News Article | May 22, 2017
Each year, up to 650,000 people who were previously diagnosed with various forms of cancer will develop brain metastases, or cancerous tumors that migrate from the original location of the cancer into the brain.(1) Of these patients, at least 200,000 will receive whole brain radiation therapy (WBRT),(1) which has increasingly been shown to cause a variety of side effects that negatively affect the patient. As alternatives to this treatment are explored, more healthcare providers and patients are choosing options such as Gamma Knife™ stereotactic radiosurgery, offered in healthcare facilities like the San Diego Gamma Knife Center® (SDGKC). Since WBRT is nonspecific, the entire brain receives a dose of radiation during treatment, which usually occurs in multiple sessions over the course of two to three weeks.(6) The treatment is known to cause serious side effects for patients, including extreme fatigue, nausea, neurotoxicity, and notable cognitive decline.(2,3,4) While it was once seen as a standard in brain tumor treatment, many healthcare providers and patients—especially those with a limited number of brain metastases arising from certain types of cancers—are now finding that it does not improve tumor control, increase the quality of the patient’s life, or extend life expectancy.(2,4) For many patients, especially those with a limited number of brain metastases, a radiosurgical approach to brain surgery is often more effective in controlling brain tumors. Stereotactic radiosurgery options, like the Gamma Knife™, delivers radiation in a precise manner directly to cancerous masses in the brain.(5) Treatment is often delivered in one convenient dose, rather than in multiple doses over the course of several days or weeks. Dr. Ken Ott, Neurosurgeon and Founder of the SDGKC, says, “Gamma knife radiosurgery targets the brain tumor with extreme accuracy and allows a tumor-lethal dose of radiation to be given in a single treatment while the surrounding, normal brain receives no significant radiation. This is translated into the control of the vast majority of brain metastases treated with gamma knife radiosurgery with prolonged survival, prolonged improvement or maintenance of the quality of our patients’ lives, while the same time avoiding harmful whole brain radiation. Comparison studies have shown that whole brain radiation therapy in the treatment of brain metastases offers little advantage over supportive treatment with steroids alone and the harmful effects of whole brain radiation began within months of treatment.” By targeting brain tumors directly, targeted treatment using the Gamma Knife™ helps to preserve the surrounding healthy brain tissue. As a result, patients reap the benefits of effective treatment while also experiencing side effects that are less severe than those associated with WBRT.(5,7) Between 73 – 98% of patients achieve complete tumor control after treatment with the Gamma Knife™(7), at a cost that is typically 25 – 30% less than traditional neurosurgery.(8) If a patient has a recurrent type of brain tumor, the Gamma Knife™ system can easily be used again to deliver a concentrated dose of radiation to the affected brain tissue.(7) Because of the reduction in severity of side effects—especially cognitive decline—patients who receive treatment using a precision medicine approach such as the Gamma Knife™ often enjoy a better quality of life compared to patients receiving WBRT.(7) In most cases, cognitive function, especially learning and memory, are not impacted after treatment, and most patients are able to resume normal daily activities with little to no down-time.(7, 8) Surgical systems like the Gamma Knife™ have also been shown to control the spread of cancerous cells within the brain as effectively as treatments like WBRT.(5) Perhaps most importantly, this type of targeted radiosurgery has been shown to increase life expectancy in many patients. A growing body of evidence is showing that patients who receive treatment using a precision-based approach, such as with the Gamma Knife™, have significant increases in life expectancy when compared to patients receiving contemporary therapies like WBRT.(5) About San Diego Gamma Knife Center: Since its opening, the San Diego Gamma Knife Center has treated over 4,000 patients with various brain disorders from around the world. The facility is equipped to provide advanced radiosurgical treatment for a variety of conditions, including metastatic brain tumors, primary brain tumors, arteriovenous malformations, and functional disorders such as trigeminal neuralgia and cluster headaches. On the campus of Scripps Memorial Hospital in La Jolla, California, the Center offers the use of its facilities to the neurosurgeons and radiation oncologists in Southern California. To learn more about the San Diego Gamma Knife Center, please visit http://www.sdgkc.com. Sources: 1. For Small Brain Metastases, Side Effects of Whole Brain Radiation Outweigh Benefits. Cure. http://www.curetoday.com/articles/for-small-brain-metastases-side-effects-of-whole-brain-radiation-outweigh-benefits 2. Whole brain radiotherapy offers little benefit to people whose lung cancer has spread to the brain, despite its widespread use. ScienceDaily. https://www.sciencedaily.com/releases/2016/09/160905064457.htm 3. Side effects from radiation therapy to the brain. American Cancer Society. https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/radiation/radiation-therapy-guide/radiation-to-brain.html 4. Whole-Brain Radiotherapy: Risks Worth Benefit? Medscape. http://www.medscape.com/viewarticle/845758 5. Targeted radiosurgery better than whole-brain radiation for treating brain tumors. ScienceDaily. https://www.sciencedaily.com/releases/2017/02/170216130335.htm 6. Stereotactic radiosurgery and stereotactic radiotherapy for brain metastases. Surgical Neurology International. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656557/ 7. Stereotactic radiosurgery in the treatment of brain metastases: The current evidence. Cancer Treatment Reviews. http://www.sciencedirect.com/science/article/pii/S0305737213000947 8. Gamma Knife Surgery. International Radiosurgical Association. http://www.irsa.org/gamma_knife.html
Ott K.,Scripps Memorial Hospital |
Ott K.,San Diego Gamma Knife Center |
Hodgens D.W.,Scripps Memorial Hospital |
Goetsch S.,Scripps Memorial Hospital
Radiosurgery | Year: 2010
Introduction: Cluster headache is a particularly severe, periodic cephalalgia which is occasionally refractory to medical treatment. In the past, surgical lesions of the trigeminal nerve (TN) have produced initial relief in more than one-half of patients. Radiosurgical lesions of the TN have produced short-lived pain relief and perhaps increased toxicity. In this pilot study we added the sphenopalatine ganglion (SPG) as an additional target in an effort to extend the degree and length of pain relief. Methods: Over an 8-year period, we carried out 12 gamma knife radiosurgical treatments in 7 patients, treating only the TN or later both the TN and SPG contemporaneously. A 4-mm collimated shot was placed on the nerve root entry zone of the TN and a maximum dose of 85 to 103 Gy was prescribed. The SPG was radiated in the pterygopalatine fossa using an 8-mm collimated shot and maximum dose of 85 to 97 Gy. Results: One patient with three treatments to the TN enjoyed immediate and complete relief for 5, 22, and 25 months. Four of 5 patients with radiation of both the TN and SPG experienced pain relief for 8 and 30 months, or are continuing to enjoy pain relief 7, 18, and 22 months after treatment or re-treatment at the last follow-up. Most patients reported facial paresthesias following radiation. No profound numbness or deafferentation pain was experienced. Conclusions: These results, in some respects, reflect the morbidity and pain relief experience of Gamma Knife® radiosurgery for classical trigeminal neuralgia. The addition of the SPG as a target may prove to be valuable and has not increased the morbidity of treatment. © 2010 S. Karger AG.
Gonda D.D.,University of California at San Diego |
Kim T.E.,University of California at San Diego |
Goetsch S.J.,San Diego Gamma Knife Center |
Kawabe T.,Katsuta Hospital Mito GammaHouse |
And 12 more authors.
European Journal of Cancer | Year: 2014
Introduction Defining key prognostic factors for patients with cerebral metastases who underwent stereotactic radiosurgery (SRS) treatment will greatly facilitate future clinical trial designs. Methods We adopted a two-phase study design where results from one cohort were validated in a second independent cohort. The exploratory analysis reviewed the survival outcomes of 1017 consecutive patients (with 3610 metastases) who underwent Gamma radiosurgery at the University of California, San Diego (UCSD)/San Diego Gamma Knife Center (SDGKC). Multivariate analysis was performed to identify prognostic factors. Results were validated using data derived from 2519 consecutive patients (with 17,498 metastases) treated with SRS at the Katsuta Hospital. Results For the SDGKC cohort, the median overall survival of patients following SRS was 7 months. Two year follow-up data were available for 85% of the patients. Multivariate analysis found that patient age, Karnofsky Performance Status, systemic cancer status, tumour histology, number of metastasis and cumulative tumour volume independently associated with overall survival (p < 0.001). All statistical associations were validated by multivariate analysis of data derived from the Katsuta Hospital cohort. Conclusions This is the first integrated study that defined prognostic factors for SRS-treated patients with cerebral metastases using an inter-institutional validation study design. The work establishes a model for collaborative interactions between large volume centers and provides prognostic variables that should be incorporated into future clinical trial design. © 2014 Elsevier Ltd. All rights reserved.
Marshall D.C.,University of California at San Diego |
Marcus L.P.,University of California at Los Angeles |
Kim T.E.,Wake Forest Baptist Health |
McCutcheon B.A.,Mayo Medical School |
And 8 more authors.
Journal of Neuro-Oncology | Year: 2016
With escalating focus on cost containment, there is increasing scrutiny on the practice of multiple stereotactic radiosurgeries (SRSs) for patients with cerebral metastases distant to the initial tumor site. Our goal was to determine the survival patterns of patients with cerebral metastasis who underwent multiple SRSs. We retrospectively analyzed survival outcomes of 801 patients with 3683 cerebral metastases from primary breast, colorectal, lung, melanoma and renal histologies consecutively treated at the University of California, San Diego/San Diego Gamma Knife Center (UCSD/SDGKC), comparing the survival pattern of patients who underwent a single (n = 643) versus multiple SRS(s) (n = 158) for subsequent cerebral metastases. Findings were recapitulated in an independent cohort of 2472 patients, with 26,629 brain metastases treated with SRS at the Katsuta Hospital Mito GammaHouse (KHMGH). For the UCSD/SDGKC cohort, no significant difference in median survival was found for patients undergoing 1, 2, 3, or ≥4 SRS(s) (median survival of 167, 202, 129, and 127 days, respectively). Median intervals between treatments consistently ranged 140–178 days irrespective of the number of SRS(s) (interquartile range 60–300; p = 0.25). Patients who underwent >1 SRSs tend to be younger, with systemic disease control, harbor lower cumulative tumor volume but increased number of metastases, and have primary melanoma (p < 0.001, <0.001, <0.001, 0.02, and 0.009, respectively). Comparable results were found in the KHMGH cohort. Using an independent validation study design, we demonstrated comparable overall survival between judiciously selected patients who underwent a single or multiple SRS(s). © 2016 Springer Science+Business Media New York
Taich Z.J.,University of California at San Diego |
Goetsch S.J.,San Diego Gamma Knife Center |
Monaco E.,San Diego Gamma Knife Center |
Carter B.S.,University of California at San Diego |
And 3 more authors.
World Neurosurgery | Year: 2016
Background Stereotactic radiosurgery (SRS) is a minimally invasive surgical option for the treatment of trigeminal neuralgia (TN). Here we review our institutional experience to identify prognostic factors associated with pain relief after SRS. Methods 263 patients with TN treated at the University of California, San Diego/San Diego Gamma Knife (2001-2013) were followed for more than 6 months. Univariate and multivariate Cox proportional hazard models analysis of factors associated with outcome was performed. Results Of the 263 patients, 229 (87%) presented with classical idiopathic TN, 31 (12%) presented with atypical TN, and 4 (1%) presented with secondary TN. 143 (54%) had undergone prior treatment. Most patients were treated with 85 (52%) or 90 Gy (42%). 79% of the SRS treated patients experienced a favorable response (defined as Barrow Neurological Institute Pain Scale <3 pain relief), with a median time to relief of 2.5 months. In a multivariate analysis, diagnosis of classical TN, previous percutaneous procedures, and age older than 70 years were associated with favorable responses; classical TN was associated with sustained pain relief. Dose prescription >85 Gy and prior SRS were associated with bothersome facial numbness posttreatment. For patients presenting with classical TN, diagnosis of multiple sclerosis (MS) did not decrease the likelihood of pain relief after SRS. Conclusions Excellent TN pain relief was achieved with the delivery of 85 Gy in a single-shot, 4-mm isocenter SRS targeting the dorsal root entry zone. Patients with classical TN, with age older than 70 years, or who underwent previous percutaneous procedures were more likely to benefit from SRS. SRS is efficacious in patients with classical TN despite concurrent diagnosis of MS. © 2016 Elsevier Inc. All rights reserved.
PubMed | University of California at San Diego, Tokyo Women's Medical University, Kyoto Prefectural University of Medicine, University of Tsukuba and San Diego Gamma Knife Center
Type: Journal Article | Journal: European journal of cancer (Oxford, England : 1990) | Year: 2014
Defining key prognostic factors for patients with cerebral metastases who underwent stereotactic radiosurgery (SRS) treatment will greatly facilitate future clinical trial designs.We adopted a two-phase study design where results from one cohort were validated in a second independent cohort. The exploratory analysis reviewed the survival outcomes of 1017 consecutive patients (with 3610 metastases) who underwent Gamma radiosurgery at the University of California, San Diego (UCSD)/San Diego Gamma Knife Center (SDGKC). Multivariate analysis was performed to identify prognostic factors. Results were validated using data derived from 2519 consecutive patients (with 17,498 metastases) treated with SRS at the Katsuta Hospital.For the SDGKC cohort, the median overall survival of patients following SRS was 7 months. Two year follow-up data were available for 85% of the patients. Multivariate analysis found that patient age, Karnofsky Performance Status, systemic cancer status, tumour histology, number of metastasis and cumulative tumour volume independently associated with overall survival (p<0.001). All statistical associations were validated by multivariate analysis of data derived from the Katsuta Hospital cohort.This is the first integrated study that defined prognostic factors for SRS-treated patients with cerebral metastases using an inter-institutional validation study design. The work establishes a model for collaborative interactions between large volume centers and provides prognostic variables that should be incorporated into future clinical trial design.