Dataset Information

Long-Term Outcome of Unilateral Acoustic Neuromas With or Without Hearing Loss: Over 10 Years and Beyond After Gamma Knife Radiosurgery.

ABSTRACT:

Background

Since the long-term outcomes of 162 patients who underwent gamma knife radiosurgery (GKS) as an initial or adjuvant treatment for acoustic neuromas (ANs) with unilateral hearing loss were first reported in 1998, there has been no report of a comprehensive analysis of what has changed in GKS practice.

Methods

We performed a retrospective study of the long-term outcomes of 106 patients with unilateral sporadic ANs who underwent GKS as an initial treatment. The mean patient age was 50 years, and the mean initial tumor volume was 3.68 cm³ (range, 0.10-23.30 cm³). The median marginal tumor dose was 12.5 Gy (range, 8.0-15.0 Gy) and the median follow-up duration was 153 months (range, 120-216 months).

Results

The tumor volume increased in 11 patients (10.4%), remained stationary in 27 (25.5%), and decreased in 68 patients (64.2%). The actuarial 3, 5, 10, and 15-year tumor control rates were 95.3 ± 2.1%, 94.3 ± 2.2%, 87.7 ± 3.2%, and 86.6 ± 3.3%, respectively. The 10-year actuarial tumor control rate was significantly lower in the patients with tumor volumes of ≥ 8 cm³ (P = 0.010). The rate of maintaining the same Gardner-Robertson scale grade was 28.6%, and that of serviceable hearing was 46.4%. The rates of newly developed facial and trigeminal neuropathy were 2.8% and 4.7%, respectively. The patients who received marginal doses of less than 12 Gy revealed higher tumor control failure rates (P = 0.129) and newly occurred facial or trigeminal neuropathy rates (P = 0.040 and 0.313, respectively).

Conclusion

GKS as an initial treatment for ANs could be helpful in terms of tumor control, the preservation of serviceable hearing, and the prevention of cranial neuropathy. It is recommended to perform GKS as soon as possible not only for tumor control in unilateral ANs with hearing loss but also for hearing preservation in those without hearing loss.

SUBMITTER: Park HR

PROVIDER: S-EPMC10578997 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Publications

Long-Term Outcome of Unilateral Acoustic Neuromas With or Without Hearing Loss: Over 10 Years and Beyond After Gamma Knife Radiosurgery.

Park Hye Ran HR Jeong Sang Soon SS Kim Jung Hoon JH Myeong Ho Sung HS Park Hyun Joo HJ Park Kwang Hyon KH Park Kawngwoo K Yoon Byung Woo BW Park Suyeon S Kim Jin Wook JW Chung Hyun-Tai HT Kim Dong Gyu DG Paek Sun Ha SH

Journal of Korean medical science 20231016 40

<h4>Background</h4>Since the long-term outcomes of 162 patients who underwent gamma knife radiosurgery (GKS) as an initial or adjuvant treatment for acoustic neuromas (ANs) with unilateral hearing loss were first reported in 1998, there has been no report of a comprehensive analysis of what has changed in GKS practice.<h4>Methods</h4>We performed a retrospective study of the long-term outcomes of 106 patients with unilateral sporadic ANs who underwent GKS as an initial treatment. The mean patien ...[more]

PMID: 37846791

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Project description:The Leksell GammaPlan software version 10 introduces a CT image-based segmentation tool for automatic skull definition and a convolution dose calculation algorithm for tissue inhomogeneity correction. The purpose of this work was to evaluate the impact of these new approaches on routine clinical Gamma Knife treatment planning. Sixty-five patients who underwent CT image-guided Gamma Knife radiosurgeries at the University of Pittsburgh Medical Center in recent years were retrospectively investigated. The diagnoses for these cases include trigeminal neuralgia, meningioma, acoustic neuroma, AVM, glioma, and benign and metastatic brain tumors. Dose calculations were performed for each patient with the same dose prescriptions and the same shot arrangements using three different approaches: 1) TMR 10 dose calculation with imaging skull definition; 2) convolution dose calculation with imaging skull definition; 3) TMR 10 dose calculation with conventional measurement-based skull definition. For each treatment matrix, the total treatment time, the target coverage index, the selectivity index, the gradient index, and a set of dose statistics parameters were compared between the three calculations. The dose statistics parameters investigated include the prescription isodose volume, the 12 Gy isodose volume, the minimum, maximum and mean doses on the treatment targets, and the critical structures under consideration. The difference between the convolution and the TMR 10 dose calculations for the 104 treatment matrices were found to vary with the patient anatomy, location of the treatment shots, and the tissue inhomogeneities around the treatment target. An average difference of 8.4% was observed for the total treatment times between the convolution and the TMR algorithms. The maximum differences in the treatment times, the prescription isodose volumes, the 12 Gy isodose volumes, the target coverage indices, the selectivity indices, and the gradient indices from the convolution and the TMR 10 calculations are 14.9%, 16.4%, 11.1%, 16.8, 6.9%, and 11.4%, respectively. The maximum differences in the minimum and the mean target doses between the two calculation algorithms are 8.1% and 4.2% of the corresponding prescription doses. The maximum differences in the maximum and the mean doses for the critical structures between the two calculation algorithms are 1.3 Gy and 0.7 Gy. The results from the two skull definition methods with the TMR 10 algorithm agree either within ± 2.5% or 0.3 Gy for the dose values, except for a 4.9% difference in the treatment times for a lower cerebellar lesion. The imaging skull definition method does not affect Gamma Knife dose calculation considerably when compared to the conventional measurement-based skull definition method, except in some extreme cases. Large differences were observed between the TMR 10 and the convolution calculation method for the same dose prescription and the same shot arrangements, indicating that the implementation of the convolution algorithm in routine clinical use might be desirable for optimal dose calculation results.

Project description:ObjectiveTo evaluate the scientometrics characteristics of the scientific production on the treatment of brain tumors with gamma knife radiosurgery in Scopus.MethodsThe Scopus database (Elsevier) was used to collect all relevant studies for this bibliometric analysis. Data was obtained as a .csv file; it was downloaded from Scopus and was exported by SciVal to Microsoft Excel for a presentation using tables for more detailed analysis. The citations and the number of papers for the most productive institutions, authors, countries, and journals publishing scientific papers were analyzed on the use of gamma knife radiosurgery for brain tumors.Results458 metadata were obtained from scientific publications, on which inclusion and exclusion criteria were applied, leaving 248 studies. The maximum peak of publications was 2018 with 31 publications, and the minimum peak was 2015 with 18. The most related subtopics were neurology, surgery, and oncology, and most of the retrieved papers had only institutional collaboration. As for more productive journals, Journal of Neurosurgery is first with 23 publications; within the countries with the most scientific publications, we have the United States, Japan, and China. With the United States being the country with the highest number of productions, University of Texas MD Anderson Cancer Center was the main university with the highest scientific production and Sheehan and Trifiletti and American authors dominate the list with the highest number of documents.ConclusionScientific production regarding gamma knife surgery and brain tumors has been increasing during the last 10 years, with a high incidence during 2018, and the highest number of published articles was in the first quartile. Likewise, the United States is the country with the most publications, authors, and universities on the subject. Greater efforts are still lacking from all countries in the world to reach the quantity and quality of production of the United States.

Dataset Information

Long-Term Outcome of Unilateral Acoustic Neuromas With or Without Hearing Loss: Over 10 Years and Beyond After Gamma Knife Radiosurgery.

Background

Methods

Results

Conclusion

Publications

Long-Term Outcome of Unilateral Acoustic Neuromas With or Without Hearing Loss: Over 10 Years and Beyond After Gamma Knife Radiosurgery.

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