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Stereotactic radiosurgery for hypervascular intracranial tumors

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Abstract

Objective

To evaluate the safety and efficacy of SRS treatment of central neurocytomas (CNCs), cavernous sinus hemangiomas (CSHs), and glomus tumors (GTs); and to compare upfront stereotactic radiosurgery (SRS) and adjuvant SRS in the treatment of these hypervascular tumors.

Methods

This was a retrospective review of consecutive CNCs, CSHs, and GTs treated with SRS between 1993 and 2017. Tumor response was categorized based on volumetric analysis on magnetic resonance imaging: (1) tumor regression [> 10% decrease in tumor volume (TV)]; (2) stable tumor (≤ 10% change in TV); or (3) tumor progression (> 10% increase in TV).

Results

Sixty hypervascular tumors (CNC: 28; CSH: 16; GT: 16) underwent SRS between 1993 and 2017. Margin doses were 13 Gy, 12 Gy, and 14 Gy for CNCs, CSHs, and GTs, respectively. Tumor regression was observed in 54 tumors (90%) with initial SRS after a median follow-up of 82 months. Relative reductions in TVs for CNCs were 38%, 52%, and 73% at 12, 24, and 48 months, respectively. Relative reductions in TVs for CSHs were 51%, 68%, and 88% at 12, 24, and 48 months, respectively. Relative reductions in TVs for GTs were 22%, 31%, and 47% at 12, 24, and 48 months, respectively. Upfront SRS was performed in 26 patients (43%). No difference in relative TV reductions were found between upfront and adjuvant SRS. Adverse radiation effects were observed in five patients. No mortality was encountered.

Conclusion

SRS for hypervascular tumors is associated with high rates of tumor regression with low risk of complications. No significant difference in rates of relative TV reduction were found between upfront and adjuvant SRS. Hence, upfront SRS may be considered in select patients.

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Abbreviations

CNC:

Central neurocytoma

CSF:

Cerebrospinal fluid signal

CSH:

Cavernous sinus hemangioma

SRS:

Stereotactic radiosurgery

Gy:

Gray

GT:

Glomus tumor

References

  1. Razzaq AA, Cohen AR (1997) Neoadjuvant chemotherapy for hypervascular malignant brain tumors of childhood. Pediatr Neurosurg 27:296–303. https://doi.org/10.1159/000121274

    Article  CAS  PubMed  Google Scholar 

  2. Chen CL, Shen CC, Wang J, Lu CH, Lee HT (2008) Central neurocytoma: a clinical, radiological and pathological study of nine cases. Clin Neurol Neurosurg 110:129–136. https://doi.org/10.1016/j.clineuro.2007.09.023

    Article  PubMed  Google Scholar 

  3. Jaiswal S, Vij M, Rajput D, Mehrotra A, Jaiswal AK, Srivastava AK, Behari S, Krishnani N (2011) A clinicopathological, immunohistochemical and neuroradiological study of eight patients with central neurocytoma. J Clin Neurosci 18:334–339. https://doi.org/10.1016/j.jocn.2010.05.031

    Article  PubMed  Google Scholar 

  4. Kocaoglu M, Ors F, Bulakbasi N, Onguru O, Ulutin C, Secer HI (2009) Central neurocytoma: proton MR spectroscopy and diffusion weighted MR imaging findings. Magn Reson Imaging 27:434–440. https://doi.org/10.1016/j.mri.2008.07.012

    Article  PubMed  Google Scholar 

  5. Lee CC, Pan DH, Wu JC, Chung WY, Wu HM, Yang HC, Liu KD, Guo WY, Shih YH (2011) Gamma knife radiosurgery for glomus jugulare and tympanicum. Stereotact Funct Neurosurg 89:291–298. https://doi.org/10.1159/000328890

    Article  CAS  PubMed  Google Scholar 

  6. Lee CC, Sheehan JP, Kano H, Akpinar B, Martinez-Alvarez R, Martinez-Moreno N, Guo WY, Lunsford LD, Liu KD (2017) Gamma Knife radiosurgery for hemangioma of the cavernous sinus. J Neurosurg 126:1498–1505. https://doi.org/10.3171/2016.4.JNS152097

    Article  PubMed  Google Scholar 

  7. Shah T, Jayasundar R, Singh VP, Sarkar C (2011) MRS characterization of central neurocytomas using glycine. NMR Biomed 24:1408–1413. https://doi.org/10.1002/nbm.1705

    Article  CAS  PubMed  Google Scholar 

  8. Tlili-Graiess K, Mama N, Arifa N, Kadri K, Hasni I, Krifa H, Mokni M (2014) Diffusion weighted MR imaging and proton MR spectroscopy findings of central neurocytoma with pathological correlation. J Neuroradiol 41:243–250. https://doi.org/10.1016/j.neurad.2013.09.004

    Article  PubMed  Google Scholar 

  9. Karlsson B, Guo WY, Kejia T, Dinesh N, Pan DH, Jokura H, Kawagishi J, van Eck AT, Horstmann GA, Yeo TT, Yamamoto M (2012) Gamma Knife surgery for central neurocytomas. J Neurosurg 117:96–101. https://doi.org/10.3171/2012.6.GKS12214

    Article  PubMed  Google Scholar 

  10. Wichmann W, Schubiger O, von Deimling A, Schenker C, Valavanis A (1991) Neuroradiology of central neurocytoma. Neuroradiology 33:143–148

    Article  CAS  PubMed  Google Scholar 

  11. Schmidt MH, Gottfried ON, von Koch CS, Chang SM, McDermott MW (2004) Central neurocytoma: a review. J Neuro-oncol 66:377–384

    Article  Google Scholar 

  12. Choudhari KA, Kaliaperumal C, Jain A, Sarkar C, Soo MY, Rades D, Singh J (2009) Central neurocytoma: a multi-disciplinary review. Br J Neurosurg 23:585–595. https://doi.org/10.3109/02688690903254350

    Article  PubMed  Google Scholar 

  13. Lombardi D, Giovanelli M, de Tribolet N (1994) Sellar and parasellar extra-axial cavernous hemangiomas. Acta Neurochir 130:47–54

    Article  CAS  PubMed  Google Scholar 

  14. Yao Z, Feng X, Chen X, Zee C (2006) Magnetic resonance imaging characteristics with pathological correlation of cavernous malformation in cavernous sinus. J Comput Assist Tomogr 30:975–979. https://doi.org/10.1097/01.rct.0000221953.06135.3e

    Article  PubMed  Google Scholar 

  15. Suzuki Y, Shibuya M, Baskaya MK, Takakura S, Yamamoto M, Saito K, Glazier SS, Sugita K (1996) Extracerebral cavernous angiomas of the cavernous sinus in the middle fossa. Surg Neurol 45:123–132

    Article  CAS  PubMed  Google Scholar 

  16. Ivanov P, Chernov M, Hayashi M, Nakaya K, Izawa M, Murata N, Kubo O, Ujiie H, Muragaki Y, Nakamura R, Iseki H, Hori T, Takakura K (2008) Low-dose gamma knife radiosurgery for cavernous sinus hemangioma: report of 3 cases and literature review. Minim Invasive Neurosurg 51:140–146. https://doi.org/10.1055/s-2008-1065346

    Article  CAS  PubMed  Google Scholar 

  17. Rao AB, Koeller KK, Adair CF (1999) From the archives of the AFIP. Paragangliomas of the head and neck: radiologic-pathologic correlation. Armed Forces Inst Pathol Radiogr 19:1605–1632. https://doi.org/10.1148/radiographics.19.6.g99no251605

    Article  CAS  Google Scholar 

  18. Vogl T, Bruning R, Schedel H, Kang K, Grevers G, Hahn D, Lissner J (1989) Paragangliomas of the jugular bulb and carotid body: MR imaging with short sequences and Gd-DTPA enhancement. AJR Am J Roentgenol 153:583–587. https://doi.org/10.2214/ajr.153.3.583

    Article  CAS  PubMed  Google Scholar 

  19. Snell JW, Sheehan J, Stroila M, Steiner L (2006) Assessment of imaging studies used with radiosurgery: a volumetric algorithm and an estimation of its error. Technical note. J Neurosurg 104:157–162. https://doi.org/10.3171/jns.2006.104.1.157

    Article  PubMed  Google Scholar 

  20. Devuyst L, Defreyne L, Praet M, Geukens S, Dhooge I (2016) Treatment of glomus tympanicum tumors by preoperative embolization and total surgical resection. Am J Otolaryngol 37:544–551. https://doi.org/10.1016/j.amjoto.2016.08.011

    Article  PubMed  Google Scholar 

  21. Tasar M, Yetiser S (2004) Glomus tumors: therapeutic role of selective embolization. J Craniofac Surg 15:497–505

    Article  PubMed  Google Scholar 

  22. Lazzaro MA, Badruddin A, Zaidat OO, Darkhabani Z, Pandya DJ, Lynch JR (2011) Endovascular embolization of head and neck tumors. Front Neurol 2:64. https://doi.org/10.3389/fneur.2011.00064

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kamitani H, Hirano N, Takigawa H, Yokota M, Miyata H, Ohama E, Watanabe T (2004) Attenuation of vascularity by preoperative radiosurgery facilitates total removal of a hypervascular hemangioblastoma at the cerebello-pontine angle: case report. Surg Neurol 62:238–243. https://doi.org/10.1016/j.surneu.2003.09.030 (discussion 243–234)

    Article  PubMed  Google Scholar 

  24. Song CW, Park H, Griffin RJ, Levitt SH (2011) Radiobiology of stereotactic radiosurgery and stereotactic body radiation therapy. Springer, Heidelberg

    Book  Google Scholar 

  25. Song CW, Levitt SH (1971) Vascular changes in Walker 256 carcinoma of rats following X irradiation. Radiology 100:397–407. https://doi.org/10.1148/100.2.397

    Article  CAS  PubMed  Google Scholar 

  26. Song CW, Payne JT, Levitt SH (1972) Vascularity and blood flow in X-irradiated Walker carcinoma 256 of rats. Radiology 104:693–697. https://doi.org/10.1148/104.3.693

    Article  CAS  PubMed  Google Scholar 

  27. Song CW, Sung JH, Clement JJ, Levitt SH (1974) Vascular changes in neuroblastoma of mice following x-irradiation. Cancer Res 34:2344–2350

    CAS  PubMed  Google Scholar 

  28. Cohen-Inbar O, Lee CC, Sheehan JP (2016) The contemporary role of stereotactic radiosurgery in the treatment of meningiomas. Neurosurg Clin N Am 27:215–228. https://doi.org/10.1016/j.nec.2015.11.006

    Article  PubMed  Google Scholar 

  29. Lee CC, Trifiletti DM, Sahgal A, DeSalles A, Fariselli L, Hayashi M, Levivier M, Ma L, Alvarez RM, Paddick I, Regis J, Ryu S, Slotman B, Sheehan J (2018) Stereotactic Radiosurgery for Benign (World Health Organization Grade I) Cavernous Sinus Meningiomas-International Stereotactic Radiosurgery Society (ISRS) Practice Guideline: a systematic review. Neurosurgery. https://doi.org/10.1093/neuros/nyy009

    Article  PubMed  Google Scholar 

  30. Song CW, Cho LC, Yuan J, Dusenbery KE, Griffin RJ, Levitt SH (2013) Radiobiology of stereotactic body radiation therapy/stereotactic radiosurgery and the linear-quadratic model. Int J Radiat Oncol Biol Phys 87:18–19. https://doi.org/10.1016/j.ijrobp.2013.03.013

    Article  PubMed  Google Scholar 

  31. Chou CW, Wu HM, Huang CI, Chung WY, Guo WY, Shih YH, Lee LS, Pan DH (2010) Gamma knife surgery for cavernous hemangiomas in the cavernous sinus. Neurosurgery 67:611–616. https://doi.org/10.1227/01.NEU.0000378026.23116.E6 (discussion 616)

    Article  PubMed  Google Scholar 

  32. Iwai Y, Yamanaka K, Nakajima H, Yasui T (1999) Stereotactic radiosurgery for cavernous sinus cavernous hemangioma—case report. Neurol Med Chir 39:288–290 p do

    Article  CAS  Google Scholar 

  33. Kida Y, Kobayashi T, Mori Y (2001) Radiosurgery of cavernous hemangiomas in the cavernous sinus. Surg Neurol 56:117–122 (discussion 122–113)

    Article  CAS  PubMed  Google Scholar 

  34. Seo Y, Fukuoka S, Sasaki T, Takanashi M, Hojo A, Nakamura H (2000) Cavernous sinus hemangioma treated with gamma knife radiosurgery: usefulness of SPECT for diagnosis—case report. Neurol Med Chir 40:575–580

    Article  CAS  Google Scholar 

  35. Thompson TP, Lunsford LD, Flickinger JC (2000) Radiosurgery for hemangiomas of the cavernous sinus and orbit: technical case report. Neurosurgery 47:778–783

    CAS  PubMed  Google Scholar 

  36. Zhou LF, Mao Y, Chen L (2003) Diagnosis and surgical treatment of cavernous sinus hemangiomas: an experience of 20 cases. Surg Neurol 60:31–36 (discussion 36–37)

    Article  PubMed  Google Scholar 

  37. Lubrano V, Francois P, Loundou A, Vasiljevic A, Roche PH, French Society of Neurosurgery (2013) Outcomes after surgery for central neurocytoma: results of a French multicentre retrospective study. Acta Neurochir 155:1261–1269. https://doi.org/10.1007/s00701-013-1732-y

    Article  PubMed  Google Scholar 

  38. Qian H, Lin S, Zhang M, Cao Y (2012) Surgical management of intraventricular central neurocytoma: 92 cases. Acta Neurochir 154:1951–1960. https://doi.org/10.1007/s00701-012-1446-6

    Article  PubMed  Google Scholar 

  39. Rades D, Fehlauer F, Schild SE (2004) Treatment of atypical neurocytomas. Cancer 100:814–817. https://doi.org/10.1002/cncr.20032

    Article  PubMed  Google Scholar 

  40. Rades D, Schild SE (2006) Treatment recommendations for the various subgroups of neurocytomas. J Neuro-oncol 77:305–309. https://doi.org/10.1007/s11060-005-9047-3

    Article  Google Scholar 

  41. Kim CY, Paek SH, Jeong SS, Chung HT, Han JH, Park CK, Jung HW, Kim DG (2007) Gamma knife radiosurgery for central neurocytoma: primary and secondary treatment. Cancer 110:2276–2284. https://doi.org/10.1002/cncr.23036

    Article  PubMed  Google Scholar 

  42. Kim JW, Kim DG, Kim IK, Kim YH, Choi SH, Han JH, Park CK, Chung HT, Park SH, Paek SH, Jung HW (2013) Central neurocytoma: long-term outcomes of multimodal treatments and management strategies based on 30 years’ experience in a single institute. Neurosurgery 72:407–413. https://doi.org/10.1227/NEU.0b013e3182804662 (discussion 413–404)

    Article  PubMed  Google Scholar 

  43. Sheehan JP, Starke RM, Mathieu D, Young B, Sneed PK, Chiang VL, Lee JY, Kano H, Park KJ, Niranjan A, Kondziolka D, Barnett GH, Rush S, Golfinos JG, Lunsford LD (2013) Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas: a multicenter study. J Neurosurg 119:446–456. https://doi.org/10.3171/2013.3.JNS12766

    Article  PubMed  Google Scholar 

  44. Lee CC, Chen CJ, Chen SC, Yang HC, Lin CJ, Wu CC, Chung WY, Guo WY, Hung-Chi Pan D, Shiau CY, Wu HM (2017) Gamma Knife surgery for clival epidural-osseous dural arteriovenous fistulas. J Neurosurg. https://doi.org/10.3171/2017.1.JNS161346

    Article  PubMed  PubMed Central  Google Scholar 

  45. Mineura K, Sasajima T, Itoh Y, Sasajima H, Kowada M, Tomura N, Uesaka Y, Ogawa T, Hatazawa J, Uemura K (1995) Blood flow and metabolism of central neurocytoma: a positron emission tomography study. Cancer 76:1224–1232

    Article  CAS  PubMed  Google Scholar 

  46. Soni N, Dhanota DPS, Kumar S, Jaiswal AK, Srivastava AK (2017) Perfusion MR imaging of enhancing brain tumors: comparison of arterial spin labeling technique with dynamic susceptibility contrast technique. Neurol India 65:1046–1052. https://doi.org/10.4103/neuroindia.NI_871_16

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank all colleagues who contributed to this study. We are grateful to our research assistants, Fong-Jiao Lee, Hsueh-Jen Huang, Wen-Chi Ku, Yi-Bei Tseng, and Jr Lan Huang for their data recording and transcription. We thank the editor and series editor for constructive criticisms of an earlier version of this chapter. This work was partly supported by the Ministry of Science and Technology (MOST), Taiwan, (under the project MOST 106-2314-B-075-075).

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Authors and Affiliations

  1. Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, 17F, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei, 11217, Taiwan, ROC

    Cheng-Chia Lee, Chun-Lung Chou, Huai-Che Yang, David Hung-Chi Pan & Wen-Yuh Chung

  2. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Cheng-Chia Lee, Huai-Che Yang, Hsiu-Mei Wu, Cheng-Ying Shiau, David Hung-Chi Pan & Wen-Yuh Chung

  3. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Hsiu-Mei Wu

  4. Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan

    Cheng-Ying Shiau

  5. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA

    Ching-Jen Chen

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  1. Cheng-Chia Lee
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Lee, CC., Chou, CL., Chen, CJ. et al. Stereotactic radiosurgery for hypervascular intracranial tumors. J Neurooncol 140, 547–558 (2018). https://doi.org/10.1007/s11060-018-2980-8

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