Plenary Oral Presentations - Macquarie University Hospital

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16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaMA-232Prospective Multi-institute Study of Gamma KnifeRadiosurgery Alone Treatment for Patients with 1-10 BrainMetastases (JLGK0901): Interim Monitoring Report1Yoshinori Higuchi, 2 Toru Serizawa, 3 Masaaki Yamamoto, 4 Takashi Shuto, 5 Astuya Akabane,6Yasunori Sato, 7 Jun Kawagishi, 8 Kazuhiro Yamanaka, 9 Naokatsu Saeki1Department of Neurological Surgery, Chiba University Graduate School of Medicine2Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo, Japan3Katsuta Hospital Mito GammaHouse, Hitachinaka, Japan4Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Japan5Gamma Knife Center, Kanto Medical Center, NTT EC, Tokyo, Japan6Chiba University Hospital Clinical Research Center, Chiba, Japan7Jiro Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Furukawa, Japan8Department of Neurosurgery, Osaka City General Hospital, Osaka, JapanObjective: To present interim monitoring results of the prospective multi-institute study (JLGK0901)of gamma knife radiosurgery (GKRS) for 1-10 brain metastases without whole brain radiationtherapy conducted by the JLGK society.Methods: As of the end of 2010, 819 patients meeting the following 5 major JLGK0901 inclusioncriteria, were evaluated: 1) newly diagnosed, 2) largest tumor less than 3 cm in diameter or 10cc involume, 3) maximum of 10 brain metastases; 4) no more than 15 cc total tumor volume; 5) no MRfindings of CSF dissemination. Primary organs were the lung in 633 patients, breast in 88, colon in 36,kidney in 19, and others in 43. Most cases were RTOG-RPA class II (765 patients, 93.4%), followedby III (28, 3.4%) and I (26, 3.2%).Results: Overall median survival time after GKRS was 0.99 years. The tumor progression-free survival(TPFS) rate was 89.8% at one year. There were statistically significant differences in one-year-TPFSrates among three tumor volume groups, 94.9% in 1576 lesions
16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaMA-278Bevacizumab therapy for cerebral radiation necrosis1Manmeet Ahluwalia, 1 Neda Hashemi-Sadraei, 1 Gazanfar Rahmatullah, 2 John Suh, 1 Sam Chao,1Robert Weil, 1 Michael Vogelbaum, 1 David Peereboom, 1 Glen Stevens, 1 Gene Barneet1Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic2Taussig Cancer Institute, Cleveland ClinicObjective: Radiation necrosis is a serious complication of radiation treatment for brain tumors.Therapeutic options including steroids, anticoagulation and hyperbaric oxygen have limited efficacy.Radiation necrosis is postulated to be a continuous process involving endothelial cell dysfunction thatleads to tissue hypoxia and necrosis, with secretion of the vascular endothelial growth factor (VEGF).Bevacizumab, an antibody against VEGF had been reported to reduce edema in patients with suspectedradiation necrosis.Methods: After obtaining IRB approval, the Cleveland Clinic Brain Tumor and Neuro-OncologyCenter’s database was used to identify patients with diagnosis of Radiation necrosis on the basisof magnetic resonance imaging (MRI) and/ or biopsy who were treated with bevacizumab between7/2007 and 1/2011.Results: 19 patients with diagnosis of radiation necrosis (4 were biopsy proven) received bevacizumab.Post treatment MRI was performed at an average of 8 weeks after initiating therapy with bevacizumab.Follow-up MRI demonstrated a radiographic response in all patients on the MRI fluid-attenuatedinversion-recovery (FLAIR) sequences and 18 of 19 patients showed improvement in the T1-weightedpost-Gadolinium contrast images. The average area change in the T1-weighted post-Gadoliniumcontrast abnormalities was a decrease of 45.1%, and the average change in the FLAIR images was adecrease of 49.1% (using McDonald’s criteria). Fifteen patients showed clinical benefit. There was amean daily dose reduction of 5.96 mg of dexamethasone after initiation of bevacizumab in patientswho were on steroids at start of bevaciuzmab for radiation necrosis.Conclusions: Bevacizumab appears to produce radiographic response as well as clinical benefit in thetreatment of patients with cerebral radiation necrosis. The improvements can be rapid and bevacizumabis effective in cases that do not respond to traditional corticosteroid therapy.49
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