Volume changes following gamma knife radiosurgery of intracranial tumors

The primary goal of radiosurgery for brain tumors is the prevention of further growth. The purpose of this article is to evaluate temporal changes of tumor volume after Gamma Knife radiosurgery on intracranial tumors.

Some 137 patients with 148 intracranial tumors who were treated with Gamma Knife radiosurgery and underwent radiological follow-up were reviewed. The tumors with high radiosensitivities to conventional external radiation were excluded.

The median radiological follow-up period was 12 months (range 1.5-38 months). Volume decreased after radiosurgery in 15 of 45 meningiomas; 10 of 37 schwannomas; 6 of 21 pituitary adenomas; 4 of 15 benign gliomas, including both of 2 subependymal giant cell astrocytomas; and 2 of 8 malignant gliomas. Some 87% of meningiomas and 60% of schwannomas whose volume had decreased began to shrink within 12 months and after 12 months, respectively. Transitory increase in volume preceded shrinkage in 16.2% of schwannomas, 13.3% of benign gliomas, 4.8% of pituitary adenomas, and 2.2% of meningiomas. Marked shrinkage occurred in 17 of 19 metastatic tumors and in all 3 neurocytomas shortly after radiosurgery. Of eight malignant gliomas, five began to grow 2-14 months (median = 5 months) after radiosurgery.

Several points should be considered carefully while following up on patients after radiosurgery: the possibility of transient volume increase, tumor-specific volume change patterns, and the tumor-specific goals of radiosurgery.