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Safety and efficacy of primary dose fractionated gamma knife radiosurgery for large volume glomus jugulare tumours
EANS Academy. Tripathi M. 09/26/19; 281632; EP07006
Manjul Tripathi
Manjul Tripathi

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Abstract
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Objective: Stereotactic radiosurgery is emerging as optimal primary treatment modality for glomus jugulare tumours (GJT). This study evaluates efficacy and safety of dose fractionated gamma knife radiosurgery (DFGKRS) in treatment of glomus jugulare tumours not amenable for single session GKRS.
Material and methods: Between 2012 and 2017, 10 patients of glomus jugulare tumours were treated with DFGKRS in 2 or 3 sessions. The Leksell G frame was kept in situ during the whole procedure. The tumour volumes on pre- and posttreatment imaging were compared utilizing the Leksell Gamma Plan treatment plan software to assess tumour progression. Pre- and posttreatment symptoms and complications were recorded.
Results: The mean radiological follow up was 39 months. The mean marginal dose for three fractions and two fractions was 7.64 Gy @ 50% and 11.2 Gy @ 50 % respectively. The mean tumour size was 29.9cc at treatment and 21.9cc at follow-up. Tumour control (defined as stable or reduced tumour volume at follow up) was achieved in all patients (100%). Out of 110 potential neurological problems (signs/ symptoms) evaluated (11 in each patient), 56 (50.9%) were present preoperatively. Of them, 27 (48.2%) improved and 29 (51.8%) stabilised after treatment. There were 2 new onset neurological problems (out of 110, 1.8%) attributable to treatment.
Conclusion: DFGKRS is feasible for glomus jugulare tumours (GJT) with a fair tumour control rate and acceptable toxicity (CTCAE grade 1-2). DFGKRS should be preferred over surgery or radiotherapy in GJT not amenable for single session GKRS.


[FIGURE 1: CLINICAL OUTCOME OF PATIENTS RECEIVING DF-GKRS FOR LARGE VOLUME GLOMUS TUMORS]




[FIGURE 2: VOLUMETRIC REDUCTION OF THE TUMORS RECEIVING DF GKRS AT SHORT TERM FOLLOW UP]

Objective: Stereotactic radiosurgery is emerging as optimal primary treatment modality for glomus jugulare tumours (GJT). This study evaluates efficacy and safety of dose fractionated gamma knife radiosurgery (DFGKRS) in treatment of glomus jugulare tumours not amenable for single session GKRS.
Material and methods: Between 2012 and 2017, 10 patients of glomus jugulare tumours were treated with DFGKRS in 2 or 3 sessions. The Leksell G frame was kept in situ during the whole procedure. The tumour volumes on pre- and posttreatment imaging were compared utilizing the Leksell Gamma Plan treatment plan software to assess tumour progression. Pre- and posttreatment symptoms and complications were recorded.
Results: The mean radiological follow up was 39 months. The mean marginal dose for three fractions and two fractions was 7.64 Gy @ 50% and 11.2 Gy @ 50 % respectively. The mean tumour size was 29.9cc at treatment and 21.9cc at follow-up. Tumour control (defined as stable or reduced tumour volume at follow up) was achieved in all patients (100%). Out of 110 potential neurological problems (signs/ symptoms) evaluated (11 in each patient), 56 (50.9%) were present preoperatively. Of them, 27 (48.2%) improved and 29 (51.8%) stabilised after treatment. There were 2 new onset neurological problems (out of 110, 1.8%) attributable to treatment.
Conclusion: DFGKRS is feasible for glomus jugulare tumours (GJT) with a fair tumour control rate and acceptable toxicity (CTCAE grade 1-2). DFGKRS should be preferred over surgery or radiotherapy in GJT not amenable for single session GKRS.


[FIGURE 1: CLINICAL OUTCOME OF PATIENTS RECEIVING DF-GKRS FOR LARGE VOLUME GLOMUS TUMORS]




[FIGURE 2: VOLUMETRIC REDUCTION OF THE TUMORS RECEIVING DF GKRS AT SHORT TERM FOLLOW UP]

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