ABSTRACT
BACKGROUND: Brain metastases (BMs) are the most common expansive intracranial lesions in adults. Approximately 50% of patients diagnosed with new BMs will have >1 BM at the diagnosis. We report our experience with BMs treated with Leksell Gamma Knife stereotactic radiosurgery (GKSR) and evaluate the outcomes. METHODS: Patients treated by GKSR in our institution between 2008 and 2021 for BMs were evaluated retrospectively. RESULTS: A total of 205 patients (56.6% women) were included, with a median age of 59 years (range, 25-83 years). The breast (n = 85; 42.5%) and lung (n = 76; 38%) were the most common original locations for the primary tumors. Of the 205 patients, 103 (50.3%) had a single BM and 102 (49.7%) had ≥2 BMs. The median number of multiple BMs treated was 4 (range, 2-43). The mean overall survival (OS) time was 6.00 months (95% confidence interval [CI], 5.07-6.93 months) for all BMs. The median rate of tumor control after radiosurgery was 65% (range, 20%-99%) during a median follow-up of 6.00 months (95% CI, 3-84 months). In the overall population, the 1-, 2-, and 5-year OS rate was 37.55%, 25.12%, and 18.51%, respectively. The mean OS time was longer for those with multiple BMs than for those with a single BM (mean, 10 months [95% CI, 6.67-13.33 months] vs. mean, 5 months [95% CI, 4.21-5.70 months]; P = 0.03). Retreatment, tumor stability (control), and progression influenced the OS of patients with BMs, whether single or multiple (P < 0.001). CONCLUSIONS: GKSR provides good results in terms of OS and better quality of life for patients with BMs, whether single or multiple. Tumor stability and retreatment influenced the OS of patients with BMs.
Subject(s)
Brain Neoplasms , Radiosurgery , Adult , Humans , Female , Middle Aged , Aged , Aged, 80 and over , Male , Radiosurgery/methods , Retrospective Studies , Quality of Life , Brain Neoplasms/pathology , Survival Rate , Treatment OutcomeABSTRACT
Background: Brain metastases (BM) occur in the natural course of malignant tumors in 18-40% of cases. Their management has changed considerably over the past decade thanks to the advent of Gamma knife Stereotactic Radiosurgery (GKSR). Objective: We report our experience on Single Brain metastasis treated with (GKSR). Methods: Patients treated by Gamma Knife stereotaxic radiosurgery (GKSR) in our institution between 2009 and 2021 for Single BM were recorded retrospectively. Results: A total of 103 patients (n = 52; 50.5% females) were included, with a mean age of 56.33 ± 11.33. Breast (n = 39, 37.9%) and lung (n = 36, 35%) were the common original location for the primary tumors. GKSR alone without prior surgery, radiotherapy, or chemotherapy was achieved in 81.5% (n = 84). Thirteen patients (15.1%) progressed in BM volume while finding the appearance of de novo BM in 5 (5.8%) patients. The median percentage of tumor control after radiosurgery treatment was 70% (IQR: 65-78) and only 26.2% (n = 27) of patients had > 80% tumor control and stability over the median follow-up time of 5 (95% CI, 4-6) months. We found only two cases of radionecrosis (1.9%). The median survival time was 5.21 (IQR, 3-8) months. Retreatment, recursive partitioning analysis (RPA) class, and tumor stability influenced the overall survival of BM respectively (Hazard Ratio adjust (HRa)= 5.610,p = 0.045; HRa= 6.133,p = 0.031; HRa= 22.463, p = 0.036). Conclusion: Stereotaxic Radiosurgery provides good results in terms of Overall survival with fewer neurocognitive disorders.RPA class and tumor control (stability) influenced the overall survival of single BM.
ABSTRACT
The International Commission on Radiological Protection (ICRP) through its publications recommends the estimation of Specific Absorbed Fractions (SAFs) using voxelized phantoms in order to assess the doses internally absorbed by organs exposed to ionizing radiation. In the present work, we report a large set of SAFs calculated using the ICRP Adult Female (ICRP-AF) phantom. The new Geant4-based code called InterDosi version 1.0 was used to simulate monoenergetic electrons of 20 different energies, ranging from 0.005 to 10 MeV, emitted uniformly from 18 different source organs. In order to estimate SAFs in 169 target organs/regions, 360 Monte Carlo multithreaded simulations were run on 32 CPUs of the HPC-MARWAN-CNRST computing grid. The calculated SAFs were compared to the recent results obtained using GATE 8.1 code and published by the OpenDose collaboration. It is shown that the obtained results are in well-agreement with the reference values, with absolute discrepancies less than 0.6% for a self-absorption condition and less than 5% in almost all energies for a cross-absorption condition. We concluded that InterDosi code might be used for dosimetry of internal electron emitters.
