Early decreased tumor volume following fractionated gammaknife radiosurgery for metastatic melanoma and the role of "adaptive radiosurgery": Case report

Gabriel Zada, Cheng Yu, Paul G. Pagnini, Alexander A. Khalessi, Vladimir Zelman, Michael L.J. Apuzzo

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)

Abstract

OBJECTIVE: We report a case in which fractionated gamma knife radiosurgery was used to treat a metastatic melanoma lesion. The tumor demonstrated a rapid response to radiosurgery with an observable reduction in tumor volume between the second and third treatments, requiring a favorable modification in the third fractionated treatment. CLINICAL PRESENTATION: A 61-year-old woman presented with a frontal floor metastatic melanoma lesion that was located adjacent to the optic apparatus. INTERVENTION: Gamma knife radiosurgery was administered in three fractionated treatments of 6.5 Gy to the 50% isodose line in each case. Repeat imaging for the purpose of planning demonstrated that tumor volume at the time of the third treatment, 9 days following the first treatment, had decreased by 31%, resulting in a 21% decrease in the dose administered to the optic chiasm. CONCLUSION: A case of metastatic melanoma treated with fractionated GKRS is presented, in which a significant reduction in tumor volume was noted 9 days following the initial treatment. This case provides insight into the rate with which malignant neoplasms may respond to intermediate-dose hypofractionated GKRS, and lends support to the concept of "adaptive radiosurgery" as a means of optimizing radiation to an evolving target while minimizing collateral radiation to surrounding structures.

Original languageEnglish
Pages (from-to)E512-E513
JournalNeurosurgery
Volume67
Issue number2
DOIs
Publication statusPublished - Aug 2010
Externally publishedYes

Keywords

  • Adaptive radiotherapy
  • Fractionation
  • Gamma knife
  • Melanoma
  • Metastatic brain disease
  • Radiosurgery

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