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In this paper, the mobile stereotactic radiosurgical system, a new therapeutant for interstitial radiotherapy, is introduced. Its principle and initial clinical applications are also summarized
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ObjectiveTo study the clinical effects of X-kn ife in the treatment of intracranial meningiomas.MethodsA retrospective analysis of 52 cases of intracranial meningioma treated by X-knife was made. The peripheral dose was (10 ～20) Gy, with a mean of 13 Gy. Follow-up checkups consisted of clinical examina tions and contrast-enhanced CT scans.ResultsAfter the treatm ent, unilateral m ild hemiplegia occurred in 1 case (1 9%) and local epileptic attack occurred in 2 cases (3 8%). Imaging findings revealed asymptomatic transient peritumoral ed e ma in 12 cases (23 1%). Follow-up imaging lasting (3～92) months (mean, 23 mont hs ) in 40 cases (76 9%) found regression of tumor in 18 cases (45 0%) and unchan ge d tumor size in 22 cases (55 0%).ConclusionsX-knife is an e ffective and safe procedure for meningiomas.
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Objective To assess the technique and the safety of radical resection for large pituitary adenoma. Methods Unilateral transorbital subfrontal approach operations were employed for treating 14 cases of large or giant pituitary adenomas. Tumors, at least the suprasellar extension of them, were removed as thoroughly as possible in surgery. Then the X-knife was administered for intrasellar residual lesions 1.5～3.5 months after the surgery. Results Total removal of tumors was achieved in 4 patients, while intrasellar residual tumors were found in the remaining 10 patients. No severe complications occurred. Out of the 10 patients with residual tumors, 8 underwent postoperative X-knife therapy, without visual defects or pituitary function failure. Follow-up observations in these 8 patients for 5～26 months (mean,14.8 months) revealed no recurrence. Conclusions Transorbital subfrontal approach surgery which is characterized by simplicity of its performance facilitates the radical resection of tumors and the avoidance of complications. Postoperative X-knife therapy may further control the recurrence of tumors.
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Objective To discuss the X-knife radiosurgery (XKS) in the treatment of brain metastasis of lung carcinoma. Methods A total of 100 patients with similar prognostic factors were divided into two groups with 50 patients in each group, receiving either whole-brain radiotherapy alone (30~40 Gy/3~4 weeks) (Radiotherapy Group) or XKS combined with radiotherapy (Combination Group). In the Combination Group, 27 patients received XKS with single fraction of radiation, with a median prescription dose of 14.2 Gy, and the other 23 patients received multiple fractions of radiation (5~10 Gy/f, 3 times weekly), with a total dose of 15~30 Gy. Results In the Combination Group and the Radiotherapy Group, the median survival time was 16.4 and 10 months, respectively (P=0.0064), the 2-year local tumor control rate was 88% (44/50) and 44% (22/50), respectively (?2=21.569,P=0.000), and the effective rate under CT or MRI scanning at 1~3 months after treatment was 87.5% (35/40) and 52.2% (24/46), respectively (?2=16.497,P=0.001). An analysis on the cause of death showed that 11.9% of patients (5/42) in the Combination Group died from brain metastasis, which was significantly lower than that in the Radiotherapy Group (55.6%, 25/45) (?2=25.908,P=0.000). The incidence of complications was not significantly different between the Combination Group (8%, 4/50) and the Radiotherapy Group (4%, 2/50) (?2=0.709,P=0.400). Conclusions Combined use of X-knife radiosurgery and routine radiotherapy has better therapeutic effects than radiotherapy alone for treating brain metastatic tumor.
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Among the existing radiotherapy technologies, ?(X) stereotatic radiotherapy,especially the whole body ? knife,provides better dose distribution and has advantages in increasing target volume dose and reducing normal tissue damage.The whole body ? knife,patented in China with unique characteristics of dose focusing and dose distribution,could provide higher curative effect and minimal toxicity in the treatment of cancers of the lung,liver,pancreas,etc.It has initiated a new phase of Chinese mode of ?(X) stereotatic radiotherapy and was drawn great attention at home and abroad.In this review,the clinical application criteria,treatment progress,existing problem and expectation of ?(X) stereotatic radiotherapy have been summarized.
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Purpose: There is no appropriate instrument or devices and corresponding technological specification for measurement of output dose and dose disdribution in stereotactic radiothrapy. Small field of the stereotatic radiotherapy can't be measured by normal ionization chamber for its characteristics.A practible instrument and method were developed for dose measurement in stereotactic irradiation.Materials and Methods:A diode detector with 1mm sensitivety volume and a 0.3cc graphite chamber developed by us are used to measure the dose output & dose distribution in warious phantom for the beams used in stereotactic irradiation.Results:The dose outputs and dose ditributions measured by SCD-61 diode developed by us were tested and verified by TLD dosemeter,and the results show tha there is a 5% consistency for the value at the focus point.Conclusion: the diameter of the detector used for measurement must be smaller than the halt size of the radiation beams to be measured. A diode detector with 1mm sensitivity volume is the best choice for the dosimetric measurements for smaller beams used in stereotactic irradiation.
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Objective To observe CT findings of brain malignant tumor treated by X-knife. Methods 59 patients of brain malignant tumors after the treatment of X-knife were underwent plain and enhanced CT scan.According to the rate of disappearance,the density,the changes of edema and the radioactive encephalitis,all patients were followed up. Results Metastatic brain tumor disappeared faster than primary ones,the more extensively primitive tumors in metastasis disappeared more rapidly.Lymphoma and germinoma disappeared faster than astrocytoma.The low density tumors did not recured,the middle density tumors without enhancemant recured difficultly and the blend density tumors with middle enhancenent recured easily.Conclusion Plain and enhanced CT scan can be a good standard to demostrate the effect and prognosis of brain malignant tumor after X-knife treatment.