CASE REPORT: Adaptive fractionated treatment of Metastatic Oesophageal

Carcinoma with Leksell Gamma Knife® Icon™

Bristol Gamma Knife Centre, University Hospitals Bristol

• 54 year old male with Metastatic Oesophageal Carcinoma (Dec, 2014)

• 8 x palliative chemotherapy

• Left-sided weakness (July, 2016)

• MRI 2 x brain metastases

• Significant increase in volume on planning scan compared to diagnostic imaging

[Document reference number: 4513 371 1528]

2 | Focus where it matters

TREATMENT OVERVIEW

Adaptive

fractionated

radiosurgery

• Mask based treatment due to tumor

size

• 30Gy in 3# delivered 2 weeks apart

• MRI and re-planning prior to each

fraction

• Patient tolerated treatment with

minimal side effects

Tumor Regression

57.6% reduction at fraction 2

83.1% reduction at fraction 3

FRACTION 1: volume 15.643 cm3

C = 0.99 S = 0.87 GI = 2.85 PCI = 0.86

FRACTION 3: volume 2.639 cm3

C = 1.0 S = 0.86 GI = 2.52 PCI = 0.86

FRACTION 2: volume 6.628 cmC = 1.00 S = 0.86 GI = 2.64 PCI = 0.86 57.6% reduction in volume

83.1% reduction in volume

3 month follow-up scan

5 | Focus where it matters

Benefits of Leksell Gamma Knife

Icon treatment for this patient

• Fractionated treatment of large metastasis possible with Icon

• Avoided surgery and the inherent risks and expenses associated with it

• Minimal side effects:- The patient would have experienced increased side-

effects if treatment had been delivered in a single session

- A single treatment increases the likelihood of the patient getting increased oedema and intracranial swelling. Therefore, with single session treatments it is more likely to experience an increase in symptoms such as headaches, nausea and tiredness.

Thank you

Photographies supplied courtesy of Bristol Gamma Knife Centre, University Hospitals Bristol, NHS Foundation Trust.