Stereotactic
Fractionated Irradiation of Low-grade Malignant Gliomas
with Leksell Gamma Knife - First Experience
Šimonová G., Novotný J. ml., Novotný J., Liščák R., Vymazal J.
Oddělení stereotaktické a radiační neurochirurgie Nemocnice Na Homolce, Praha, přednosta MUDr. Roman Liščák, CSc. |
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Summary:
During 4 years (1993 - 1997) 45 patients (pts) with a mean age of 21 years (range 5 to 49 years) were
treated by stereotactic fractionated therapy (SRT) (5 fractions on 5 consecutive days). There were
low grade gliomas grade I in 20 patients and grade II in 25 patients. For imaging authors used
magnetic resonance including T1 (post-contrast), T2 and PD sequences. The median target volume
was 3 500 cmm (range from 200 to 25 000 cmm). The median minimal dose applied to the periphery
was 22,5 Gy (ranged from 23 to 30 Gy). All patients were followed up clinically and by CT or MRI
every 6 months first two years after SRT, then every 12 months.
Complete and partial regression (CR, PR) was observed in 34 (75%), stabilization in 8 (18 %) and local
progression in 3 (7%) patients. All CR, PR had relatively long latent periods with a median of 18
months (range from 8 to 48 months). Four patients had asymptomatic and reversible enlargement
of the pathological volume from 6 to 9 months after SRT. One patient with repeated stereobiopsy
which proved grade II - III died from local progression 10 months after SRT. 44 patients are still
alive with minimal follow up 26 months after SRT and median survival 38 months (ranged from 26
to 80 months). A larger number of treated patients is needed to find proper indication criteria, the
optimal level of doses and fractionation pattern with acceptable late toxicity.
Key words:
low grade gliomas - stereotactic irradiation - fractionation pattern - acute and late
toxicity
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