Gamma knife surgery for cancer pain—pituitary gland—stalk ablation: a multicenter prospective protocol since 2002

Lung Neoplasms Polymers Antigens, CD34 Stereotaxic Techniques brain metastasis; brainstem tumor; gamma knife; melanoma; radiosurgery; renal cell carcinoma Activities of Daily Living Factor VIII -- analysis Cooperative Behavior Melanoma Oral Ulcer Cells, Cultured Bone Marrow Transplantation Cysts brainstem tumor Sciences bio-médicales et agricoles Prognosis Survival Rate Dystonia Evaluation Studies as Topic Child, Preschool Cerebrovascular Circulation Pituitary Gland Acute Disease Cell Division Rotation Oligodendroglioma Neurosurgery Vision Disorders 610 Gamma knife Radiation Dosage 03 medical and health sciences Neurologie melanoma Endothelium RNA, Messenger Neoplasms, Squamous Cell Retrospective Studies Aged Vascular -- pathology Astrocytoma -- radionuclide imaging Cranial Nerve Diseases Ki-67 Antigen Cranial Fossa, Posterior Brain Neoplasms -- chemistry Neuritis/complications Uveal Neoplasms Cranial Sinuses Weight-Bearing Astrocytoma -- metabolism Postoperative Complications Hearing Thalamus Risk Factors Carcinoma, Non-Small-Cell Lung Carcinoma, Small Cell Brain Neoplasms -- radionuclide imaging Nuclear Proteins Neuroma, Acoustic Treatment Outcome Intracranial Hemorrhages Malignant astrocytoma Intracranial Arteriovenous Malformations Adult gamma knife Adolescent Pain Skull Base Neoplasms Imaging, Three-Dimensional Antigens CD34 -- analysis Prostatic Neoplasms Radiosurgery* Telephone Quality of Life Gels Male Microsurgery Neoplasms, Radiation-Induced Skin Neoplasms Trigeminal Neuralgia/surgery* Visual Acuity Craniopharyngioma Cognition 0302 clinical medicine Surveys and Questionnaires Pons Meningeal Neoplasms Prospective Studies Child Tomography Aged, 80 and over Phantoms, Imaging Brain Neoplasms Incidence Palliative Care Headache Proto-Oncogene Proteins c-mdm2 Sarcoma Kidney Neoplasms 3. Good health Dry Eye Syndromes Artifacts Meningioma Neurilemmoma Tomography, Emission-Computed Cyclin-Dependent Kinase Inhibitor p21 Adenoma Quality Control renal cell carcinoma Multiple Sclerosis Trigeminal Neuralgia/etiology* Astrocytoma -- surgery Movement Essential Tremor Hypothalamus Bone Neoplasms Adenocarcinoma Radiosurgery Hypopituitarism Disease-Free Survival Subthalamic Nucleus Cyclins Vimentin Humans Sella Turcica Pituitary Neoplasms Sweden Factor VIII Dose-Response Relationship, Radiation Recovery of Function Fibroblasts Survival Analysis Gamma Rays Emission-Computed Endothelium, Vascular Software Antimetabolites Cohort Studies Recurrence brain metastasis Treatment Failure Skull Base radiosurgery Angiography Parkinson Disease Cell Differentiation Glioma Middle Aged Trigeminal Neuralgia/pathology Combined Modality Therapy Magnetic Resonance Imaging Vascular Neoplasms Neuritis/virology Sensation Disorders Colonic Neoplasms Cavernous Sinus Female Reoperation Brain Neoplasms -- metabolism Rest Histopathology Breast Neoplasms Astrocytoma Brain Neoplasms -- pathology Immobilization Neuritis Proto-Oncogene Proteins Meningitis Brain Neoplasms -- surgery Radiometry Carcinoma, Renal Cell Neuronavigation Proportional Hazards Models Hypophysectomy Central Nervous System Vascular Malformations Salvage Therapy Reproducibility of Results Endoscopy Trigeminal Neuralgia Actins Stomatitis, Herpetic Hemangioma, Cavernous Bromodeoxyuridine Tumor Suppressor Protein p53 Neoplasm Recurrence, Local Tomography, X-Ray Computed Head Follow-Up Studies
DOI: 10.3171/jns.2002.97.supplement_5.0433 Publication Date: 2018-11-16T05:38:28Z
ABSTRACT
Object. The authors have treated intractable pain, particularly cancer pain related to bone metastasis, with various protocols. Cancer pain has been treated by gamma knife radiosurgery (GKS), targeted to the pituitary gland—stalk, as an alternative new pain control method. The purpose of this study was to investigate a prospective multicenter protocol to prove the efficacy and the safety of this treatment. Methods. Indications for patient inclusion in this treatment protocol were: 1) pain related to bone metastasis; 2) no other effective pain treatment options; 3) general condition rated as greater than 40 on the Karnofsky Performance Scale; 4) morphine effective for pain control; and 5) no previous treatment with radiation (GKS or conventional radiotherapy) for brain metastasis. The authors at one institution have treated two patients, who suffered from severe cancer pain related to bone metastasis, by using GKS. The target was the pituitary gland. The maximum dose was 160 Gy with one isocenter of an 8-mm collimator, keeping the radiation dose to the optic nerve less than 8 Gy. At another institution two patients were treated in the same way; an additional five patients were treated similarly with targeting of the pituitary gland with two isocenters of 4-mm collimator. In all nine cases, pain resolved without significant complication. Pain relief was observed within several days, and this effect was prolonged until the day that they died. At a follow up of 1 to 24 months, no recurrences and no hormonal dysfunction were observed. Conclusions. Despite insufficient experience, the efficacy and the safety of GKS for intractable pain were demonstrated in nine patients. This treatment has the potential to ameliorate cancer-related pain, and GKS will play a more important role in the treatment of intractable pain. More experience and additional refined study protocols are needed to evaluate which parameters are important, to determine what treatment strategy is the best, and to clarify the safest option for patients with intractable cancer pain.
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