The Stanford stereotactic radiosurgery experience on 7000 patients over 2 decades (1999–2018): looking far beyond the scalpel

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  • 1 Departments of Neurosurgery and
  • 2 Radiation Oncology, Stanford University School of Medicine, Stanford, California
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OBJECTIVE

The CyberKnife (CK) has emerged as an effective frameless and noninvasive method for treating a myriad of neurosurgical conditions. Here, the authors conducted an extensive retrospective analysis and review of the literature to elucidate the trend for CK use in the management paradigm for common neurosurgical diseases at their institution.

METHODS

A literature review (January 1990–June 2019) and clinical review (January 1999–December 2018) were performed using, respectively, online research databases and the Stanford Research Repository of patients with intracranial and spinal lesions treated with CK at Stanford. For each disease considered, the coefficient of determination (r2) was estimated as a measure of CK utilization over time. A change in treatment modality was assessed using a t-test, with statistical significance assessed at the 0.05 alpha level.

RESULTS

In over 7000 patients treated with CK for various brain and spinal lesions over the past 20 years, a positive linear trend (r2 = 0.80) in the system's use was observed. CK gained prominence in the management of intracranial and spinal arteriovenous malformations (AVMs; r2 = 0.89 and 0.95, respectively); brain and spine metastases (r2 = 0.97 and 0.79, respectively); benign tumors such as meningioma (r2 = 0.85), vestibular schwannoma (r2 = 0.76), and glomus jugulare tumor (r2 = 0.89); glioblastoma (r2 = 0.54); and trigeminal neuralgia (r2 = 0.81). A statistically significant difference in the change in treatment modality to CK was observed in the management of intracranial and spinal AVMs (p < 0.05), and while the treatment of brain and spine metastases, meningioma, and glioblastoma trended toward the use of CK, the change in treatment modality for these lesions was not statistically significant.

CONCLUSIONS

Evidence suggests the robust use of CK for treating a wide range of neurological conditions.

ABBREVIATIONS AVM = arteriovenous malformation; CDT = Cohort Discovery Tool; CK = CyberKnife; EBRT = external beam radiation therapy; EPIC = Electronic Privacy Information Center; GBM = glioblastoma; LINAC = linear accelerator; nGBM = newly diagnosed GBM; pGBM = progressive GBM; PPV = positive predictive value; SM = Spetzler-Martin; SRS = stereotactic radiosurgery; STARR = Stanford Research Repository; TN = trigeminal neuralgia.

Supplementary Materials

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Contributor Notes

Correspondence Antonio Meola: Stanford University School of Medicine, Stanford, CA. ameola@stanford.edu.

INCLUDE WHEN CITING Published online April 2, 2021; DOI: 10.3171/2020.9.JNS201484.

Disclosures Dr. Gibbs receives honoraria from Accuray Inc. Dr. Adler is an employee of Zap Surgical Systems.

  • 1

    Liberati A, Altman DG, Tetzlaff J, . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1e34.

    • Search Google Scholar
    • Export Citation
  • 2

    Gupta R, Moore JM, Amorin A, . Long-term follow up data on difficult to treat intracranial arteriovenous malformations treated with the CyberKnife. J Clin Neurosci. 2019;61:120123.

    • Search Google Scholar
    • Export Citation
  • 3

    Ding D, Yen CP, Starke RM, . Outcomes following single-session radiosurgery for high-grade intracranial arteriovenous malformations. Br J Neurosurg. 2014;28(5):666674.

    • Search Google Scholar
    • Export Citation
  • 4

    Sinclair J, Chang SD, Gibbs IC, Adler JR Jr. Multisession CyberKnife radiosurgery for intramedullary spinal cord arteriovenous malformations. Neurosurgery. 2006;58(6):10811089.

    • Search Google Scholar
    • Export Citation
  • 5

    Sinclair J, Chang SD, Gibbs IC, Adler JR Jr. Cyber-Knife Radiosurgery for intramedullary spinal cord arteriovenous malformations. In: Mould RF, Schulz RA, eds.Robotic Radiosurgery. Vol 1.CyberKnife Society Press;2005:187196.

    • Search Google Scholar
    • Export Citation
  • 6

    Kalani MA, Choudhri O, Gibbs IC, . Stereotactic radiosurgery for intramedullary spinal arteriovenous malformations. J Clin Neurosci. 2016;29:162167.

    • Search Google Scholar
    • Export Citation
  • 7

    Adler JR Jr, Gupta G, Chang SD, . CyberKnife ablation for intramedullary spinal cord arteriovenous malformations (AVMs): a promising new therapeutic approach. Cureus. 2010;2(8):e14.

    • Search Google Scholar
    • Export Citation
  • 8

    Zhang M, Connolly ID, Teo MK, . Management of arteriovenous malformations associated with developmental venous anomalies: a literature review and report of 2 cases. World Neurosurg. 2017;106:563569.

    • Search Google Scholar
    • Export Citation
  • 9

    Adler JR, Cox RS. Preliminary clinical experience with the CyberKnife: image-guided stereotactic radiosurgery. In: Kondziolka D, ed.Radiosurgery 1995.Karger;1996:316326.

    • Search Google Scholar
    • Export Citation
  • 10

    Yamamoto M, Serizawa T, Shuto T, . Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol. 2014;15(4):387395.

    • Search Google Scholar
    • Export Citation
  • 11

    Brennan C, Yang TJ, Hilden P, . A phase 2 trial of stereotactic radiosurgery boost after surgical resection for brain metastases. Int J Radiat Oncol Biol Phys. 2014;88(1):130136.

    • Search Google Scholar
    • Export Citation
  • 12

    Hara W, Tran P, Li G, . CyberKnife for brain metastases of malignant melanoma and renal cell carcinoma. Neurosurgery. 2009;64(2 Suppl):A26A32.

    • Search Google Scholar
    • Export Citation
  • 13

    Liu SH, Murovic J, Wallach J, . CyberKnife radiosurgery for brainstem metastases: management and outcomes and a review of the literature. J Clin Neurosci. 2016;25:105110.

    • Search Google Scholar
    • Export Citation
  • 14

    Azad TD, Esparza R, Chaudhary N, Chang SD. Stereotactic radiosurgery for metastasis to the craniovertebral junction preserves spine stability and offers symptomatic relief. J Neurosurg Spine. 2016;24(2):241247.

    • Search Google Scholar
    • Export Citation
  • 15

    Murovic J, Ding V, Han SS, . Impact of CyberKnife radiosurgery on median overall survival of various parameters in patients with 1–12 brain metastases. Cureus. 2017;9(12):e1926.

    • Search Google Scholar
    • Export Citation
  • 16

    Lutz S, Berk L, Chang E, . Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline. Int J Radiat Oncol. 2011;79(4):965976.

    • Search Google Scholar
    • Export Citation
  • 17

    Gibbs IC, Kamnerdsupaphon P, Ryu MR, . Image-guided robotic radiosurgery for spinal metastases. Radiother Oncol. 2007;82(2):185190.

  • 18

    Veeravagu A, Lieberson RE, Mener A, . CyberKnife stereotactic radiosurgery for the treatment of intramedullary spinal cord metastases. J Clin Neurosci. 2012;19(9):12731277.

    • Search Google Scholar
    • Export Citation
  • 19

    Pham CJ, Chang SD, Gibbs IC, . Preliminary visual field preservation after staged CyberKnife radiosurgery for perioptic lesions. Neurosurgery. 2004;54(4):799812.

    • Search Google Scholar
    • Export Citation
  • 20

    Adler JR Jr, Gibbs IC, Puataweepong P, Chang SD. Visual field preservation after multisession CyberKnife radiosurgery for perioptic lesions. Neurosurgery. 2006;59(2):244254.

    • Search Google Scholar
    • Export Citation
  • 21

    Cheshier SH, Hanft SJ, Adler JR Jr, Chang SD. CyberKnife radiosurgery for lesions of the foramen magnum. Technol Cancer Res Treat. 2007;6(4):329336.

    • Search Google Scholar
    • Export Citation
  • 22

    Patil CG, Hoang S, Borchers DJ III, . Predictors of peritumoral edema after stereotactic radiosurgery of supratentorial meningiomas. Neurosurgery. 2008;63(3):435442.

    • Search Google Scholar
    • Export Citation
  • 23

    Tuniz F, Soltys SG, Choi CY, . Multisession CyberKnife stereotactic radiosurgery of large, benign cranial base tumors: preliminary study. Neurosurgery. 2009;65(5):898907.

    • Search Google Scholar
    • Export Citation
  • 24

    Choi CYH, Soltys SG, Gibbs IC, . Cyberknife stereotactic radiosurgery for treatment of atypical (WHO grade II) cranial meningiomas. Neurosurgery. 2010;67(5):11801188.

    • Search Google Scholar
    • Export Citation
  • 25

    Fatima N, Meola A, Pollom E, . Stereotactic radiosurgery for large benign intracranial tumors. World Neurosurg. 2020;134:e172e180.

  • 26

    Hansasuta A, Choi CYH, Gibbs IC, . Multisession stereotactic radiosurgery for vestibular schwannomas: single-institution experience with 383 cases. Neurosurgery. 2011;69(6):12001209.

    • Search Google Scholar
    • Export Citation
  • 27

    Lim M, Gibbs IC, Adler JR Jr, . The efficacy of linear accelerator stereotactic radiosurgery in treating glomus jugulare tumors. Technol Cancer Res Treat. 2003;2(3):261265.

    • Search Google Scholar
    • Export Citation
  • 28

    Lim M, Gibbs IC, Adler JR Jr, Chang SD. Efficacy and safety of stereotactic radiosurgery for glomus jugulare tumors. Neurosurg Focus. 2004;17(2):E11.

    • Search Google Scholar
    • Export Citation
  • 29

    Lim M, Villavicencio AT, Burneikiene S, . CyberKnife radiosurgery for idiopathic trigeminal neuralgia. Neurosurg Focus. 2005;18(5):E9.

  • 30

    Stupp R, Mason WP, van den Bent MJ, . Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987996.

    • Search Google Scholar
    • Export Citation
  • 31

    Lipani JD, Jackson PS, Soltys SG, . Survival following CyberKnife radiosurgery and hypofractionated radiotherapy for newly diagnosed glioblastoma multiforme. Technol Cancer Res Treat. 2008;7(3):249255.

    • Search Google Scholar
    • Export Citation
  • 32

    Villavicencio AT, Burneikienė S, Romanelli P, . Survival following stereotactic radiosurgery for newly diagnosed and recurrent glioblastoma multiforme: a multicenter experience. Neurosurg Rev. 2009;32(4):417424.

    • Search Google Scholar
    • Export Citation
  • 33

    Romanelli P, Heit G, Chang SD, . Cyberknife radiosurgery for trigeminal neuralgia. Stereotact Funct Neurosurg. 2003;81(1-4):105109.

  • 34

    Lim M, Cotrutz C, Romanelli P, . Stereotactic radiosurgery using CT cisternography and non-isocentric planning for the treatment of trigeminal neuralgia. Comput Aided Surg. 2006;11(1):1120.

    • Search Google Scholar
    • Export Citation
  • 35

    Patil CG, Veeravagu A, Bower RS, . CyberKnife radiosurgical rhizotomy for the treatment of atypical trigeminal nerve pain. Neurosurg Focus. 2007;23(6):E9.

    • Search Google Scholar
    • Export Citation
  • 36

    Adler JR, Bower R, Gupta G, . Nonisocentric radiosurgical rhizotomy for trigeminal neuralgia. Neurosurgery. 2009;64(suppl 2):8490.

  • 37

    Borchers JD III, Yang H-J, Sakamoto GT, . CyberKnife stereotactic radiosurgical rhizotomy for trigeminal neuralgia: anatomic and morphological considerations. Neurosurgery. 2009;64(2 Suppl):A91A95.

    • Search Google Scholar
    • Export Citation
  • 38

    Ho A, Lo AT, Dieterich S, . Trigeminal neuralgia treatment dosimetry of the Cyberknife. Med Dosim. 2012;37(1):4246.

  • 39

    Ryu S, Buatti JM, Morris A, . The role of radiotherapy in the management of progressive glioblastoma: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2014;118(3):489499.

    • Search Google Scholar
    • Export Citation
  • 40

    Buatti J, Ryken TC, Smith MC, . Radiation therapy of pathologically confirmed newly diagnosed glioblastoma in adults. J Neurooncol. 2008;89(3):313337.

    • Search Google Scholar
    • Export Citation
  • 41

    Schüler E, Lo A, Chuang CF, . Clinical impact of the VOLO optimizer on treatment plan quality and clinical treatment efficiency for CyberKnife. J Appl Clin Med Phys. 2020;21(5):3847.

    • Search Google Scholar
    • Export Citation
  • 42

    McGuinness CM, Gottschalk AR, Lessard E, . Investigating the clinical advantages of a robotic LINAC equipped with a multileaf collimator in the treatment of brain and prostate cancer patients. J Appl Clin Med Phys. 2015;16(5):284295.

    • Search Google Scholar
    • Export Citation
  • 43

    Gibbs IC, Patil C, Gerszten PC, . Delayed radiation-induced myelopathy after spinal radiosurgery. Neurosurgery. 2009;64(suppl 2):6772.

    • Search Google Scholar
    • Export Citation
  • 44

    Soltys SG, Adler JR, Lipani JD, . Stereotactic radiosurgery of the postoperative resection cavity for brain metastases. Int J Radiat Oncol Biol Phys. 2008;70(1):187193.

    • Search Google Scholar
    • Export Citation
  • 45

    Lieberson RE, Veeravagu A, Eckermann JM, . Intramedullary spinal cord metastasis from prostate carcinoma: a case report. J Med Case Rep. 2012;6(1):139.

    • Search Google Scholar
    • Export Citation
  • 46

    Atalar B, Modlin LA, Choi CYH, . Risk of leptomeningeal disease in patients treated with stereotactic radiosurgery targeting the postoperative resection cavity for brain metastases. Int J Radiat Oncol Biol Phys. 2013;87(4):713718.

    • Search Google Scholar
    • Export Citation
  • 47

    Lim M, Bower R, Nangiana JS, . Radiosurgery for glomus jugulare tumors. Technol Cancer Res Treat. 2007;6(5):419423.

  • 48

    Chang SD, Gibbs IC, Sakamoto GT, . Staged stereotactic irradiation for acoustic neuroma. Neurosurgery. 2005;56(6):12541263.

  • 49

    Dodd RL, Ryu MR, Kamnerdsupaphon P, . CyberKnife radiosurgery for benign intradural extramedullary spinal tumors. Neurosurgery. 2006;58(4):674685.

    • Search Google Scholar
    • Export Citation
  • 50

    Teo M, Zhang M, Li A, . The outcome of hypofractionated stereotactic radiosurgery for large vestibular schwannomas. World Neurosurg. 2016;93:398409.

    • Search Google Scholar
    • Export Citation
  • 51

    Zhang M, Lamsam LA, Schoen MK, . Brainstem dose constraints in nonisometric radiosurgical treatment planning of trigeminal neuralgia: a single-institution experience. World Neurosurg. 2018;113:e399e407.

    • Search Google Scholar
    • Export Citation

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