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Beersheba, Israel

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.

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.

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.

Shimon I.,Institute of Endocrinology and Metabolism | Shimon I.,Tel Aviv University | Manisterski Y.,Institute of Endocrinology and Metabolism | 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.

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