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Mask-based immobilization in Gamma Knife stereotactic radiosurgery.

Aaron Bush1, Laura Vallow1, Henry Ruiz-Garcia1

  • 1Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|December 19, 2020
PubMed
Summary

Mask-based Gamma Knife stereotactic radiosurgery (SRS) offers a safe, frameless alternative for brain tumors. Early results show high local control rates for metastases and limited toxicity, supporting its clinical use.

Keywords:
FramelessGamma KnifeImmobilizationStereotactic radiosurgery

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Area of Science:

  • Neurosurgery
  • Radiation Oncology
  • Medical Physics

Background:

  • The Gamma Knife Icon system enables frameless stereotactic radiosurgery (SRS) using a thermoplastic mask, onboard cone-beam CT (CBCT), and intrafraction motion management (IFMM).
  • This technology aims to provide a more comfortable immobilization alternative to rigid stereotactic frames.

Purpose of the Study:

  • To evaluate the safety, efficacy, and patient tolerance of mask-based Gamma Knife SRS for intracranial tumors.
  • To analyze interfraction shifts and treatment outcomes in patients treated with this frameless approach.

Main Methods:

  • Retrospective review of 124 patients treated with Gamma Knife SRS using a mask-based system between January 2018 and December 2019.
  • Data collected included patient and treatment characteristics, interfraction shifts measured by CBCT, and treatment-related outcomes for 358 intracranial tumors (primary brain tumors and metastases).

Main Results:

  • 91% local control rate was observed in patients with brain metastases.
  • Median interfraction shifts were submillimeter, indicating high positional accuracy.
  • The treatment demonstrated limited toxicity profiles and high patient tolerance.

Conclusions:

  • Mask-based Gamma Knife SRS is a safe and well-tolerated alternative for frameless radiosurgery.
  • This approach is suitable for patients with large target volumes requiring fractionation or small targets in non-eloquent areas.
  • Encouraging response rates warrant further investigation into long-term control and survival.