Sergey ILYALOVGamma Clinic, Russia
Title: Staged radiosurgery of large brain metastasis with mass effect and brain dislocation (two cases report)
Currently, one of the effective methods of treatment of intracranial metastases is stereotactic radiosurgery. The main factors limiting its use are the size (volume) of the tumor or the location of the metastasis in critical proximity to radiosensitive brain structures, such as the visual pathways, thalamus, brain stem, due to the high risk of developing local radiation necrosis. To reduce the risk of radiation side effects, hypofractionated radiation therapy with linear accelerators or staged radiosurgery with the Gamma Knife is used. At the same time, pronounced perifocal edema, according to many radiotherapists, may increase during irradiation, which serves as a basis for refusing to carry out such treatment. Therefore, large brain metastases, accompanied by severe perifocal edema and causing dislocation of the midline structures or axial displacement of the brain, are traditionally considered an object for surgical removal, the main purpose of which is to eliminate the mass effect caused by the tumor. We present two cases of successful application of staged Gamma Knife radiosurgery in patients with solitary breast cancer metastases accompanied by MRI signs of lateral and axial brain dislocation. The treatment was carried out with the Gamma Knife in 2 stage with an interval of 4 and 6 weeks. As a result of treatment, not only a significant decrease in tumor volume was noted, but also a complete regression of perifocal edema with regression of signs of brain dislocation and a significant improvement in the neurological status of patients. These observations demonstrate the possibility of effective and safe non-invasive treatment of large brain metastases accompanied by compression and dislocation of the brain, which makes it possible to achieve regression of the mass effect and improve the neurological quality of life of cancer patients.
Leading neurosurgeon specializing in functional brain disorders, vascular malformations, and neurosurgical treatment of neuro-oncology. He is the first specialist in Russia who defend his dissertation on the use of the Gamma Knife in the treatment of cancer patients. Today, he offers progressive treatment techniques and conducts active scientific activities. Today he is the head of the Gamma Clinic Center and the author of numerous scientific reports devoted to the subject of stereotaxic radiosurgery. Also, his scientific articles, written in collaboration with other doctors, are published in various medical journals; he is an active participant in Russian national congresses and foreign forums; and he is a winner of the IN VITA VERITAS award "For achievements in the field of radiotherapy".