Artikel
Hypo-fractionated robotic radiosurgery for skull base tumors – early results
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Autoren
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Daniel Rueß
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln
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Martin Kocher
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Köln
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Klaus Luyken
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln
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Alexandra Hellerbach
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln
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Moritz Hoevels
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln
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Harald Treuer
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln
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Maximilian I. Ruge
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: The treatment of skull base tumors (i.e. meningeomas, pituitary adenomas) can be challenging due to size, complex shape and close proximity to critical structures. Stereotactic Radiosurgery (SRS) is widely accepted as treatment concept for nonresectable tumors, and/or remnants/recurrences after microsurgical resection. However, size (>3 cm) and contact to critical structures (cranial nerves/optical pathway/pituitary gland) excluded single fraction SRS so far. The introduction of robotic radiosurgery using the Cyberknife® permits SRS in three to five fractions and may overcome these limitations. Here we present our early results regarding clinical and radiological short-term outcome using hypo-fractionated Cyberknife® SRS.
Method: Every patient with skull base located tumor either size >3 cm (max. diameter, or >15 ml volume) and/or close proximity to critical structures was included in this prospective protocol and treated with hypo-fractionated Cyberkinfe® SRS using a tumor surface dose of 25 Gy applied in five fractions (isodose level 65-80%). Clinical and radiological outcome as well as incidence of radiation induced side effects were evaluated after 6 and 12 months.
Results: Since 2013 we included 16 patients (meningeomas n=11, pituitary adenomas n=5). Four patients reached 12 months follow-up and all other patients were evaluated after 6 month. Tumor was radiologically controlled in all cases and there was no new neurological deficit during follow-up. In one case we observed transient increase of edema resulting in headache and dizziness and finally resolved after administration of steroids.
Conclusions: These preliminary data show that hypo-fractionated radiosurgery using Cyberknife® for skull base tumours exceeding 3 cm (or 15 ml) and/or in contact to critical structures is feasible and show no remarkable adverse side effects during early follow-up. These results are consistent with other preliminary data in literature. However, further prospective and comparative studies with extended follow-up are mandatory, especially with regard to local tumor control and late side effects.
