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

• DOI: 10.3171/jns.2002.97.supplement_5.0433
• Publication Date: 2018-11-16T05:38:28Z
• Authors: Motohiro Hayashi; Takaomi Taira; Mikhail Chernov; Seiji Fukuoka; Roman Liscak; Chung Ping Yu; Robert T. K. Ho; Jean Regis; Yoko Katayama; Yoriko Kawakami; Tomokatsu Hori
• Keywords: 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

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.