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New Message on Pituitary Chat

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From: Acro1974
Message 5 in Discussion

 SU-FF-T-183: Dosimetric Comparison Of Gamma Knife Vs. CyberKnife Radiosurgery 
For Patients With Tumors Near Optic Apparatus  C Yu, C Aho, C Liu, and S 
Giannotta  MLJ Apuzzo, Univ Southern California, Los Angeles, CA  
 
 
Purpose: We reviewed our 10-year experience with GK radiosurgery (GKRS) and 
recent experience with CK radiosurgery (CKRS) for patients with tumors near 
optic apparatus to make a dosimetric comparison between the two modalities. 
Method and Materials: From 1994 to 2004, a total of 186 patients (165 GKRS and 
21 CKRS) with tumors near the optic apparatus were treated. The majority of 
this group included 80 meningiomas and 93 pituitary adenomas. Dosimetric 
parameters, such as, the conformity index, tumor coverage, the closest 
distances and the maximum radiation doses to optic apparatus and brainstem were 
evaluated between the two modalities. Results: Mean tumor volume was 4.5cm3 
(0.2 to 20.7cm3) for GKRS and 11.0cm3 (0.9 to 38.7cm3) for CKRS. The maximum 
doses to optic apparatus and brainstem were significantly higher (p < 0.05) 
even though the closest distances to the structures were very similar. For a 
subgroup of GKRS patients (n=40) with a mean of tumor volume equivalent to that 
of CKRS, radiation dose to brainstem was virtually comparable. The mean 
conformity index was1.35 for CKRS, 1.68 for all GKRS patients (n=165) and 1.49 
for the subgroup of GKRS (n=40) in favor of CKRS. The mean tumor coverage was 
98.4% for CKRS, 96.0% for all GKRS patients, and 90.9% for the subgroup in 
favor of CKRS also. Conclusion: CKRS provides excellent radiation conformity 
and tumor coverage by means of the non-isocentric beam delivery. However, due 
to the limits of beam access, the dose fall-off for CKRS is less rapid, 
resulting in higher radiation doses to the critical structures. GKRS is best 
used for small tumors located at least 2mm from the visual pathways. CKRS can 
be used but is not limited to tumors abutting the optic apparatus or for tumors 
greater than 3 millimeters in size. This is accomplished via dose 
fractionation. ©2006 American Association of Physicists in Medicine 


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