The Role of Gamma Knife Radiosurgery for Diffuse Astrocytomas.

Kim, Kyung Hyun; Park, Yong Sook; Chang, Jong Hee; Chang, Jin Woo; Park, Yong Gou

Original Article

Journal of Korean Neurosurgical Society 2006;39(2): 102-108.

Kyung Hyun Kim, Yong Sook Park, Jong Hee Chang, Jin Woo Chang, Yong Gou Park

Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea. ygpark@yumc.yonsei.ac.kr

ABSTRACT

OBJECTIVE
The management of diffuse astrocytomas is one of the most controversial areas in clinical neurooncology. There are numerous reviews and editorials outlining the difficulties in the management of these lesions. In this study, we assess the role of Gamma Knife radiosurgery(GKS) for diffuse astrocytomas.
METHODS
Twenty-three patients with a diffuse astrocytoma were treated with GKS as a primary or adjuvant method from February 1995 to October 2003. The mean marginal dose was 13.6 (8.5~17.5)Gy and the mean maximal dose was 27.3 (17.0~35.0)Gy. Local control and the pattern of radiologic response were evaluated. The probable factors affecting local control, such as tumor volume, margin dose, previous history of craniotomy or stereotactic biopsy, and the presence or absence of previous radiotherapy were statistically analyzed. The average duration of follow-up was 39.7 (11.3~101.5) months after GKS.
RESULTS
Of the 23 lesions treated, 16 lesions (69.6%) were controlled during the follow-up period. The mean progressionfree interval was 57.4 months and the 5-year progression-free rate was 68%. Only tumor volume was found to be a statistically significant factor for local control. Smaller tumors were better controlled by GKS; it was significantly effective in tumors with less than a 10 cm3 volume.
CONCLUSION
GKS could be a valuable therapeutic modality both as a primary treatment and as a postoperative adjuvant therapy in some selected cases.

Key Words: Diffuse astrocytoma; Gamma Knife radiosurgery; Radiologic response