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Harel R.,Stereotactic Radiosurgery Unit | Harel R.,Spine Surgery Unit | Zach L.,Oncology Institute
Neurological Research | Year: 2014

Early diagnosis, better imaging, and advanced treatment of cancer patients extend survival and increase the incidence of symptomatic spine metastases. The treatment algorithm for spine metastases has shifted to a more aggressive approach in recent years. Spine stereotactic radiosurgery (SRS) is a relatively new tool utilizing advanced imaging systems, planning software, image-guided localization, and intensitymodulated dose delivery. Radiosurgery of spine metastases yields high rates of pain-and tumor control, and offers both the patients and the treating physicians an effective noninvasive alternative. This review presents the indications and outcomes for SRS and describes current techniques. © W. S. Maney & Son Ltd 2014.


Zach L.,Oncology Institute | Tsvang L.,Oncology Institute | Alezra D.,Oncology Institute | Ben Ayun M.,Sheba Medical Center | And 2 more authors.
BioMed Research International | Year: 2016

Purpose. Spine stereotactic radiosurgery (SRS) delivers an accurate and efficient high radiation dose to vertebral metastases in 1-5 fractions. We aimed to compare volumetric modulated arc therapy (VMAT) to static beam intensity modulated radiotherapy (IMRT) for spine SRS. Methods and Materials. Ten spine lesions of previously treated SRS patients were planned retrospectively using both IMRT and VMAT with a prescribed dose of 16 Gy to 100% of the planning target volume (PTV). The plans were compared for conformity, homogeneity, treatment delivery time, and safety (spinal cord dose). Results. All evaluated parameters favored the VMAT plan over the IMRT plans. D m i n in the IMRT was significantly lower than in the VMAT plan (7.65 Gy/10.88 Gy, p < 0.001), the Dice Similarity Coefficient (DSC) was found to be significantly better for the VMAT plans compared to the IMRT plans (0.77/0.58, resp., p value < 0.01), and an almost 50% reduction in the net treatment time was calculated for the VMAT compared to the IMRT plans (6.73 min/12.96 min, p < 0.001). Conclusions. In our report, VMAT provides better conformity, homogeneity, and safety profile. The shorter treatment time is a major advantage and not only provides convenience to the painful patient but also contributes to the precision of this high dose radiation therapy. © 2016 Leor Zach et al.


Kanner A.A.,Tel Aviv Sourasky Medical Center | Kanner A.A.,Stereotactic Radiosurgery Unit | Levita M.,Institute of Radiotherapy | Levita M.,Stereotactic Radiosurgery Unit | And 5 more authors.
Radiosurgery | Year: 2010

Background: Local control of brain metastasis (BM) is increased by whole-brain irradiation (WBI) with or without resection. However, patients who have new or recurrent BM after WBI and undergo resection are left without adjuvant therapy options. Methods: We performed a retrospective analysis evaluating the addition of a stereotactic radiosurgery (SRS) boost to the resection cavity both as an adjuvant and salvage procedure. Results: For the period from May 2005 to March 2007, we identified 16 patients. Nine patients were female and the median age for the entire group was 59.6 years (range 33.5-73.5) and median KPS 90 (60-100) at the time of SRS. Time to SRS after surgical removal was 2-16.9 weeks (median 6.5) and the overall median follow-up was 7.6 months (3.0-26.2). During the follow-up period, 1 patient recurred locally and was referred for additional surgery. Two patients with primary breast cancer developed leptomeningeal spread. Both of these patients as well as all other patients have remained free of local recurrence thus far. No treatment-related toxicity (as defined by imaging or clinical criteria) has been observed. Distant metastases occurred in 3 patients. Conclusion: These preliminary results demonstrate feasibility of post-resection SRS in selected patients with outstanding local tumor control. Larger prospective BM studies and longer follow-up are needed to determine the role of post-resection SRS (to the cavity) as salvage therapy in patients with BM. © 2010 S. Karger AG.


Hadelsberg U.,Technion - Israel Institute of Technology | Nissim U.,Chaim Sheba Medical Center | Nissim U.,Stereotactic Radiosurgery Unit | Cohen Z.R.,Chaim Sheba Medical Center | And 2 more authors.
Stereotactic and Functional Neurosurgery | Year: 2015

Background: At present, there is no general agreement for the best approach to parasagittal meningiomas. Invasion of the superior sagittal sinus is frequent and responsible for relatively high recurrence rates following conventional microsurgery. Radiosurgery has the potential to treat less accessible portions of these tumors, and its application in this pathology is increasing either as a primary or a complementary therapeutic tool. Objective: To evaluate our results with LINAC radiosurgery for the treatment of parasagittal meningiomas. Methods: The patient cohort consisted of 74 patients treated for parasagittal meningioma by LINAC radiosurgery at our institution's Radiosurgery Unit during a 15-year period. Women accounted for 61% of patients. Thirteen patients (18%) underwent radiosurgery as the primary treatment for their meningioma. Results: The overall actuarial control rate was 90.6% at a mean follow-up of 49 months. In 17 patients (22.9%), there was no volumetric change. Fifty patients (67.5%) showed tumor shrinkage ranging from 15 to 80% of the original mass. In 7 patients, tumor recurrence was observed at an average time of 42.2 months after radiosurgery. All the patients with previously untreated tumors were controlled. Symptomatic transient peritumoral edema developed in 5 patients (6.7%) at a mean of 6.4 months after radiosurgery. Three patients complained of protracted headaches after treatment. Conclusions: LINAC radiosurgery was highly effective for the treatment of parasagittal meningiomas in this series. For small to medium-sized meningiomas with clear invasion of the sinusal lumen, radiosurgery is a reasonable option as a first-line treatment. Either alone or combined with conventional surgery, radiosurgery may improve the control rate for parasagittal meningiomas. © 2014 S. Karger AG, Basel.


Lawrence Y.R.,Center for Translational Research in Radiation Oncology | Blumenthal D.T.,Tel Aviv Sourasky Medical Center | Matceyevsky D.,Tel Aviv Sourasky Medical Center | Kanner A.A.,Stereotactic Radiosurgery Unit | Bokstein F.,Tel Aviv Sourasky Medical Center
Journal of Neuro-Oncology | Year: 2011

Glioblastoma is a malignant tumor characterized by a rapid proliferation rate. Contemporary multimodality treatment consists of maximal surgical resection followed by radiation therapy (RT) combined with cytotoxic chemotherapy. The optimal timing of these different steps is not known. Four studies from the pre-temozolomide era, encompassing a total of 4,584 subjects, have examined the consequences of a delay between resection and starting RT. Whereas the two small single-institution studies found this delay to be detrimental, two large multiinstitutional studies found delay to be either slightly beneficial or at least not harmful. Here, we critically compare the methodologies and results presented in these studies, and include a novel analysis of the combined datasets. We conclude that moderate wait periods (up to 4-6 weeks post-operatively) are safe and may be modestly beneficial. Conversely, there is no evidence to justify waiting longer than 6 weeks. Underlying radiobiological principles are discussed. © Springer Science+Business Media, LLC. 2011.


Strauss I.,Tel Aviv Sourasky Medical Center | Strauss I.,Tel Aviv University | Jonas-Kimchi T.,Diagnostic Neuroradiology Unit | Jonas-Kimchi T.,Tel Aviv University | And 12 more authors.
Israel Medical Association Journal | Year: 2013

Background: Radiation treatment of spinal and paraspinal tumors has been limited by the tolerance of the spinal cord. As such, therapeutic options are restricted to surgically accessible lesions or the use of suboptimal dosing of external beam irradiation. objectives: To evaluate the safety and applicability of the Elekta Synergy-S radiation unit for the treatment of spinal tumors. Methods: We retrospectively reviewed all patients treated with stereotactic radiosurgery for spinal tumors between November 2007 and June 2011. results: Thirty-four patients were treated for 41 lesions. Treatment indications were local tumor control and pain palliation. The mean follow-up was 10.8 ± 11.6 months (range 0.5-38 months). No acute radiation toxicity or new neurological defcits occurred during the follow-up period. Local tumor control was achieved in 21 of the 24 lesions (87.5%) available for radiological follow-up at a median of 9.8 months (range 3-32 months). Good analgesia was achieved in 24/30 lesions (80%) that presented with intractable pain. conclusions: The safety and feasibility of delivering single and multiple-fraction stereotactic spinal irradiation was demonstrated and became a standard treatment option in our institution.


Stiebel-Kalish H.,Neuro Ophthalmology Unit | Stiebel-Kalish H.,Tel Aviv University | Reich E.,Rabin Medical Center | Reich E.,Tel Aviv University | And 11 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: Meningiomas threatening the anterior visual pathways (AVPs) and not amenable for surgery are currently treated with multisession stereotactic radiotherapy. Stereotactic radiotherapy is available with a number of devices. The most ubiquitous include the gamma knife, CyberKnife, tomotherapy, and isocentric linear accelerator systems. The purpose of our study was to describe a case series of AVP meningiomas treated with linear accelerator fractionated stereotactic radiotherapy (FSRT) using the multiple, noncoplanar, dynamic conformal rotation paradigm and to compare the success and complication rates with those reported for other techniques. Patients and Methods: We included all patients with AVP meningiomas followed up at our neuro-ophthalmology unit for a minimum of 12 months after FSRT. We compared the details of the neuro-ophthalmologic examinations and tumor size before and after FSRT and at the end of follow-up. Results: Of 87 patients with AVP meningiomas, 17 had been referred for FSRT. Of the 17 patients, 16 completed >12 months of follow-up (mean 39). Of the 16 patients, 11 had undergone surgery before FSRT and 5 had undergone FSRT as first-line management. Tumor control was achieved in 14 of the 16 patients, with three meningiomas shrinking in size after RT. Two meningiomas progressed, one in an area that was outside the radiation field. The visual function had improved in 6 or stabilized in 8 of the 16 patients (88%) and worsened in 2 (12%). Conclusions: Linear accelerator fractionated RT using the multiple noncoplanar dynamic rotation conformal paradigm can be offered to patients with meningiomas that threaten the anterior visual pathways as an adjunct to surgery or as first-line treatment, with results comparable to those reported for other stereotactic RT techniques. © 2012 Elsevier Inc.


Shimon I.,Beilinson Hospital | Shimon I.,Tel Aviv University | Manisterski Y.,Beilinson Hospital | Kanner A.A.,Stereotactic Radiosurgery Unit | Kanner A.A.,Tel Aviv University
Pituitary | Year: 2012

A 33-year old male was diagnosed with Cushing's disease due to a large and invasive ACTH-secreting macroadenoma. After surgical failure ketoconazole therapy was initiated to control cortisol hypersecretion and his symptoms. He was referred to radiotherapy, and fractionated stereotactic radiotherapy in 30 fractions was delivered. After 12 daily fractions of radiotherapy the urinary cortisol release increased abruptly together with clinical deterioration. The daily ketoconazole dose was increased, and 10 days after concluding radiotherapy his urinary cortisol returned to normal values. Hormonal remission was observed less than 1 year following radiotherapy. © 2011 Springer Science+Business Media, LLC.


PubMed | Oncology Institute, Stereotactic Radiosurgery Unit and Sheba Medical Center
Type: | Journal: BioMed research international | Year: 2016

Spine stereotactic radiosurgery (SRS) delivers an accurate and efficient high radiation dose to vertebral metastases in 1-5 fractions. We aimed to compare volumetric modulated arc therapy (VMAT) to static beam intensity modulated radiotherapy (IMRT) for spine SRS.Ten spine lesions of previously treated SRS patients were planned retrospectively using both IMRT and VMAT with a prescribed dose of 16Gy to 100% of the planning target volume (PTV). The plans were compared for conformity, homogeneity, treatment delivery time, and safety (spinal cord dose).All evaluated parameters favored the VMAT plan over the IMRT plans. D min in the IMRT was significantly lower than in the VMAT plan (7.65Gy/10.88Gy, p < 0.001), the Dice Similarity Coefficient (DSC) was found to be significantly better for the VMAT plans compared to the IMRT plans (0.77/0.58, resp., pvalue < 0.01), and an almost 50% reduction in the net treatment time was calculated for the VMAT compared to the IMRT plans (6.73min/12.96min, p < 0.001).In our report, VMAT provides better conformity, homogeneity, and safety profile. The shorter treatment time is a major advantage and not only provides convenience to the painful patient but also contributes to the precision of this high dose radiation therapy.

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