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
AUTHORS (11)
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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