Repeat stereotactic radiosurgery for treatment of brain metastases locally recurrent following initial radiosurgery.

Purpose: We report outcomes of repeat stereotactic radiosurgery (rSRS) to sites of tumor progression following initial SRS. Additionally, we sought to determine if, at the time of recurrence following initial SRS, surgical resection of the tumor followed by SRS (surgery + rSRS) provided benefit compared to rSRS alone.

Methods: We retrospectively reviewed patients treated with rSRS for local recurrence after initial SRS.

Stereotactic radiosurgery for brain metastases from extra-renal clear cell carcinoma: A series of four patients and review of the literature.

Background: Clear cell carcinoma occurring outside of the kidney represents an aggressive histological subtype which is frequently resistant to standard chemotherapy. Brain metastases (BM) from extra-renal clear cell carcinoma (erCCC) are exceedingly rare, and the optimal treatment approach for this histology remains uncertain. To our knowledge, stereotactic radiosurgery (SRS) has not been specifically investigated for this patient population.

Adenoid cystic carcinoma brain metastases treated with stereotactic radiosurgery: A single institution retrospective cohort study and comprehensive literature review.

Adenoid cystic carcinoma (ACC) is a malignant neoplasm arising from the minor and major salivary glands that tend to spread by perivascular and perineural routes. Brain metastases (BM) secondary to ACC are extremely rare, and the standard management strategy has not been well reported due to the rarity. Notably, no previous study has specifically examined the efficacy of stereotactic radiosurgery (SRS) for BM from ACC.

Overview of Preclinical and Clinical Trials of Nanoparticles for the Treatment of Brain Metastases.

Brain metastases (BM), which most commonly originate from lung, breast, or skin cancers, remain a major clinical challenge, with standard treatments such as stereotactic radiosurgery (SRS), surgical resection, and whole-brain radiation therapy (WBRT). The prognosis for patients with BM remains poor, with a median overall survival (OS) of just 10-16 months. Although recent advances in systemic therapies, including small molecule inhibitors, monoclonal antibodies, chemotherapeutics, and gene therapies, have demonstrated success in other malignancies, their effectiveness in central nervous system (CNS) cancers is significantly limited by poor blood-brain barrier (BBB) permeability and subtherapeutic drug concentrations in the brain.

Stereotactic radiosurgery for intracranial and spinal adenoid cystic carcinoma: systematic review and illustrative case presentation.

Purpose: Adenoid cystic carcinoma (ACC) is a rare, aggressive malignancy with a predilection for perineural spread and distant metastases. Given the limited but emerging evidence on the role of stereotactic radiosurgery (SRS) in managing intracranial and spinal ACC, a systematic review was deemed necessary to synthesize relevant parameters related to clinical features and management of ACC patients, SRS treatment characteristics, and clinical outcomes across published studies.

Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Radiosensitizers in Cancer Therapy: A Global Bibliometric Analysis.

Background/objectives: Radiosensitizers are compounds given concurrently with radiotherapy to enhance the killing of cancer cells while sparing healthy tissue. Radiosensitization research has involved a diverse range of therapeutic agents. In the present study, we aimed to investigate international trends in the development of radiosensitizers across the most common cancer types.

Perilesional Edema as a Predictor of Local Failure in Metastatic Brain Lesions Treated With Stereotactic Radiosurgery: A Systematic Review and Meta-Analysis.

Background: Identifying prognostic factors to improve local tumor control (LTC) after stereotactic radiosurgery (SRS) for brain metastases (BM) is crucial for optimizing patient outcomes. This study synthesizes evidence on the impact of perilesional edema (PLE) on LTC in BM managed with SRS.

Methods: A systematic search was conducted in PubMed, Scopus, Embase, and Web of Science, to identify relevant studies reporting PLE as a prognostic factor for LTC in BM treated with SRS.

Vertebral fracture following primary stereotactic body radiation therapy for spinal bone metastases: a decade of experience.

Objective: The aim of this retrospective study was to comprehensively evaluate the factors that contribute to and protect against the occurrence of vertebral fracture (VF) following stereotactic body radiation therapy (SBRT) for the treatment of spinal bone metastasis (SBM).

Methods: This study focused on adult patients who underwent primary SBRT for management of solid tumor SBMs from March 2012 to January 2023 with detailed follow-up medical records for at least 6 months. Target volume delineation for sacral and spinal SBRT was conducted in accordance with International Spine Radiosurgery Consortium guidelines and international consensus recommendations.

Understanding the Radiobiology of Central Nervous System Diseases in the Golden Age of Radiosurgery-Does It Matter?

Stereotactic radiosurgery (SRS) deploys image-guidance to deliver multiple beams of highly focused ionizing radiation to tightly conformed anatomical targets, leading to precise dosing of radiation-induced cellular injury and predictable biological responses that can be applied to treat a multitude of central nervous system (CNS) disorders. Herein we review the principles of CNS radiobiology, comparing differences between SRS and conventional radiation therapy. We then review the radiobiology of SRS as it pertains to the treatment of CNS tumors and vascular malformations and the emerging application of SRS for the treatment of functional and psychiatric neurological disorders.

Radiosurgical management of SDHx-related paraganglioma.

Background And Objectives: Paragangliomas (PGLs) are rare neuroendocrine tumors which frequently occur in the head and neck. Mutations in subunits of the succinate dehydrogenase complex (SDHx) account for approximately 50% of hereditary PGLs and are associated with increased rates of malignancy, recurrence, and multifocality. While the use of stereotactic radiosurgery (SRS) for PGLs has expanded, there is a lack of data correlating genetic background with outcomes in this distinct patient population.

Paired molecular profiling of malignant transformation of an epidermoid cyst for potential genetic drivers: illustrative case.

Background: Malignant transformation of an intracranial epidermoid cyst (EC) into squamous cell carcinoma (SCC) is an exceedingly rare occurrence that is typically diagnosed on postoperative histology. The mechanisms underlying transformation remain poorly understood, with limited characterization of genetic changes associated with progression.

Observations: A 55-year-old female presented with a large cerebellopontine angle EC with an enhancing nodule in the left tectum, for which she underwent resection.

Efficacy and Safety of Donut-Shaped Circumferential Spine CyberKnife Stereotactic Body Radiotherapy for Metastatic Spine Disease.

Background And Objectives: Spinal metastases (SM) with epidural spinal cord compression (ESCC) present a significant challenge because of the high risk of radiation-induced injury to critical structures such as the spinal cord and nerve roots. Traditional treatment approaches often avoid circumferential stereotactic body radiotherapy (SBRT) to reduce these risks. The efficacy and safety of donut-shaped circumferential SBRT, designed to target the spinal column while sparing the spinal cord, remains underexplored.

Stereotactic radiosurgery for brain metastases secondary to adrenal ganglioneuroblastoma: illustrative case.

Background: Neuroblastic tumors, including malignant neuroblastoma, ganglioneuroblastoma (GNB), and benign ganglioneuroma, are embryonal tumors derived from neural crest cells. GNB often metastasizes to the bone marrow and bone, with lung and brain metastases (BMs) remaining extremely rare. To date, only 2 prior reports of GNB BM exist, with both cases documenting resection alone.

Isolated unilateral hypoglossal nerve palsy due to an atlanto-occipital juxta-articular cyst: illustrative case.

Background: Atlanto-occipital (AO) juxta-articular cysts are positioned within the hypoglossal canal, which houses the hypoglossal nerve. These cysts, whether intraneural or extraneural, can exert localized pressure on the nerve, causing isolated ipsilateral hypoglossal nerve palsy (HNP), an unusual clinical finding. The authors contribute to the scarce literature on this atypical and challenging pathology, reviewing the diagnostic complexities, preoperative indicators, key imaging features, and management strategies.

Primary Stereotactic Body Radiation Therapy for Breast Cancer Spinal Metastases.

Background: To present insights gained from a decade of employing stereotactic body radiation therapy (SBRT) as a primary intervention for spinal bone metastasis (SBM) originating from breast cancer (BC).

Methods: We retrospectively examined the application of primary SBRT (the CyberKnife System) for BC SBMs between March 2012 and January 2023.

Results: We recruited 47 female patients with 82 SBMs affecting 104 vertebrae.

Stereotactic Radiosurgery and Surgical Resection for Jugular Foramen Schwannomas: A Retrospective Comparative Study of Outcomes.

Background And Objectives: Jugular foramen schwannomas (JFS) are rare benign tumors arising from lower cranial nerves. In this study, we aim to compare the outcomes of surgical resection (SR) and stereotactic radiosurgery (SRS) in the treatment of JFS.

Methods: We conducted a retrospective analysis of 31 patients with JFS who underwent SRS (13 patients [41.

The spectrum of radiation therapy options for craniopharyngioma: a systematic review.

Purpose: Craniopharyngiomas (CPs) are rare, slow-growing brain tumors which originate in the sellar region. CPs may present with symptoms secondary to compression of surrounding structures, particularly the pituitary gland, and surgical removal has traditionally been the mainstay of treatment. However, due to high recurrence rates for CPs, especially when gross total resection is not feasible, radiotherapy has played an increasingly significant role in their management.

Use of Carbon Fiber Implants to Improve the Safety and Efficacy of Radiation Therapy for Spine Tumor Patients.

Current standard of care treatment for patients with spine tumors includes multidisciplinary approaches, including the following: (1) surgical tumor debulking, epidural spinal cord decompression, and spine stabilization techniques; (2) systemic chemo/targeted therapies; (3) radiation therapy; and (4) surveillance imaging for local disease control and recurrence. Titanium pedicle screw and rod fixation have become commonplace in the spine surgeon's armamentarium for the stabilization of the spine following tumor resection and separation surgery. However, the high degree of imaging artifacts seen with titanium implants on postoperative CT and MRI scans can significantly hinder the accurate delineation of vertebral anatomy and adjacent neurovascular structures to allow for the safe and effective planning of downstream radiation therapies and detection of disease recurrence.

Coexisting sellar Rathke cleft cyst and planum sphenoidale meningioma: illustrative case.

Background: The co-occurrence of Rathke cleft cysts (RCCs) and meningiomas in the sellar and parasellar regions represents an exceedingly rare clinical entity. Achieving maximal resection through a single operative approach while minimizing adverse events is challenging, often necessitating multiple surgical approaches, as suggested by previous reports.

Observations: The authors report the case of a 49-year-old female with a history of kidney transplant who presented with headaches and was diagnosed with coexisting RCC and meningioma in the sellar and planum sphenoidale regions, respectively.

"Beyond the Knife"-Applying Theranostic Technologies to Enhance Outcomes in Neurosurgical Oncology.

The current standard of care for brain tumor management includes maximal safe surgical resection followed by concurrent chemotherapy and radiation therapy. Recent advances in image-guided surgical techniques have enhanced the precision of tumor resections, yet there remains a critical need for innovative technologies to further improve patient outcomes. Techniques such as fluorescence image-guided neurosurgery in combination with stereotactic radiosurgery have improved outcomes for patients with brain tumors.

Genomic predictors of radiation response: recent progress towards personalized radiotherapy for brain metastases.

Radiotherapy remains a key treatment modality for both primary and metastatic brain tumors. Significant technological advances in precision radiotherapy, such as stereotactic radiosurgery and intensity-modulated radiotherapy, have contributed to improved clinical outcomes. Notably, however, molecular genetics is not yet widely used to inform brain radiotherapy treatment.

Stereotactic radiosurgery for pancreatic neuroendocrine tumor brain Metastases: Systematic review and Illustrative case presentation.

Background: Neuroendocrine tumor (NET) brain metastases (BM) are rare malignancies which frequently bear a poor prognosis and have the potential to secrete hormones. The optimal treatment approach for these metastases remains unclear, with significant heterogeneity occurring both across and within primary tumor types, and outcome data are limited. Pancreatic neuroendocrine tumor (pNET) BM may be particularly aggressive.

Stereotactic Radiosurgery for Choriocarcinoma Brain Metastases: Illustrative Case Presentation and Systematic Review.

Background: Choriocarcinoma (CC) is a rare and aggressive form of germ cell tumor. There is limited evidence describing clinical outcomes in patients with primary CC and brain metastases (BM). Only a few single case reports have documented the use of stereotactic radiosurgery (SRS) for CC BM.

KEAP1-mutant atypical meningioma: illustrative case.

Background: While genetic testing of tumors is commonly used to inform the selection of systemic therapies, there is limited evidence for the application of radiotherapy for brain cancer. Recent studies have shown that Kelch-like ECH-associated protein 1 (KEAP1), a key regulator of cellular responses to oxidative and electrophilic stress, is associated with radioresistance in multiple cancer types. Several studies have reported the clinical significance of KEAP1 mutation in brain metastasis; however, the effect of KEAP1 mutations on radioresponse in meningioma has never been reported.

Bilateral Multiple Orbital Metastases Successfully Treated with Standalone Stereotactic Radiosurgery: Clinical Image.

Bilateral orbital metastases are extremely rare, and no previous literature has reported bilateral multiple orbital metastases treated with stereotactic radiosurgery (SRS). We present the impressive images of a patient with history of metastatic leiomyosarcoma with newly diagnosed bilateral multiple orbital metastases. The pre-SRS magnetic resonance imaging (MRI) showed 1 right and 2 left orbital metastatic lesions.