title: Leksell Gamma Knife treatment for pilocytic astrocytomas: long-term results.
abstract: OBJECTIVE The purpose of this study was to evaluate long-term treatment results, radiation-related toxicity, and prognostic factors for the progression-free survival (PFS) of patients with pilocytic astrocytomas treated by means of stereotactic radiosurgery with a Leksell Gamma Knife. METHODS A total of 25 patients with pilocytic astrocytomas underwent Gamma Knife surgery during the period 1992-2002. The median target volume was 2700 mm(3) (range 205-25,000 mm(3)). The 18 patients treated with 5 daily fractions received a median minimum target dose of 25 Gy. Doses for the 2 patients treated with 10 fractions over 5 days (2 fractions delivered on the same day at least 6 hours apart) were 23 and 28 Gy. For the 5 patients treated with a single fraction, the minimum target dose ranged from 13 to 20 Gy (median 16 Gy). RESULTS Complete regression occurred in 10 patients (40%) and partial regression in 10 patients (40%). The 10-year overall survival rate was 96% and the 10-year PFS rate was 80%. Target volume appeared to be a significant prognostic factor for PFS (p = 0.037). Temporary Grade 3 toxicity appeared in 2 patients (8%), and these patients were treated with corticosteroids for 2 months. Permanent Grade 4 toxicity appeared in 2 patients (8%) and was associated with neurocognitive dysfunction. In these 2 individuals, the neurocognitive dysfunction was also felt to be in part the result of the additional therapeutic interventions (4 in one case and 6 in the other) required to achieve durable control of their tumors. CONCLUSIONS Radiosurgery represents an alternative treatment modality for small residual or recurrent volumes of pilocytic astrocytomas and provides long-term local control. Target volume appears to be the most important factor affecting PFS.
authors.affiliation: Departments of 1 Stereotactic and Radiation Neurosurgery and.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Simonova
authors.affiliation: Departments of 1 Stereotactic and Radiation Neurosurgery and.|Medical Physics, Na Homolce Hospital, Prague; and.|Department of Dosimetry and Application of Ionizing Radiation, Faculty of Nuclear Science and Physical Engineering, Czech Technical University in Prague, Czech Republic.
authors.forename: Petra
authors.initials: P
authors.lastname: Kozubikova
authors.affiliation: Departments of 1 Stereotactic and Radiation Neurosurgery and.
authors.forename: Roman
authors.initials: R
authors.lastname: Liscak
authors.affiliation: Departments of 1 Stereotactic and Radiation Neurosurgery and.|Medical Physics, Na Homolce Hospital, Prague; and.|Department of Dosimetry and Application of Ionizing Radiation, Faculty of Nuclear Science and Physical Engineering, Czech Technical University in Prague, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Novotny
mesh_terms: D000293:Adolescent; D001254:Astrocytoma / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D016634:Radiosurgery / Q000379:methods / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome
keywords: BED = biologically effective dose; EBRT = external beam radiation therapy; EORTC = European Organization for Research and Treatment of Cancer; FLT PET = 18F-fluorothymidine positron emission tomography; GKS = Gamma Knife surgery; Gamma Knife; KPS = Karnofsky Performance Status; PFS = progression-free survival; PLT = planning target volume; RTOG = Radiation Therapy Oncology Group; neurosurgical resection; pilocytic astrocytoma; radiotherapy; stereotactic radiosurgery