treated, whereas the local tumor control rate was 89.4%. The 1-year survival rate was 54.9% with a median survival of 54 weeks. In 55 patients we have treated 57 meningiomas, mostly located at the skull base (37 out of 55 patients). Local tumor control rate in our patients with skull base meningiomas at 5-year follow up was 97.2%. In this time period, we have also treated acoustic schwannoma, glioma, pituitary adenoma, arteriovenous malformations and patients with trigeminal neuralgia. LINAC radiosurgery has become a daily tool in neurosurgery and changed treatment strategies especially in the treatment of brain metastases and skull base meningiomas towards a less aggressive and multimodality approach. It is not only an alternative to open surgery, but also a very effective adjuvant treatment modality in many neuro-oncological patients, which helps us to enhance tumor control rate, minimize morbidity and increase postoperative quality of life.
Deinsberger
R
R
Department of Neurosurgery, Klagenfurt General Hospital, Austria. r.deinsberger@kh-st-poelten.at
Tidstrand
J
J
D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery; D016634:Radiosurgery / Q000379:methods*; D011881:Radiotherapy, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome
Neurosurgery. 1998 Jan;42(1):1-5; discussion 5-6
9442497
J Neurosurg Sci. 1990 Jul-Dec;34(3-4):303-8
2098510
Int J Radiat Oncol Biol Phys. 1985 Jun;11(6):1185-92
3997600
Neurosurgery. 1995 Sep;37(3):445-53; discussion 453-5
7501109
Neurosurgery. 1994 Jan;34(1):14-20; discussion 20-1
8121550
Clin Neurosurg. 1999;45:18-20
10461496
Clin Neurosurg. 1992;38:445-71
1537197
Int J Radiat Oncol Biol Phys. 2003 Jul 1;56(3):801-6
12788188
Neurology. 1985 Feb;35(2):219-26
3969210
Int J Radiat Oncol Biol Phys. 1992;24(4):619-25
1429083
J Neurosurg. 1996 May;84(5):748-54
8622147
J Neurosurg. 2000 Dec;93 Suppl 3:68-73
11143266
J Neurosurg. 1996 Jan;84(1):20-8
8613831
Neurosurg Clin N Am. 1999 Jul;10(3):503-11
10419574
Int J Radiat Oncol Biol Phys. 2004 Jul 15;59(4):1097-106
15234044
Stereotact Funct Neurosurg. 1996;66 Suppl 1:184-92
9032860
Acta Chir Scand. 1968;134(8):585-95
5713443
Neurosurgery. 2001 Feb;48(2):285-94; discussion 294-6
11220370
Surg Neurol. 1989 Nov;32(5):334-42
2683164
J Neurosurg. 1999 Jul;91(1):44-50
10389879
Neurosurgery. 1993 May;32(5):699-704; discussion 704-5
8492844
Lancet. 2004 May 22;363(9422):1665-72
15158627
Neurosurgery. 2002 Dec;51(6):1373-79; discussion 1379-80
12445342
J Neurosurg. 1995 Nov;83(5):825-31
7472550
Int J Radiat Oncol Biol Phys. 2004 May 1;59(1):87-93
15093903
Int J Radiat Oncol Biol Phys. 1994 Oct 15;30(3):521-9
7928482
Int J Radiat Oncol Biol Phys. 1988 Feb;14(2):373-81
3276655
Int J Radiat Oncol Biol Phys. 1997 Jan 15;37(2):375-83
9069310
Neurosurgery. 1997 Oct;41(4):776-83; discussion 783-5
9316038
Cancer. 2004 Apr 15;100(8):1705-11
15073860
Acta Neurochir (Wien). 2001 Nov;143(11):1141-52
11731865
Neurosurgery. 2003 Feb;52(2):296-307; discussion 307-8
12535357
Neurosurgery. 1997 Nov;41(5):1019-25; discussion 1025-7
9361055
Int J Radiat Oncol Biol Phys. 1996 Apr 1;35(1):27-35
8641923
Neurosurgery. 1993 Apr;32(4):643-57
8474655
J Neurosurg. 1991 Oct;75(4):512-24
1885968
Adv Neurol. 1978;19:579-92
570349
Neurosurgery. 1989 Jan;24(1):18-30
2927595
J Neurosurg. 2000 May;92(5):745-59
10794287
J Neurosurg. 1994 Feb;80(2):195-201
8283256
Neurosurg Clin N Am. 1994 Apr;5(2):299-330
8032229
J Neurosurg. 1996 Dec;85(6):1013-9
8929489
J Natl Cancer Inst. 1995 Jan 4;87(1):34-40
7666461
Acta Neurochir (Wien). 2001;143(6):555-62
11534672
J Clin Neurosci. 2001 Nov;8(6):528-33
11683599
Acta Chir Scand. 1951 Dec 13;102(4):316-9
14914373
Int J Radiat Oncol Biol Phys. 1994 Mar 1;28(4):797-802
8138431
Int J Radiat Oncol Biol Phys. 1987 Feb;13(2):279-82
3102416
J Neurosurg. 1999 Jul;91(1):35-43
10389878
Neurosurgery. 1985 Mar;16(3):421-30
3885072
J Clin Neurosci. 2001 May;8 Suppl 1:12-4
11386818
Strahlenther Onkol. 2004 May;180(5):263-7
15127155
Neurosurg Clin N Am. 1992 Jan;3(1):141-66
1633444
Acta Neurochir (Wien). 2000;142(6):621-6
10949435
Neurosurgery. 1998 Mar;42(3):446-53; discussion 453-4
9526976
Int J Radiat Oncol Biol Phys. 1999 Jan 15;43(2):321-7
10030256
Urol Oncol. 2004 Jan-Feb;22(1):25-31
14969800
Cancer. 1993 Feb 15;71(4):1353-61
8435811
Neurosurgery. 1998 Aug;43(2):213-20; discussion 220-1
9696072
Neurosurgery. 1985 Feb;16(2):154-60
3883221
Minim Invasive Neurosurg. 2004 Dec;47(6):333-8
15674748
Stereotact Funct Neurosurg. 1998;71(1):43-50
10072673
Int J Radiat Oncol Biol Phys. 1979 Oct;5(10):1725-31
231022
N Engl J Med. 1990 Feb 22;322(8):494-500
2405271
J Neurosurg. 1994 Feb;80(2):187-90
8283254