Is fractionated Gamma Knife radiosurgery a safe and effective treatment approach for large volume (>10 cm(3)) XXXX ?

@entity1 @entity410 @entity137 @entity1276 @entity5 @entity1269 @entity4 @entity1653
BACKGROUND: Even with great advances in surgery and improved clinical outcome, morbidity and mortality are still high for large volume @entity1653 ( @entity1653 ). Recently, gamma knife radiosurgery (GKS) has proven to be a safe and effective treatment for many @entity1 with intracranial @entity1653 . However, single session GKS may increase the risk of radiation-induced @entity137 for large @entity1653 . Recently, fractionated gamma knife radiosurgery (FGKS) has been performed for an increasing number of @entity1 with surgically high-risk and large @entity5 . In this study, we report our results on the efficacy and safety of FGKS for large @entity1653 . METHODS: The authors performed a retrospective review of 70 @entity1 who underwent GKS for large volume (>10 cm(3)) intracranial @entity1653 between 2004 and 2015, with a minimum follow-up of 12 months. The authors classified these @entity1 into two groups of single-session GKS, fractionated GKS (FGKS). The @entity1 were followed by clinical examination as well as serial imaging with magnetic resonance imaging (MRI). RESULTS: In the single-session GKS group (42 @entity1 ), the median @entity5 volume was 15.2 cm(3) (range 10.3-48.3 cm(3)); the median prescription dose was 12 Gy (range 8-14 Gy), and the median follow-up duration was 57.8 months (range 14.5-128.4 months). In the FGKS group (28 @entity1 ), the median @entity5 volume was 21 cm(3) (range 10.2-54.7 cm(3)), and the median prescription was 7.5 Gy in 2 fractions (range 5-8 Gy), 6 Gy in 3 fractions (range 5-6.5 Gy), 4.5 Gy in 4 fractions. The median follow-up duration for the FGKS group was 50 months (range 12.5-90.6 months). The overall 5-year @entity5 control rate was 92.9% in the FGKS group and 88.1% in the single-session GKS group. Fourteen (33.3%) symptomatic complications after single session GKS were noted, including 5 cases of @entity1269 , 4 of @entity410 , 3 of peritumoral @entity4 , and 2 of @entity1276 . Two (7.1%) symptomatic complications after FGKS were noted, including 2 cases of @entity1269 . The FGKS group had higher progression free survival (PFS) rate at 5 years (92.9% vs. 88.1%), but the differences did not reach statistical significance (p=0.389). The @entity1 in the FGKS group, however, experienced a lower complication rate compared with @entity1 with single session GKS group (p=0.017, hazard ratio, 5.7: 1). CONCLUSION: When the large-volume (>10 cm(3)) intracranial @entity1653 are expected to have high morbidity after microsurgery and for @entity1 that have a poor medical status for surgery, FGKS can be considered a good alternative with @entity5 control and lower complications rates compared with single-session GKS (p=0.017).
