Podcasts about gamma knife

Host Dr. Davide Soldato and guest Dr. Harriet Kluger discuss the JCO article "Phase II Trial of Pembrolizumab in Combination With Bevacizumab for Untreated Melanoma Brain Metastases." Transcript The guest on this podcast episode has no disclosures to declare. Dr. Davide Soldato Hello and welcome to JCO After Hours, the podcast where we sit down with authors from some of the latest articles published in the Journal of Clinical Oncology. I am your host, Dr. Davide Soldato, Medical Oncologist at Ospedale San Martino in Genoa, Italy. Today, we are joined by JCO author Dr. Harriet Kluger. Dr. Kluger is a professor of medicine at Yale School of Medicine, Director of the Yale SPORE in Skin Cancer, and an internationally recognized expert in immuno-oncology for melanoma and renal cell carcinoma. She leads early-phase and translational trials that pair novel immunotherapies with predictive biomarkers to personalized care. Today, Dr. Kluger and I will be discussing the article titled "Phase 2 Trial of Pembrolizumab in Combination with Bevacizumab for Untreated Melanoma Brain Metastases." In this study, Dr. Kluger and colleagues evaluated four cycles of pembrolizumab plus the anti-VEGF antibody bevacizumab followed by pembrolizumab maintenance in patients with asymptomatic non-hemorrhagic melanoma brain metastases that had not previously received PD-1 therapy. Thank you for speaking with us, Dr. Kluger. Dr. Harriet Kluger Thank you for inviting me. The pleasure is really all mine. Dr. Davide Soldato So to kick off our podcast, I just wanted to ask if you could outline a little bit the biological and clinical rationale that led you to test this type of combination for patients with untreated brain metastases from metastatic melanoma. Dr. Harriet Kluger Back in approximately 2012, patients who had untreated brain metastases were excluded from all clinical trials. So by untreated, I mean brain metastases that had not received local therapy such as surgery or radiation. The reason for it was primarily because there was this fear that big molecules wouldn't penetrate brain lesions because they can't pass the blood-brain barrier. Turns out that the blood-brain barrier within a tumor is somewhat leaky and drugs sometimes can get in there. When PD-1 inhibitors were first identified as the next blockbuster class of drugs, we decided to conduct a phase 2 clinical trial of pembrolizumab monotherapy in patients with untreated brain metastases. We actually did it also in lung cancer, and we could talk about that later on. Responses were seen. The responses in the brain and the body were similar. They were concordant in melanoma patients. Now, at approximately that time, also another study was done by the Australian group by Dr. Georgina Long, where they did a randomized trial where patients who didn't require immediate steroid therapy received either nivolumab alone or nivolumab with ipilimumab, and the combination arm was substantially superior. Subsequently, also, Bristol Myers Squibb also conducted a large phase 2 multicenter trial of ipilimumab and nivolumab in patients with untreated brain metastases. And there, once again, they saw that the responses in the brain were similar to the responses in the body. Now, somewhere along the line there, we completed our anti-PD-1 monotherapy trial. And when we looked at our data, we still didn't have the data on ipilimumab and nivolumab. And our question was, “Well, how can we do better?” Just as we're always trying to do better. We saw two really big problems. One was that patients had a lot of perilesional edema. And the other one was that we were struggling with radiation necrosis in lesions that were previously Gamma Knifed. The instance of radiation necrosis was in excess of 30%. So the rationale behind this study was that if we added bevacizumab, maybe we could treat those patients who had some edema, not requiring steroids, but potentially get them on study, get that PD-1 inhibitor going, and also prevent subsequent radiation necrosis. And that was the main rationale behind the study. We had also done some preclinical work in mouse models of melanoma brain metastases and in an in vitro blood-brain barrier model where we showed that bevacizumab, or anti-VEGF, really tightens up those leaky basement membranes and therefore would be very likely to decrease the edema. Dr. Davide Soldato Thank you very much for putting in context the combination. So this was a phase 2 trial, and you included patients who had at least one lesion, and you wanted lesions that were behind 5 and 20 millimeters. Patients could be included also if the brain metastasis was higher in dimension than 20 millimeters, but it had to be treated, and it was then excluded from the evaluation of the primary objective of the trial. So regarding, a little bit, these characteristics, do you think that this is very similar to what we see in clinical practice? And what does this mean in terms of applicability of these results in clinical practice? Dr. Harriet Kluger So that's an excellent question. The brain metastasis clinical research field has somewhat been struggling with this issue of inclusion/exclusion criteria. When we started this, we showed pretty clearly that 5 to 10 millimeter lesions, which are below the RECIST criteria for inclusion, are measurable if you use MRIs with slices that are 1 to 2 millimeters. Most institutions in the United States do use these high-resolution MRIs. I don't know how applicable that is on a worldwide scale, but we certainly lowered the threshold for inclusion so that patients who have a smattering of small brain metastases would be eligible. Now, patients with single large brain metastases, the reason that we excluded those from the trial was because we were afraid that if a patient didn't respond to the systemic therapy that we were going to give them, they could really then develop severe neurological symptoms. So, for patient safety, we used 20 millimeters as the upper level for inclusion. Some of the other trials that I mentioned earlier also excluded patients with very large lesions. Now, in practice, one certainly can do Gamma Knife therapy to the large lesions and leave the smaller ones untreated. So I think it actually is very applicable to clinical practice. Dr. Davide Soldato Thank you very much for that insight, because I think that sometimes criteria for clinical trials, they have to be very restrictive. But then we know that in clinical practice, the applicability of these results is probably broader. So, going a little bit further in the results of the study, I just wanted a little bit of comment from you regarding what you saw in terms of intracranial response rate and duration of response among patients who obtained a response from the combination treatment. Dr. Harriet Kluger So we were actually surprised. When we first designed this study, as I said earlier, we weren't trying to beat out ipilimumab and nivolumab. We were really just trying to exclude those patients who wouldn't have otherwise been eligible for ipilimumab and nivolumab because of edema or possibly even previous radiation necrosis. So it was designed to differentiate between a response rate of 34%, and I believe the lower bound was somewhere in the 20s, because that's what we'd seen in the previous pembrolizumab study. What we saw in the first 20 patients that we enrolled was actually a response rate that far exceeded that. And so we enrolled another cohort to verify that result because we were concerned about premature publishing of a result that we might have achieved just by chance. The two cohorts were very similar in terms of the response rates. And certainly this still needs to be verified in a second study with additional institutions. We did include the Moffitt Cancer Center, and the response rate with Moffitt Cancer Center was very similar to the Yale Cancer Center response rate. Now, your other question was about duration of response. So the other thing that we started asking ourselves was whether this high response rate was really because the administration of the anti-VEGF will decrease the gadolinium enhancement and therefore we might actually just be seeing prettier scans but not tumor shrinkage. And the way to differentiate those two is by looking at the duration of the response. Median progression-free survival was 2.2 years. That's pretty long. The upper bound on the 95% confidence interval was not reached. I can't tell you that the duration is as good as the duration would be when you give ipilimumab. Perhaps it is less good. This was a fairly sick population of patients, and it included some who might not have been able to receive ipilimumab and nivolumab. So it provides an alternative. I do believe that we need to do a randomized trial where we compare it to ipilimumab and nivolumab, which is the current standard of care in this patient population. We do need to interpret these results with caution. I also want to point out regarding the progression-free survival that we only gave four doses of anti-VEGF. So one would think that even though anti-VEGF has a long half-life of three or four weeks, two years later, you no longer have anti-VEGF effect, presumably. So it does something when it's administered fairly early on in the course of the treatment. Dr. Davide Soldato So, in terms of clinical applicability, do you see this combination of pembrolizumab and bevacizumab - and of course, as we mentioned, this was a phase 2 trial. The number of patients included was not very high, but still you saw some very promising results when compared with the combination of ipilimumab and nivolumab. So do you see this combination as something that should be given particularly to those patients who might not be able to receive ipilimumab and nivolumab? So, for example, patients who are very symptomatic from the start or require a high dose of steroids, or also to provide a quicker response in terms of patients who have neurological symptoms, or do you think that someday it could be potentially used for all patients? Dr. Harriet Kluger The third part of your question, whether it can be used someday for all patients: I think we need to be very careful when we interpret these results. The study was substantially smaller than the ipilimumab/nivolumab trial that was conducted by Bristol Myers Squibb. Also going to point out that was a different population of patients. Those were all frontline patients. Here we had a mix of patients who'd had previous anti-CTLA-4 and frontline patients. So I don't think that we can replace ipilimumab and nivolumab with these results. But certainly the steroid-sparing aspect of it is something that we really need to take into consideration. A lot of patients have lesions in locations where edema can be dangerous, and some of them have a hard time coming off the steroids. So this is certainly a good approach for those folks. Dr. Davide Soldato And coming back to something that you mentioned in the very introduction, when you said that there were two main problems, which was one, the problem of the edema, and the second one, the problem of the radionecrosis. In your trial, there was a fair percentage of patients who received some type of local treatment before the systemic one. So the combination of pembrolizumab and bevacizumab. And most of the patients received radiosurgery. So I just wanted a brief comment regarding the incidence of radionecrosis in the trial and whether that specific component of the combination with bevacizumab was reduced. And how do you think that this fares in terms of what we see in clinical practice in terms of radionecrosis? Dr. Harriet Kluger I'm not sure that we really reduced the incidence of radiation necrosis. We saw radiation necrosis here. We saw less of it than in the trial of pembrolizumab monotherapy, but these were also different patients, different time. We saw more than we thought that we were going to see. It was 27%, I believe, which is fairly high still. We only gave the four doses of bevacizumab. Maybe to really prevent radiation necrosis, you have to continue to give the bevacizumab. That, too, needs to be tested. The reason that we gave the four doses of bevacizumab was simply because of the cost of the bevacizumab at the time. Dr. Davide Soldato Thank you very much for that comment on radionecrosis. And I really think that potentially this is a strategy, so continuing the bevacizumab, that really makes a lot of sense, especially considering that the tolerability of the regimen was really very, very good, and you didn't see any significant or serious adverse events related to bevacizumab. So just wondering if you could comment a little bit on the toxicities, whether you had anything unexpected. Dr. Harriet Kluger There was one patient who had a microperforation of a diverticulum, which was probably related to the bevacizumab. It was conservatively managed, and the patient did fine and actually remains alive now, many years later. We had one patient who had dehiscence of a previous wound. So there is some. We did not see any substantial hypertension, proteinuria, but we only gave the four doses. So it is possible that if you give it for longer, we would see some side effects. But still, relative to ipilimumab, it's very, very well tolerated. Dr. Davide Soldato Yeah, exactly. I think that the safety profile is really different when we compare the combination of ipilimumab/nivolumab with the pembrolizumab/bevacizumab. And as you said, this was a very small trial and probably we need additional results. But still, these results, in terms of tolerability and safety, I think they are very interesting. So one additional question that I think warrants a little bit of comment on your part is actually related to the presence of patients with BRAF mutation and, in general, to what you think would be the best course of treatment for these patients who present with the upfront brain metastases. So this, it's actually not completely related to the study, but I think that since patients with BRAF mutation were included, I think that this warrants a little bit of discussion on your part. Dr. Harriet Kluger So we really believe that long-term disease control, particularly in brain metastases, doesn't happen when you give BRAF/MEK inhibitors. You sometimes get long-term control if you've got oligometastatic disease in extracranial sites and if they've previously been treated with a lot of immune checkpoint inhibitors, which wasn't the case over here. So a patient who presents early in the course of the disease, regardless of their BRAF status, I do believe that between our studies and all the studies that have been done on immunotherapy earlier in the course of disease, we should withhold BRAF/MEK inhibitors unless they have overwhelming disease and we need immediate disease control, and then we switch them very quickly to immunotherapy. Can I also say something about the toxicity question from the bevacizumab? I have one more comment to make. I think it's important. We were very careful not to include patients who had overt hemorrhage from brain metastases. So melanoma brain metastases relative to other tumor types tend to bleed, and that was an exclusion criteria. We didn't see any bleeding that was attributable to the bevacizumab, but we don't know for sure that, if this is widely used, that that might not be a problem that's observed. So I would advise folks to use extreme caution and perhaps not use it outside of the setting of a clinical trial in patients with overt hemorrhage in the melanoma brain metastases. Dr. Davide Soldato Thank you very much. I think that one aspect that is really interesting in the trial is actually related to the fact that you collected a series of biomarkers, both circulating ones, but also some that were collected actually from the tissue. So just wondering if you could explain a little bit which type of biomarkers you evaluated and whether you saw any significant results that could suggest higher or lower efficacy of the combination. Dr. Harriet Kluger Thank you for that. So yes, the biomarker studies are fairly exploratory, and I want to emphasize that we don't have anything that's remotely useful in clinical practice at this juncture. But we did see an association between vessel density in the tumors and improved response to this regimen. So possibly those lesions that are more vascular are more fed by or driven by VEGF, and that could be the reason that there was improved response. We also saw that when there was less of an increase in circulating angiopoietin-2 levels, patients were more likely to respond. Whether or not that pans out in larger cohorts of patients remains to be determined. Dr. Davide Soldato Still, do you envision validation of these biomarkers in a potentially additional trial that will evaluate, again, the combination? Because I think that the signals were quite interesting, and they really make sense from a biological point of view, considering the mechanism of action of bevacizumab. So I think that, yeah, you're right, they are exploratory. But still, I think that there is very strong biological rationale. So really I wanted to congratulate you on including that specific part and on reporting it. And so the question is, really, do you envision validation of these biomarkers in larger cohorts? Dr. Harriet Kluger I would hope to see that, just as I'd like to see validation of the clinical results as well. The circulating biomarkers are very easy to do. It's a simple ELISA test. And the vessel density on the tumor is essentially CD34 staining and units per area of tumor. Also very simple to do. So I'd love to see that happen. Dr. Davide Soldato Do you think that considering the quality of the MRI that we are using right now, it would be possible to completely bypass even the evaluation on the tissue? Like, are we going in a direction where we can, at a certain point, say the amount of vessels that we see in these metastases is higher versus lower just based on MRI results? Dr. Harriet Kluger You gave me an outstanding idea for a follow-up study. I don't know whether you can measure the intensity of gadolinium as a surrogate, but certainly something worth asking our neuroradiology colleagues. Excellent idea. Thank you. Dr. Davide Soldato You're welcome. So just moving a step further, we spoke a lot about the validation of these results and the combination. And just wanted your idea on what do you think it would be more interesting to do: if designing a clinical trial that really compares pembrolizumab/bevacizumab with ipilimumab and nivolumab or going directly for the triplet. So we know that there has been some type of exploration of triplet combination in metastatic melanoma. So just your clinical impression: What would you do as an investigator? Dr. Harriet Kluger So it's under some discussion, actually. It's very difficult to compare drugs from different companies in an investigator-initiated trial. Perhaps our European colleagues can do that trial for us. In the United States, it's much harder, but it can be done through the cooperative groups, and we are actually having some discussions about that. I don't have the answer for you. It would be lovely to have a trial that compared the three drugs to ipi/nivo and to pembrolizumab/bevacizumab. So a three-arm trial. But remember, these are frontline melanoma patients. There aren't that many of them anymore like there used to be. So accrual will be hard, and we have to be practical. Dr. Davide Soldato Yeah, you're right. And in the discussion of the manuscript, you actually mentioned some other trials that are ongoing, especially one that is investigating the combination of pembro and lenvatinib, another one that is investigating the combination of nivolumab and relatlimab. So just wondering, do you think that the molecule in terms of VEGF inhibition, so bevacizumab versus lenvatinib, can really make a difference or is going to be just a mechanism of action? Of course, we don't have the results from this trial but just wondering if you could give us a general comment or your opinion on the topic. Dr. Harriet Kluger So that's a really great question. The trial of pembrolizumab and lenvatinib was our answer to the fact that bevacizumab is not manufactured by the same company as pembrolizumab, and we're trying to give a practical answer to our next study that might enable us to take this approach further. But it does turn out from our preclinical studies that bevacizumab and VEGF receptor inhibition aren't actually the same thing in terms of the effects on the blood-brain barrier or the perilesional tumor microenvironment in the brain. And these studies were done in mice and in in vitro models. Very different effects. The lenvatinib has stronger effect on the tumors themselves, the tumor cells themselves, than the bevacizumab, which has no effect whatsoever. But the lenvatinib doesn't appear to tighten up that blood-brain barrier. Dr. Davide Soldato Thank you. I think that's very interesting, and I think it's going to be interesting to see also results of these trials to actually improve and give more options to our patients in terms of different mechanism of action, different side effects. Because in the end, one thing that we discussed is that some combination may be useful in some specific clinical situation while others cannot be applicable, like, for example, an all immunotherapy-based combination. Just one final comment, because I think that we focused a lot on the intracranial response and progression-free survival. You briefly mentioned this but just wanted to reinforce the concept. Did you see any differences in terms of intracranial versus extracranial response for those patients who also had extracranial disease with the combination of pembro and bevacizumab? Dr. Harriet Kluger So the responses were almost always concordant. There were a couple of cases that might have had a body response and not an intracranial response and vice-versa, but the vast majority had concordant response or progression. We do believe that it's a biological phenomenon. The type of tumor that tends to go to the brain is going to be the type of tumor that will respond to whatever the regimen is that we're giving. In the previous trial also, we saw concordance of responses in the body and the brain. Dr. Davide Soldato Thank you very much. Just to highlight that really the combination is worth pursuing considering that there was not so much discordant responses, and the results, even in a phase 2 trial, were very, very promising. So thank you again, Dr. Kluger, for joining us today and giving us a little bit of insight into this very interesting trial. Dr. Harriet Kluger Thank you for having me. Dr. Davide Soldato So we appreciate you sharing more on your JCO article titled "Phase 2 Trial of Pembrolizumab in Combination with Bevacizumab for Untreated Melanoma Brain Metastases," which gave us the opportunity to discuss current treatment landscape in metastatic melanoma and future direction in research for melanoma brain metastasis. If you enjoy our show, please leave us a rating and review and be sure to come back for another episode. You can find all ASCO shows at asco.org/podcasts.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

This podcast is sponsored by Elekta

This episode of VHHA's Patients Come First podcast features Dr. K. Singh Sahni, Medical Director of the Neuroscience and Gamma Knife Center at Johnston-Willis Hospital, an HCA Virginia facility. Dr. Sahni is a repeat guest who joins us for a conversation about his work, a recent Gamma Knife surgery milestone, and more. Send questions, comments, feedback, or guest suggestions to pcfpodcast@vhha.com or contact on X (Twitter) or Instagram using the #PatientsComeFirst hashtag.

We sit down with the guys from Eugene, Oregon based experimental metal band Gamma Knife to discuss their new singles, the recording process of their upcoming album and the origin of the band. We also discuss the Oregon metal scene, Eugene's food scene, I Think You Should Leave and much more. Plus, at the end of the interview the band have a special treat for you, their brand new single Baptized Liar, not up on streaming services yet. Follow and listen to Gamma Knife: gammaknife2.bandcamp.com/album/demo instagram.com/gammaknifeband

Radiocirugía con Gamma Knife, CEDIMAT. - Dr. José Orlando Bidó.

A conversation with Dr. Patrick Grover

A conversation with Dr. Dheerendra Prasad. Thank you to Elekta for sponsoring this episode! Find the Gamma Knife online at https://www.elekta.com/products/stereotactic-radiosurgery/elekta-esprit/patients-at-the-center/

A conversation with Dr. Jean Regis. Thank you to Elekta for sponsoring this episode! Find the Gamma Knife online at https://www.elekta.com/products/stereotactic-radiosurgery/elekta-esprit/patients-at-the-center/

Episode 150, we get the opportunity to interview Dr. Ricardo Komotar in between his numerous appointments. Ricardo tells us that he always wanted to be a brain surgeon from a very early age. The brain has always fascinated him. He explains that assessments and imaging can be useful in identifying potential problems in the brain, but too much screening can also be problematic. We also discuss various risk factors for tumor formation in the brain, with an emphasis on the role of nutrition, exercise and sleep for optimal brain function, health and longevity. The conversation also touches on the topics of traumatic brain injuries, dementia and new developments in the field of neurology. Dr. Komotar is Professor of Neurological Surgery at the University of Miami School of Medicine. He graduated summa cum laude with a B.S. in neuroscience from Duke University, spending a year at Oxford University in England to focus on neuropharmacology. He received his medical degree from The Johns Hopkins University School of Medicine with highest honors and completed his internship and neurosurgical residency at Columbia University Medical Center/The Neurological Institute of New York, followed by a surgical neurooncology fellowship at Memorial Sloan-Kettering Cancer Center to specialize in brain tumors. As Director of the University of Miami Brain Tumor Initiative, Director of Surgical Neurooncology at the University of Miami, Director of the UM Neurosurgery Residency Program, and Director of the UM Surgical Neurooncology Fellowship Program, Dr. Komotar's main clinical interests are surgical and radiosurgical (Gamma Knife) treatment of primary and metastatic brain tumors, as well as meningiomas and pituitary lesions. Dr. Komotar is an internationally recognized leader in the field of brain tumors and performs nearly 800 procedures for these conditions each year using advanced cutting-edge surgical/radiosurgical techniques, making him one of the highest volume brain tumor surgeons in the world. You can find out more information on Dr. Ricardo Komotar below: Instagram: https://www.instagram.com/ricardokomotar/ Website: https://www.ricardokomotar.com/ The D&D Fitness Radio podcast is available at the following locations for downloadable audio, including: iTunes – https://itunes.apple.com/us/podcast/d-d-fitness-radio-podcast/id1331724217 iHeart Radio – https://www.iheart.com/podcast/dd-fitness-radio-28797988/ Spreaker.com – https://www.spreaker.com/show/d-and-d-fitness-radios-show Spotify – https://open.spotify.com/show/5Py2SSPA4mntNwYRm0Opri You can reach both Don and Derek at the following locations: Don Saladino: http://www.DonSaladino.comTwitter and Instagram - @DonSaladinoYouTube - http://www.youtube.com/donsaladino Derek M. Hansen: http://www.SprintCoach.comTwitter and Instagram - @DerekMHansenYouTube - http://youtube.com/derekmhansen

King Gizzard and the Lizard Wizard's legendary three-night run at Red Rocks continues. This is the second set from night two (October 11, 2022) and includes a Mind Fuzz suite, The Tale of the Altered Beast and a Nonagon Infinity suite.1) Perihelion 0.132) I'm In Your Mind 3.053) I'm Not In Your Mind 6.454) Cellophane 9.555) I'm In Your Mind Fuzz 13.016) Tezeta 15.527) The Tale of the Altered Beast (incomplete) 20.308) Ambergris 32.499) Muddy Water 38.1010) Iron Lung 44.5211) Robot Stop 55.0912) Gamma Knife 1.02.2713) People-Vultures 1.07.2914) Mr. Beat 1.13.15Support the show

Sin relaciones, ¿qué puede seguir? En esta edición, con nuestra reflexión: ¿Eres justo en tus relaciones? un escrito de Gorka Jiménez Pajares, te invitamos a cuidar tus relaciones, a tu gente. Un 26 de enero nació Juan Pablo Duarte, recordamos su pasaje, trayectoria y compartimos durante todo el programa Decálogo duartiano. Madre, madre… ¿estás ayudando a tu hijo, hija a construir un camino de confianza e inteligencia emocional? Rosario Aróstegui trae el tema la mesa con la compañía de Juan Pablo Casimiro, quien comparte la misma pasión que Rosario: ayudar a los jóvenes, guiarles. Hablamos de las emociones y cómo conectar con tus adolescentes. Richard Douglas, actor, productor dominicano, nos comparte su opinión personal de la película "Transfutsion", bajo el protagonismo de Sam Worthington. También hablamos de las nominaciones a los premios Oscar. Dra. Jazmín García, Radio oncóloga del Centro Gamma Knife Dominicano, nos comparte sobre Radiocirugía Gamma Knife en Metástasis Cerebrales. Conocemos de este tratamiento que permite concentrar altas dosis de radiación en un área pequeña y precisa del cerebro, respetando al máximo los órganos cercanos. Su creador fue el neurocirujano sueco Dr. Lars Leksell del Instutito Karolinska en Estocolmo, Suecia, junto con el biofísico Prof. Börje Larsson.

Elegir conscientemente. (nuestra invitación a propósito de la locura del Black Friday). Y en nuestro espacio de reflexión te dejamos la pregunta: ¿De verdad estás viviendo conscientemente? Como cada viernes esperamos el momento para conversar con María Elena Asuad quien nos invita a interiorizar y profundizar para nuestro crecimiento y superación. En esta ocasión conocemos tres últimas características de las memorias familiares. En una nueva entrega de Gamma Knife Dominicano, en Camino al Sol, conversamos con el Dr. Giancarlo Hernández, especialista en neurocirugía cerebrovascular y base del cráneo. Conocemos sobre la radiocirugía Gamma Knife en Tumores de Hipófisis, y sobre los tumores pituitarios. ¡Llega el gozo eterno a Camino al Sol! Se trata de Milka Hernández, y como ella lo dice, Puerto Plata está de moda, y nos comparte sobre Greenland Bubble Glamping, una especie de habitación burbuja, y otros sitios cercanos para descubrir y disfrutar.

Nuestra #ActitudCaminoAlSol en esta edición: Las cosas buenas llegan si las buscas, o como dice Raquel Aldana: Las cosas buenas le llegan a quien sabe esperar, ambas son ciertas. Compartimos su escrito en nuestro espacio de reflexión. Fénix Pérez, ¡nuestra coach!, trae un tema a todas las personas que trabajan, que desempeñan un papel en un espacio colaborativo o llevan consigo responsabilidades para el objetivo y desarrollo de un grupo organizacional. Se trata del precio de la autovaloración en el trabajo. Richard Douglas nos comparte su opinión personal de la película "Old Man" o "Anciano", bajo la dirección de Lucky MacKee, protagonizada por Stephen Lang. En una nueva entrega con nuestros amigos del centro Gamma Knife Dominicana, conversamos con el Dr. Ismael Peralta, neurocirujano. En esta ocasión el Dr. nos guía para conocer sobre la radiocirugía Gamma Knife en Meningiomas. Conocemos qué es un meningioma, las causas de su aparición y más del proceso que realizan en el centro. Sergio Echenique, "Seye", cantante, cantautor dominicano, presenta su nuevo tema en inglés: “Dark Clouds” que interpreta junto a Jame Minogue.

In this episode, myself and Andy talk to Katie about Gamma Knife Radiotherapy also known as Stereotactic Radiotherapy.  Both Andy and Katie had this treatment when they had a recurrence of their brain tumours, they explain what the treatment entails and what it was like to undergo.You can find out more about Gamma Knife Radiotherapy hereIf you would like to talk to a member of our Support Team you can call 0808 800 0004 or email support@thebraintumourcharity.org

SD153 Elekta: Líder mundial em radio-oncologia. Neste episódio, a conversa é com Deborah Telésio , VP da Elekta para a América do Sul. Ela nos conta sobre a multinacional sueca especializada em tecnologia médica de radiologia de precisão. A Elekta tem seus equipamentos para radioterapia, radiocirurgia e braquiterapia apresenta em mais de 6.00 hospitais no mundo e investe nas inovações no tratamento do câncer com suas soluções, utilizando a inteligência artificial. Neste episódio, o que você vai encontrar: O background da Deborah  Experiência de 20 anos no mercado de saúde na área de equipamentos médicos. Formada em Marketing, ela trabalhou na área de consumo e entretenimento. A área de saúde através da GE, trabalhada por 14 anos, permanecendo em Markenting, mas depois migrando para a área de negócio de equipamentos. Mudou para a Elekta e sente que tem um propósito ao trabalhar com uma área de atuação em tratamento. Um pouco da Elekta Empresa sueca com 50 anos de atuação no mercado, nasceu do desenvolvimento de uma tecnologia em radiocirurgia intracraniana não invasiva; Inicialmente foco em Neurologia com uso de Radiação de Precisão e não há paralelo ao Gamma Knife no mercado; A aquisição de empresas e desenvolvimento de tecnologias na medicina e na braquiterapia; Tecnologia topo: Equipamento Unity unindo magnéticos e acelerador linear. Benefícios da Unidade Possibilidade de ver mais e ver melhor a adaptação do tumor: detecção dos movimentos e possibilidade de leitura rápida para garantir que o certo está sendo atingido no lugar e que os tecidos estão sendo preservados. Um diferencial tecnológico do Unity Precisa que traz o serviço de tecnologia para o ponto certo e dose certa; Tecnologia desenvolvida para acompanhar o movimento da lesão e irradiar de acordo com esse movimento e a paralisação imediata da irradiação, se houver fuga do ponto certo. Onde estão as soluções Gamma Knife: 4 equipamentos no Brasil, sendo 1 no HCor em SP; Unity: ainda não disponível no Brasil. O retrato da radioterapia no Brasil Apenas 360 equipamentos de radioterapia no país, sendo que, em 50% dos equipamentos, estão obsoletos. A Elekta tem 120 equipamentos no país. Para o paciente, o uso do Versa HD Beneficiando-se na Eleta Eleta paciente, o paciente é tecnologia da menos sessões de precisão e maior com maior dose por sessão e precisão. Isso se traduz em rapidez no tratamento, segurança e mais pacientes sendo atendidos. Conheça um pouco mais sobre a Débora Telésio e como ela sobreviveu ao Tsunami em 2004: OUÇA !  Podcast da Comunidade Online Saúde Você é médico? Quer interagir com Lorenzo Tomé e com outros pesquisadores inovadores da medicina digital?  Entre na Comunidade do Podcast Saúde Digital na SD Conecta! Assista este episódio também em vídeo no YouTube no nosso canal Saúde Digital Ecossistema! ACESSE AQUI ! Episódios Anteriores - Acesse! SD152 - MV Sistemas: Solução de Integração de Prontuários para médicos SD151 - GRUPO DEDALUS: líder mundial em software de saúde SD150 - ISA LAB: A Descentralização do Home Care SD149 - A Carreira do Médico Militar SD148 – Cardiopapers - A escola digital de 35 milhões de reais . Música | Declan DP -  Island " Música © Copyright Declan DP 2018 - Presente. https://license .declandp.info | ID da licença: DDP1590665"

Reconocer nuestros errores, nos fortalecen, aceptar las pequeñas faltas debe ser signo de atención, de un llamado a mejorar y crecer. Lo contrario sería darnos con el látigo y castigándonos, dejando en pensamientos continuos errores que pueden dolor, pueden causarnos emociones fuertes, pueden afectar otras partes. Lo importante es que después de sacar todas esas emociones, sea culpa, tristeza, decepción, enojo, pues, que podamos pasar la página para observarlos y sacar lo bueno: una lección, no un castigo. Dedicamos nuestro espacio de reflexión para compartir lo que Pedro González Núñez señala en su escrito: “Reconocer nuestros errores nos brinda la oportunidad de aprender de ellos”. Jessica Valdez se une a la conversación en la mesa para desarrollar el tema que nos prepara: Lo que mereces tener. Uno de los mensajes principales es honrar nuestras necesidades y nuestros deseos. Que, merecer no siempre tiene que ir relacionado con lo material, o como nos comparte Jessica: no siempre es lo que quieres, también es lo que te convenga. ¿Sabes qué pasos seguir para hacer una venta profesional? En el transcurso de los años, hemos escuchado de parte de Isaías Medina como funciona y hacemos posible la dinámica de vender, depende el sector, pero aún más la actitud y profesionalidad del vendedor. En esta ocasión, el experto en ventas Isaías, nos comparte 7 reglas de las VENTAS Profesionales. Seguimos nuestra programación con la compañía de la Doctora Maritza Arbaje, especializada en medicina holística, quien nos comparte de algunas influencias externas, y cómo repercuten en nuestro interior. En otro bloque, otro especialista de la salud, el Dr. Diones Rivera, neurocirujano del Centro Gamma Knife Dominicano, comparte unos minutos con nosotros para dar a conocer el mismo espacio de atención neurocirujana, y tratar sobre la radiocirugía con Gamma Knife y el centro Gamma Knife Dominicano.

SUBSCRIBE to The Grey Matters Podcast https://podcasts.apple.com/us/podcast/the-grey-matters-podcast/id1475573434Josh Perrywww.JoshPerryBMX.comInstagram.com/JoshPerryBMXJackie Lauricellawww.JLauricellaImages.comInstagram.com/JLauricellaImages

SUBSCRIBE to The Grey Matters Podcast https://podcasts.apple.com/us/podcast/the-grey-matters-podcast/id1475573434 Josh Perrywww.JoshPerryBMX.comInstagram.com/JoshPerryBMX Livestronghttps://www.livestrong.org/what-we-do/icon-series

Sponsored by Restream.io (Livestream anywhere) - https://restream.io/join/XK9rvJosh Perry was born and raised on Cape Cod, MA, where he developed his passion for BMX bike riding. Josh moved to Greenville, NC when he was 17 to pursue a career as a pro-BMX athlete and to ride with the best riders in the world, including Dave Mirra. In 2009, Josh won his first pro contest as well as the best trick contest, winning him a brand new Harley Davidson motorcycle. Following the big win, Josh made his first X-Games appearance and continued competing in the Dew Action Sports Tour (2007-2013).In March of 2010, a hard crash on his bike led Josh to the hospital in fear of a head traumatic brain injury (TBI). After almost a year of migraines, bouts of temporary blindness, and being repeatedly told that nothing was wrong, an MRI to rule out a concussion revealed a mass taking up the entirety of the left side of his brain. At the young age of 21, Josh faced mortality.In April of 2010, Josh underwent surgery to remove a brain tumor taking up the entire left side of his brain. This was a major turning point in his life putting him on track to learning about nutrition and taking better care of his body. In November of 2012, Josh had Gamma Knife Radiation treatment to treat two new tumors. This was another eye-opener for Josh and his health, which led him to research holistic health and nutrition even deeper.With his experiences with brain tumors and injuries, Josh became very passionate about learning about food and the correlation to our health and wellbeing, as well as sharing information with others in hopes of helping them become well. In February of 2014, Josh enrolled in the world's largest nutrition program, the Institute for Integrative Nutrition. In February of 2015, Josh completed the program to earn a certification as a Holistic Health Coach to further his efforts in sharing information with others and helping them achieve their goals with their health and wellbeing.In April of 2015, Josh launched www.DailyBrainstorms.com to share his story, and passion with the world and in October of 2016, Josh founded the Josh Perry Foundation as his way to give back to the world.Josh placed 10th overall in the world for the 2016 UCI x Fise World Cup Series, returning to competition just a few months after ACL reconstructive surgery.After the 2016 season, Josh returned from China and founded The Josh Perry Foundation as his way of giving back to those with brain tumors, brain injuries, and other brain disorders. March 2017 Josh was informed he had 2 new tumors on the other side of his brain. Josh is going to finish his 2017 season before getting Gamma Knife treatment on the new growths.Josh continues to ride BMX at a professional level today, despite living with four brain tumors, and works extremely hard to stay fit, healthy, positive, and driven while sharing as much as he can with the world.Please do NOT hesitate to reach out to me on LinkedIn, Instagram, or via email mark@vudream.comLinkedIn - https://www.linkedin.com/in/mark-metry/Instagram - https://www.instagram.com/markmetry/Twitter - https://twitter.com/markymetryMedium - https://medium.com/@markymetryFacebook - https://www.facebook.com/Humans.2.0.PodcastMark Metry - https://www.markmetry.com/Humans 2.0 Twitter - https://twitter.com/Humans2Podcast

Sponsored by Restream.io (Livestream anywhere) - https://restream.io/join/XK9rvJosh Perry was born and raised on Cape Cod, MA, where he developed his passion for BMX bike riding. Josh moved to Greenville, NC when he was 17 to pursue a career as a pro-BMX athlete and to ride with the best riders in the world, including Dave Mirra. In 2009, Josh won his first pro contest as well as the best trick contest, winning him a brand new Harley Davidson motorcycle. Following the big win, Josh made his first X-Games appearance and continued competing in the Dew Action Sports Tour (2007-2013).In March of 2010, a hard crash on his bike led Josh to the hospital in fear of a head traumatic brain injury (TBI). After almost a year of migraines, bouts of temporary blindness, and being repeatedly told that nothing was wrong, an MRI to rule out a concussion revealed a mass taking up the entirety of the left side of his brain. At the young age of 21, Josh faced mortality.In April of 2010, Josh underwent surgery to remove a brain tumor taking up the entire left side of his brain. This was a major turning point in his life putting him on track to learning about nutrition and taking better care of his body. In November of 2012, Josh had Gamma Knife Radiation treatment to treat two new tumors. This was another eye-opener for Josh and his health, which led him to research holistic health and nutrition even deeper.With his experiences with brain tumors and injuries, Josh became very passionate about learning about food and the correlation to our health and wellbeing, as well as sharing information with others in hopes of helping them become well. In February of 2014, Josh enrolled in the world’s largest nutrition program, the Institute for Integrative Nutrition. In February of 2015, Josh completed the program to earn a certification as a Holistic Health Coach to further his efforts in sharing information with others and helping them achieve their goals with their health and wellbeing.In April of 2015, Josh launched www.DailyBrainstorms.com to share his story, and passion with the world and in October of 2016, Josh founded the Josh Perry Foundation as his way to give back to the world.Josh placed 10th overall in the world for the 2016 UCI x Fise World Cup Series, returning to competition just a few months after ACL reconstructive surgery.After the 2016 season, Josh returned from China and founded The Josh Perry Foundation as his way of giving back to those with brain tumors, brain injuries, and other brain disorders. March 2017 Josh was informed he had 2 new tumors on the other side of his brain. Josh is going to finish his 2017 season before getting Gamma Knife treatment on the new growths.Josh continues to ride BMX at a professional level today, despite living with four brain tumors, and works extremely hard to stay fit, healthy, positive, and driven while sharing as much as he can with the world.Please do NOT hesitate to reach out to me on LinkedIn, Instagram, or via email mark@vudream.comLinkedIn - https://www.linkedin.com/in/mark-metry/Instagram - https://www.instagram.com/markmetry/Twitter - https://twitter.com/markymetryMedium - https://medium.com/@markymetryFacebook - https://www.facebook.com/Humans.2.0.PodcastMark Metry - https://www.markmetry.com/Humans 2.0 Twitter - https://twitter.com/Humans2Podcast

Bienvenue sur Rare à l'Écoute, la chaîne de podcast dédiée aux maladies rares. Pour ce quatrième épisode consacré à l'Acromégalie, nous recevons le Pr Jean Régis, neurochirurgien, chef du service de neurochirurgie fonctionnelle de l'hôpital neurologique de la Timone à Marseille. Nous abordons aujourd'hui la technique de radiochirurgie Gamma Knife, son mécanisme d'action, les typologies de patients pouvant en bénéficier, les bénéfices de ce type de radiochirurgie et le suivi à préconiser. Si vous désirez vous informer et aller plus loin dans la connaissance de cette pathologie, nous vous donnons rendez-vous sur notre site internet www.rarealecoute.com. L'orateur n'a reçu aucune rémunération pour la réalisation de cet épisode.   Invité : Pr Jean Régis – Hôpital de la Timone – Marseille http://www.firendo.fr/accueil-filiere-firendo/  http://fr.ap-hm.fr/site/defhy    L'équipe : Virginie Druenne - Programmation Cyril Cassard - Animation Hervé Guillot - Production   Crédits : Sonacom

Gamma knife radio surgery is surgery without a scalpel. The procedure combines radiation oncology and neurosurgery to treat lesions in the brain, including tumors. Among the upsides, there's no incision in the skull, the radiation can be given in a single outpatient setting, and there are no typical side effects like hair loss, and nausea and vomiting, that come with traditional radiation therapy. This week on the Mayo Clinic Q&A podcast, Dr. Bruce Pollock, a Mayo Clinic neurosurgeon, explains how gamma knife radiosurgery is performed.

On episode 238 of The Nurse Keith Show, Keith interviews Eric Filiput, BSN, the Operations Manager of the Gamma Knife Center at Siteman Cancer Center, which treats over 300 patients a year. Helping people is in his blood, and Filiput keeps the mood light with his frequent jokes and simple explanations of procedures, helping patients feel at home and well-cared for.  Nurse Keith is a holistic career coach for nurses, as well as a professional podcaster, published author, inspiring speaker, and successful nurse entrepreneur. Show notes NurseKeith.com Facebook.com/NurseKeithCoaching Twitter.com/nursekeith Instagram.com/nursekeithcoaching LinkedIn.com/in/keithallancarlson

Gamma Knife for Brain Metastases with guest Dr. Veronica Chiang June 23, 2019 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Gamma Knife for Brain Metastases with guest Dr. Veronica Chiang June 23, 2019 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Gamma Knife for Brain Metastases with guest Dr. Veronica Chiang June 23, 2019 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Josh Perry is a former professional athlete and 4x Brain Tumor Survivor & Thriver. I had the chance to conduct an in-person over 1-hour long interview talking about his personal story, adversity, health, recovery, fears, accountability and so much goodness you must listen to! Tufts Medical Center in Boston just called with my latest MRI results: There are two new masses on the right side of my brain the size of peas (about 8mm in size from residual growth), where the surgery was done. My options are to follow it and see if it changes in growth, MRI no sooner than six months, Gamma Knife radiosurgery or full-on open cranial surgery. Haha, yay."The message arrives in text form from Josh Perry, a 27-year-old professional BMX rider about to enter the 2017 competition season. A week before, we had spoke on the phone for an hour about his life as a professional BMX rider currently living and training in Cary, North Carolina, and how he was aiming to push himself into a larger role as an advocate for nutritional health and positive thinking, working with brands outside of BMX to help expose larger audiences to the passion that he's devoted his life to.A week later, the above message arrives. Ordinarily, the news has the potential to derail an entire day or year, let alone positive ambitions for the future. But Perry isn't like anyone I've ever met before. On top of all of the common injuries that accompany the life of a pro BMXer, this isn't Perry's first experience with masses in his brain. In fact, this is his third time.Perry quickly follows up with another text message: "Just rode a morning session and rode just as well as I've been riding. Nothing has changed if I don't allow it to." This from a guy who has already had his skull cut open to remove a large tumor, while doctors stopped the flow of blood to his brain through an artery in his groin."If I didn't hit my head riding, I'd be dead."Perry's history with brain tumors began in March of 2010.Perry was attempting to learn a new BMX Park trick on a quarterpipe when he over-rotated and landed off the bike, crashing down on his shoulder and head. Although he was wearing a helmet, Perry decided to undergo an MRI because of the fear of traumatic brain injury. But this wasn't Perry's first bout with injury as a BMX professional. There were lingering, unanswered issues in his recent medical history. Throughout that past year, he had been experiencing periods of intense headaches coupled with bouts of temporary blindness. After repeated doctor visits and an attempt by doctors to get Perry on pain killers, nothing had been diagnosed.Essentially, it took a BMX crash (the exact outcome Perry aimed to avoid) to get him to undergo a brain scan, and discover the source of his symptoms.But the outcome of the examination was not anything that he had expected. "I wanted to get an MRI to make sure my brain wasn't swelling and the doctors told me 'Yeah, you have a large mass that shouldn't be in your brain and it's a tumor, and we're not sure it's cancerous or benign but it needs to come out.'"- https://www.joshperrybmx.com/- https://www.instagram.com/joshperrybmx/Please do NOT hesitate to reach out to me on LinkedIn, Instagram, or via email mark@vudream.comLinkedIn - https://www.linkedin.com/in/mark-metry/Instagram - https://www.instagram.com/markmetry/Twitter - https://twitter.com/markymetryMedium - https://medium.com/@markymetryFacebook - https://www.facebook.com/Humans.2.0.PodcastMark Metry - https://www.markmetry.com/Humans 2.0 Twitter - https://twitter.com/Humans2Podcast

Josh Perry is a former professional athlete and 4x Brain Tumor Survivor & Thriver. I had the chance to conduct an in-person over 1-hour long interview talking about his personal story, adversity, health, recovery, fears, accountability and so much goodness you must listen to! Tufts Medical Center in Boston just called with my latest MRI results: There are two new masses on the right side of my brain the size of peas (about 8mm in size from residual growth), where the surgery was done. My options are to follow it and see if it changes in growth, MRI no sooner than six months, Gamma Knife radiosurgery or full-on open cranial surgery. Haha, yay."The message arrives in text form from Josh Perry, a 27-year-old professional BMX rider about to enter the 2017 competition season. A week before, we had spoke on the phone for an hour about his life as a professional BMX rider currently living and training in Cary, North Carolina, and how he was aiming to push himself into a larger role as an advocate for nutritional health and positive thinking, working with brands outside of BMX to help expose larger audiences to the passion that he's devoted his life to.A week later, the above message arrives. Ordinarily, the news has the potential to derail an entire day or year, let alone positive ambitions for the future. But Perry isn't like anyone I've ever met before. On top of all of the common injuries that accompany the life of a pro BMXer, this isn't Perry's first experience with masses in his brain. In fact, this is his third time.Perry quickly follows up with another text message: "Just rode a morning session and rode just as well as I've been riding. Nothing has changed if I don't allow it to." This from a guy who has already had his skull cut open to remove a large tumor, while doctors stopped the flow of blood to his brain through an artery in his groin."If I didn't hit my head riding, I'd be dead."Perry's history with brain tumors began in March of 2010.Perry was attempting to learn a new BMX Park trick on a quarterpipe when he over-rotated and landed off the bike, crashing down on his shoulder and head. Although he was wearing a helmet, Perry decided to undergo an MRI because of the fear of traumatic brain injury. But this wasn't Perry's first bout with injury as a BMX professional. There were lingering, unanswered issues in his recent medical history. Throughout that past year, he had been experiencing periods of intense headaches coupled with bouts of temporary blindness. After repeated doctor visits and an attempt by doctors to get Perry on pain killers, nothing had been diagnosed.Essentially, it took a BMX crash (the exact outcome Perry aimed to avoid) to get him to undergo a brain scan, and discover the source of his symptoms.But the outcome of the examination was not anything that he had expected. "I wanted to get an MRI to make sure my brain wasn't swelling and the doctors told me 'Yeah, you have a large mass that shouldn't be in your brain and it's a tumor, and we're not sure it's cancerous or benign but it needs to come out.'"- https://www.joshperrybmx.com/- https://www.instagram.com/joshperrybmx/Please do NOT hesitate to reach out to me on LinkedIn, Instagram, or via email mark@vudream.comLinkedIn - https://www.linkedin.com/in/mark-metry/Instagram - https://www.instagram.com/markmetry/Twitter - https://twitter.com/markymetryMedium - https://medium.com/@markymetryFacebook - https://www.facebook.com/Humans.2.0.PodcastMark Metry - https://www.markmetry.com/Humans 2.0 Twitter - https://twitter.com/Humans2Podcast

Josh Perry is a former professional BMX athlete, motivational speaker, and certified holistic health consultant that's fighting 4 brain tumors. His strong motivation for living his best and healthiest life stems from a brain tumor diagnosis & surgery in 2010 followed by 2 additional diagnoses. After overcoming the surgeries & treatments, and realizing he most likely has a genetic predisposition to accumulating tumors, he immersed himself in research on how to enhance the health, performance, and longevity of his brain. Since choosing to change his life and follow a ketogenic diet & lifestyle, the growth of the tumors have stopped and he feels better and more fulfilled than he has ever before. Today, Josh has left competing to start his health coaching business as a way of exploring his passion for helpings other improve their brain health and become the most successful versions of themselves. Josh also teamed up with the Athlete Recovery Fund to start raising awareness and funds for a non-profit BMX/Wellness event focused on raising direct funding for direct patient care through education, sport, and faith called the Brainy BMX Stunt Shows Josh shares what really helped him take back control of his life. Vision & goals are what helped him overcome adversity and become successful, still living with 4 tumors today. His tools are Gamma Knife Radiosurgery, a ketogenic diet/lifestyle, and leaving the competition side of BMX to pursue his wellness-focused purpose purpose, Brainy BMX. Josh feels strongly that health is internal and we all have the same choice in our life and that's our perspective. Key Points from the Episode with Josh Perry: Josh has taken a step back from his pro BMX career to focus on sharing his story across podcasts, public speaking and his health coaching work. And he’s doing that all with four brain tumors that he’s managing through a mix of the Keto diet, the right mindset and medical intervention when needed (mainly Gamma Knife technology) He hit on the hidden transition in his retirement from the pro BMX circuit around a loss of identity. His world has been Josh Perry the BMX rider, so aside from not riding in competitions, he’s faced the question of who he is today. He still rides at an incredible level because he loves it, but he isn’t actively competing. His dream was just to be a professional BMX rider competing, but didn’t realize what he’d be exposed to all over the world through the travel he’s done, for example performing for the troops in Afghanistan. In March 2010, he was training a jump he was working on. He was worried about under-rotating and ended up over-compensating and over-rotating, which resulted in a crash that landed him in an urgent care center to get his head scanned. As a background to this crash, he had been having intense headaches for a year with pain so severe it made him nauseous. Whenever he went to the doctor about the headaches, the doctors sort of blew it off since he was so young, and just gave him pills for the headache pain. But when he got the scan after his crash, the news the doctor shared was not something he expected at all. He was told, “There’s something in your brain that isn't supposed to be there.” And after that, things became surreal and he was almost detached from his surroundings. He called his mother to tell her the news and couldn’t even speak. He felt complete broken and out-of-body. The urgent care doctor told him he not only would never ride again, but probably would never walk again, either. That was what really set the shock in. He sound learned that he had a large tumor on top of his brain that had wrapped itself around his optic nerve, which was causing his headaches and vision issues. It was so severe that, in a month or two, he wouldn’t have woken up again. After his surgery, which took over six hours, he was riding again after five weeks, and was competing again seven to eight weeks after that. His biggest struggle coming back into competition was just around confidence and whether he was ready and able to do it. He worked on that actively and got himself back to where he was before the surgery. It was very much an action-oriented approach. He found inspiration from his mother’s battle overcoming colon cancer and also reading Lance Armstrong’s book and recognizing how he won most of his victories after he had cancer. That helped him realize he wasn’t done yet. He learned so much through this experience about himself and what he can do that he believes he wouldn’t have learned without going through this experience with the first tumor. He doesn’t think everyone needs to face something so dramatic to learn these lessons, but he feels he did. I questioned whether the fast movement to action helped him be positive and overcome it, which isn’t something he’s thought about before, but he does believe this is a crucial part of the puzzle. Had he sat longer before the surgery, he would have had more time to ruminate, worry and let his mindset slip. He talked about how worrying can lead to bad choices, like when he crashed. He was worried about under-rotating when he flipped, and he ended up over-rotating and crashing. Worry about going too far left can mean you shift too hard right, and fail. Mindset and fear can lead to the outcomes we’re fearing in the first place. Two years after coming back from his first tumor and surgery, a routine MRI found two new tumors that were not operable. He was told he could try radiation, but that didn’t sit well with him, so he researched other options, and found the Gamma Knife, which uses targeted radio waves done on an out-patient basis, which is what he has been using to fight his tumors since finding it. As he was getting fully back into BMX competition, he blew out his knee at a competition, and rode with it that way for two years with it in a brace because he didn’t want to stop riding to get it taken care of. His girlfriend, who was a trainer who he met through working through his recovery, pushed him to address his knee problem by getting surgery, and eventually he agreed to do it, timing things around BMX events. Recovery was expected to be six to eight months long, but his recovery went much faster, which he credits his physical fitness and diet with. He came back into competition and got up to 10th in the world and then, during another regularly MRI scan, they found two more tumors, and realized he has a genetic condition that predisposes him to develop tumors in his brain and spinal cord. Since then, he has used a Ketogenic diet to stop the growth of the tumors and promote brain health, and so far, the tumors have not progressed. As this episode comes out, he will have had his second annual scan to see if the tumors have stayed the same size or even shrunk, so we’ll all be thinking of Josh as we listen to this. He shared some of the science behind why the Keto diet is so helpful, which is about providing alternative fuel sources to brain cells that are damaged, for example by concussion (which Josh obviously has dealt with given his profession). Ultimately, Josh’s goal is to inspire change in perspective to help people see their lives in a more positive outlook but ultimately to prioritize the health of their brain. He shares his story to help inspire that in others, and has started to share more mindset pieces than anything. He’s using his health coaching to help make this impact, as well as public speaking to try to touch large groups. He’s not looking to just inspire people, but inspire them to take action and change. He’s also working with the Athlete Recovery Fundto create the Brain BMX Stunt Shows, which are wellness BMS events to educate and raise funds for brain tumor and injury patients to provide direct funding for them. Josh and his family benefited from the Fund when he got his diagnosis, so this is a way to give back. Books we mentioned: Buddha’s Brainand The Ketogenic Bible Links: Website: JoshPerryBMX.com& www.athleterecoveryfund.org/josh-perry Online Ketogenic Diet Course: KetoBrains.com Blog: DailyBrainstorms.com Twitter: @JoshPerryBMX LinkedIn: linkedin.com/in/joshperrybmx/ Instagram: @JoshPerryBMX YouTube: https://www.youtube.com/user/joshperry Subscribe to The Do a Day Podcast     Keep Growing with Do a Day Get the book in print, Kindle, iBooks, Audiobookand more - even get a personally-signedcopy from Bryan Falchuk Get started on your journey to Better with the Big Goal Exercise Work with Bryan as your coach, or hire him to speak at your next event

Tufts Medical Center in Boston just called with my latest MRI results: There are two new masses on the right side of my brain the size of peas (about 8mm in size from residual growth), where the surgery was done. My options are to follow it and see if it changes in growth, MRI no sooner than six months, Gamma Knife radiosurgery or full-on open cranial surgery. Haha, yay."The message arrives in text form from Josh Perry, a 27-year-old professional BMX rider about to enter the 2017 competition season. A week before, we had spoke on the phone for an hour about his life as a professional BMX rider currently living and training in Cary, North Carolina, and how he was aiming to push himself into a larger role as an advocate for nutritional health and positive thinking, working with brands outside of BMX to help expose larger audiences to the passion that he's devoted his life to.A week later, the above message arrives. Ordinarily, the news has the potential to derail an entire day or year, let alone positive ambitions for the future. But Perry isn't like anyone I've ever met before. On top of all of the common injuries that accompany the life of a pro BMXer, this isn't Perry's first experience with masses in his brain. In fact, this is his third time.Perry quickly follows up with another text message: "Just rode a morning session and rode just as well as I've been riding. Nothing has changed if I don't allow it to." This from a guy who has already had his skull cut open to remove a large tumor, while doctors stopped the flow of blood to his brain through an artery in his groin."If I didn't hit my head riding, I'd be dead."Perry's history with brain tumors began in March of 2010.Perry was attempting to learn a new BMX Park trick on a quarterpipe when he over-rotated and landed off the bike, crashing down on his shoulder and head. Although he was wearing a helmet, Perry decided to undergo an MRI because of the fear of traumatic brain injury. But this wasn't Perry's first bout with injury as a BMX professional. There were lingering, unanswered issues in his recent medical history. Throughout that past year, he had been experiencing periods of intense headaches coupled with bouts of temporary blindness. After repeated doctor visits and an attempt by doctors to get Perry on pain killers, nothing had been diagnosed.Essentially, it took a BMX crash (the exact outcome Perry aimed to avoid) to get him to undergo a brain scan, and discover the source of his symptoms.But the outcome of the examination was not anything that he had expected. "I wanted to get an MRI to make sure my brain wasn't swelling and the doctors told me 'Yeah, you have a large mass that shouldn't be in your brain and it's a tumor, and we're not sure it's cancerous or benign but it needs to come out.'"Please do NOT hesitate to reach out to me on LinkedIn, Instagram, or via email mark@vudream.comLinkedIn - https://www.linkedin.com/in/mark-metry/Instagram - https://www.instagram.com/markmetry/Twitter - https://twitter.com/markymetryMedium - https://medium.com/@markymetryFacebook - https://www.facebook.com/Humans.2.0.PodcastMark Metry - https://www.markmetry.com/Humans 2.0 Twitter - https://twitter.com/Humans2Podcast

Tufts Medical Center in Boston just called with my latest MRI results: There are two new masses on the right side of my brain the size of peas (about 8mm in size from residual growth), where the surgery was done. My options are to follow it and see if it changes in growth, MRI no sooner than six months, Gamma Knife radiosurgery or full-on open cranial surgery. Haha, yay."The message arrives in text form from Josh Perry, a 27-year-old professional BMX rider about to enter the 2017 competition season. A week before, we had spoke on the phone for an hour about his life as a professional BMX rider currently living and training in Cary, North Carolina, and how he was aiming to push himself into a larger role as an advocate for nutritional health and positive thinking, working with brands outside of BMX to help expose larger audiences to the passion that he's devoted his life to.A week later, the above message arrives. Ordinarily, the news has the potential to derail an entire day or year, let alone positive ambitions for the future. But Perry isn't like anyone I've ever met before. On top of all of the common injuries that accompany the life of a pro BMXer, this isn't Perry's first experience with masses in his brain. In fact, this is his third time.Perry quickly follows up with another text message: "Just rode a morning session and rode just as well as I've been riding. Nothing has changed if I don't allow it to." This from a guy who has already had his skull cut open to remove a large tumor, while doctors stopped the flow of blood to his brain through an artery in his groin."If I didn't hit my head riding, I'd be dead."Perry's history with brain tumors began in March of 2010.Perry was attempting to learn a new BMX Park trick on a quarterpipe when he over-rotated and landed off the bike, crashing down on his shoulder and head. Although he was wearing a helmet, Perry decided to undergo an MRI because of the fear of traumatic brain injury. But this wasn't Perry's first bout with injury as a BMX professional. There were lingering, unanswered issues in his recent medical history. Throughout that past year, he had been experiencing periods of intense headaches coupled with bouts of temporary blindness. After repeated doctor visits and an attempt by doctors to get Perry on pain killers, nothing had been diagnosed.Essentially, it took a BMX crash (the exact outcome Perry aimed to avoid) to get him to undergo a brain scan, and discover the source of his symptoms.But the outcome of the examination was not anything that he had expected. "I wanted to get an MRI to make sure my brain wasn't swelling and the doctors told me 'Yeah, you have a large mass that shouldn't be in your brain and it's a tumor, and we're not sure it's cancerous or benign but it needs to come out.'"Please do NOT hesitate to reach out to me on LinkedIn, Instagram, or via email mark@vudream.comLinkedIn - https://www.linkedin.com/in/mark-metry/Instagram - https://www.instagram.com/markmetry/Twitter - https://twitter.com/markymetryMedium - https://medium.com/@markymetryFacebook - https://www.facebook.com/Humans.2.0.PodcastMark Metry - https://www.markmetry.com/Humans 2.0 Twitter - https://twitter.com/Humans2Podcast

Tufts Medical Center in Boston just called with my latest MRI results: There are two new masses on the right side of my brain the size of peas (about 8mm in size from residual growth), where the surgery was done. My options are to follow it and see if it changes in growth, MRI no sooner than six months, Gamma Knife radiosurgery or full-on open cranial surgery. Haha, yay."The message arrives in text form from Josh Perry, a 27-year-old professional BMX rider about to enter the 2017 competition season. A week before, we had spoke on the phone for an hour about his life as a professional BMX rider currently living and training in Cary, North Carolina, and how he was aiming to push himself into a larger role as an advocate for nutritional health and positive thinking, working with brands outside of BMX to help expose larger audiences to the passion that he's devoted his life to.A week later, the above message arrives. Ordinarily, the news has the potential to derail an entire day or year, let alone positive ambitions for the future. But Perry isn't like anyone I've ever met before. On top of all of the common injuries that accompany the life of a pro BMXer, this isn't Perry's first experience with masses in his brain. In fact, this is his third time.Perry quickly follows up with another text message: "Just rode a morning session and rode just as well as I've been riding. Nothing has changed if I don't allow it to." This from a guy who has already had his skull cut open to remove a large tumor, while doctors stopped the flow of blood to his brain through an artery in his groin."If I didn't hit my head riding, I'd be dead."Perry's history with brain tumors began in March of 2010.Perry was attempting to learn a new BMX Park trick on a quarterpipe when he over-rotated and landed off the bike, crashing down on his shoulder and head. Although he was wearing a helmet, Perry decided to undergo an MRI because of the fear of traumatic brain injury. But this wasn't Perry's first bout with injury as a BMX professional. There were lingering, unanswered issues in his recent medical history. Throughout that past year, he had been experiencing periods of intense headaches coupled with bouts of temporary blindness. After repeated doctor visits and an attempt by doctors to get Perry on pain killers, nothing had been diagnosed.Essentially, it took a BMX crash (the exact outcome Perry aimed to avoid) to get him to undergo a brain scan, and discover the source of his symptoms.But the outcome of the examination was not anything that he had expected. "I wanted to get an MRI to make sure my brain wasn't swelling and the doctors told me 'Yeah, you have a large mass that shouldn't be in your brain and it's a tumor, and we're not sure it's cancerous or benign but it needs to come out.'"Please do NOT hesitate to reach out to me on LinkedIn, Instagram, or via email mark@vudream.comLinkedIn - https://www.linkedin.com/in/mark-metry/Instagram - https://www.instagram.com/markmetry/Twitter - https://twitter.com/markymetryMedium - https://medium.com/@markymetryFacebook - https://www.facebook.com/Humans.2.0.PodcastMark Metry - https://www.markmetry.com/Humans 2.0 Twitter - https://twitter.com/Humans2Podcast

Professional BMX athlete Josh Perry was just hitting his career stride when he was diagnosed with the first of three brain tumors at just 21 years old. But even after suffering through brain surgery and recovery, his spirit stayed strong, his resilience stayed intact, and he came out on the other side of his health odyssey with more fire and gratitude than ever before. Josh joins Dave to discuss how BMX saved his life, how he harnessed the power of holistic nutrition and new technologies like Gamma Knife radiosurgery to fight cancer, how to be your own best health advocate, and how he’s sharing his story of survival to advocate for brain health awareness. It’s an inspiring and cool story of triumph you won’t want to miss!

Professional BMX athlete Josh Perry was just hitting his career stride when he was diagnosed with the first of three brain tumors at just 21 years old. But even after suffering through brain surgery and recovery, his spirit stayed strong, his resilience stayed intact, and he came out on the other side of his health odyssey with more fire and gratitude than ever before. Josh joins Dave to discuss how BMX saved his life, how he harnessed the power of holistic nutrition and new technologies like Gamma Knife radiosurgery to fight cancer, how to be your own best health advocate, and how he’s sharing his story of survival to advocate for brain health awareness. It’s an inspiring and cool story of triumph you won’t want to miss!

Prof Grob speaks with ecancer at EADO 2017 about successes with combined immunotherapy and radiotherapy to treat metastatic melanoma. By treating brain metastases with upfront Gammaknife radiosurgery followed by systemic therapy, he reports disease control beyond that achieved with targeted therapy along. While there is no long-term survival or toxicity data matured so far, Prof Grob notes that the gains in overall survival are still significant and offer patients improved short-term survival.

Roswell Park Comprehensive Cancer Center is now treating patients with a brand-new, state-of-the-art Gamma Knife radiosurgery device, the Leksell Gamma Knife® Icon™ — the most advanced technology of its kind on the market. Roswell Park Comprehensive Cancer Center is the first cancer center in the United States to receive a license to operate it and remains the only facility in Western New York with Gamma Knife capabilities. We have used Gamma Knife radiosurgery to treat patients with brain tumors and metastases for 18 years. This latest technology comes with certain advances that mean more patients may qualify as candidates for the treatment, and the ultra-high accuracy minimizes long-term side effects, improving outcomes.In this segment, Dheerendra Prasad, MD, MCh, FACRO, Medical Director, Department of Radiation Medicine at Roswell Park Comprehensive Cancer Center, discusses the brand-new, state-of-the-art Gamma Knife radiosurgery, the most advanced technology of its kind on the market.

Roswell Park Comprehensive Cancer Center is now treating patients with a brand-new, state-of-the-art Gamma Knife radiosurgery device, the Leksell Gamma Knife® Icon™ — the most advanced technology of its kind on the market. Roswell Park Comprehensive Cancer Center is the first cancer center in the United States to receive a license to operate it and remains the only facility in Western New York with Gamma Knife capabilities. We have used Gamma Knife radiosurgery to treat patients with brain tumors and metastases for 18 years. This latest technology comes with certain advances that mean more patients may qualify as candidates for the treatment, and the ultra-high accuracy minimizes long-term side effects, improving outcomes.In this segment, Dheerendra Prasad, MD, MCh, FACRO, Medical Director, Department of Radiation Medicine at Roswell Park Comprehensive Cancer Center, discusses the brand-new, state-of-the-art Gamma Knife radiosurgery, the most advanced technology of its kind on the market.

CNS Tumors and Gamma Knife with guest Dr. Veronica Chiang September 20, 2015 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

CNS Tumors and Gamma Knife with guest Dr. Veronica Chiang September 20, 2015 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Despite all their schooling and expert advice, even doctors will disagree. Sometimes science is not so exact. The story about going through the decision process to recieve Gamma Knife Surgery.  Inspiration | Wisdom | Health | Healthcare | Gamma Knife | Brain Surgery | Stories

Vortragsreihe des TR3

Guest: John Y.K. Lee, MD Host: Lee Freedman, MD Dr. John Y.K. Lee, assistant professor of neurosurgery and medical director of the Gamma Knife Center within the University of Pennsylvania Health System, details the neurosurgical utility of the gamma knife with host Dr. Lee Freedman. What are its guiding principles? How does this minimally invasive approach add safety and precision to the current treatment modalities for brain tumors and other diseases? Discuss On Sermo

Guest: John Y.K. Lee, MD Host: Lee Freedman, MD Dr. John Y.K. Lee, assistant professor of neurosurgery and medical director of the Gamma Knife Center within the University of Pennsylvania Health System, details the neurosurgical utility of the gamma knife with host Dr. Lee Freedman. What are its guiding principles? How does this minimally invasive approach add safety and precision to the current treatment modalities for brain tumors and other diseases? Discuss On Sermo

Die Therapie und Nachsorge von Patienten mit uvealem Melanom gehört zu einem der Schwerpunkte der Augenklinik der Ludwig-Maximilians-Universität München. Seit Juni 1997 wurden insgesamt 100 Patienten (51 männlich, 49 weiblich) mit einseitigen uvealen Melanomen an der Augenklinik in Zusammenarbeit mit dem Gamma-Knife-Zentrum München nach einem standardisiertem Verfahren radiochirurgisch mit dem Gamma-Knife behandelt. In diese Studie wurden nur Patienten aufgenommen, die aufgrund der Tumorlokalisation und/oder der Tumorausdehnung (maximale apikale Tumorhöhe > 6mm, basaler Tumordurchmesser > 19mm) nicht mehr für eine konventionelle Brachytherapie geeignet waren. Durch die stereotaktische Präzisionsbestrahlung mit dem Gamma-Knife konnte diesen 100 Patienten die sonst nötige Enukleation des Auges erspart werden. Das mediane Alter der Patienten lag bei Diagnosestellung bei 62 Jahren (95% Konfidenzintervall (KI): 31-82 Jahren). Dabei war der jüngste Patient 24 Jahre und älteste Patient 84 Jahre zum Zeitpunkt der Erstdiagnose alt. Bei 55 Patienten befanden sich die intraokulären Tumoren im rechten Auge (55%), bei 45 Patienten im linken Auge (45%). Die Tumoren zeigten bei den 100 Patienten folgende Verteilung der Lokalisation: 61 Tumoren (61%) waren am hinteren Pol, das bedeutet die Tumoren berühren entweder die Makula und /oder die Papille und /oder einen großen temporalen oder nasalen Gefäßbogen lokalisiert; 21 Tumoren (21%) lagen ausschließlich choroideal in der mittleren Peripherie und 18 Tumoren (18%) befanden sich anterior und bezogen den Ziliarkörper mit ein. Die präoperative maximale apikale Tumorhöhe dieser 100 Patienten lag im Ultraschall bei einem Median von 7,85 mm (95% Konfidenzintervall (KI): 7,3- 8,3 mm). Das im hochauflösenden MRT ermittelte präoperative Tumorvolumen dieser 100 Patienten betrug in der 3D-MPR-Gewichtung im median 735 mm3 (95% KI: 620-880 mm3) und in der T2w Wichtung im median 655 mm3 (95% KI: 560-760 mm3). Unseres Wissens ist diese Studie die Erste, bei der eine Tumorregression bei uvealen Melanomen nach der stereotaktischen Präzisionsbestrahlung mit dem Gamma-Knife sowohl im hochauflösenden MRT als auch im Ultraschall untersucht und einander gegenüber gestellt wird. Eine signifikante Tumorregression wurde nur dann angenommen, wenn der Meßwert der Tumorgröße sich um mehr als zwei Standardabweichungen (2 SD) vom vorherigen Wert unterschied. Für die Ultraschalluntersuchung bedeutete dies, daß eine Tumorregression erst ab einer Größenänderung des Tumors von mehr als 0,36mm als sicher angenommen wurde. Im hochauflösenden MRT wurde in der MPR-3D Wichtung für ein sichere Tumorregression ein Größenänderung von >150mm3 vorausgesetzt, in der T2w Wichtung ein Änderung der Tumorgröße von >170mm3. Tumoren die nach einer kontinuierlichen Regression unter eine Tumorgröße von >0,36mm im Ultraschall und/ oder >150mm3 in der MPR-3D Wichtung beziehungsweise >170mm3 in der T2w Wichtung des hochauflösenden MRT schrumpften, wurden als nicht mehr sicher nachweisbar angesehen. 86 der 100 Patienten mit einem uvealen Melanom konnten in die weitere Untersuchung einer Tumorregression einbezogen werden. Insgesamt vier dieser 86 Patienten verstarben nach Tumorregression an der Fernmetastasierung des Primärtumors. Die Nachbeobachtungszeit dieser 86 Patienten seit der stereotaktischen Behandlung mit dem Gamma-Knife lag im median für das hochauflösende MRT (MPR-3D, T2w) bei 468,5 Tagen (95% KI: 347-611 Tagen) und im Ultraschall bei 528,5 Tagen (95% KI: 497,0- 595,0 Tagen). Bei 81 der 86 Patienten konnte eine signifikante Tumorregression nach der stereotaktischen Bestrahlung im hochauflösende MRT (MPR-3D, T2w) nachgewiesen werden. Nach einer Beobachtungszeit vom im median 73,0 Tagen (95% KI: 58,0- 84,0 Tage) zeigte sich in der MPR-3D gewichteten Sequenz des MRT eine signifikante Tumorregression. In der T2w gewichteten Sequenz betrug diese Zeit im median 78,0 Tage (95% KI: 61,0-92,0 Tage). Echographisch ließ bei 63 der 86 Patienten eine signifikante Tumorregression nach der sereotaktischen Präzisionsbestrahlung im Ultraschall nachweisen. Diese signifikante Tumorregression wurde im Ultraschall nach einer Nachbeobachtungszeit vom im median 137,0 Tagen (95% KI: 92,0- 182,0 Tagen) festgestellt. Der Unterschied bis zum Zeitpunkt (in Tagen) einer signifikanten Tumorregression zwischen hochauflösenden MRT(MPR-3D, T2w) und Ultraschall ist signifikant (p< 0,001). Bei 63 dieser 86 Patienten zeigte sich die Tumorregression nach der stereotaktischen Präzisionsbestrahlung mit dem Gamma-Knife zuerst im hochauflösenden MRT(MPR-3D, T2w), bei 10 dieser 86 Patienten ließ sich diese zuerst im Ultraschall feststellen. Bei 89 dieser 100 Patienten konnte untersucht werden, ob und wann der Tumor nach kontinuierlicher Regression nicht mehr durch das hochauflösende MRT und/oder Ultraschall nachgewiesen werden kann. Insgesamt vier dieser 86 Patienten verstarben nach Tumorregression an Fernmetastasen des Primärtumors. Die Nachbeobachtungszeit dieser 89 Patienten betrug seit der stereotaktischen Behandlung mit dem Gamma-Knife im median für das hochauflösende MRT (MPR-3D, T2w) 431,0 Tagen (95% KI: 346,0- 609,0 Tagen) und im Ultraschall 531,0 Tagen (95% KI: 497,0-668,0 Tagen). Nach einer kontinuierlichen Tumorregression lag die geschrumpfte Tumorrestgröße bei 37 der 89 Patienten unter der sicheren Nachweisbarkeitsgrenze des hochauflösenden MRT in der 3D-MPR Wichtung. Die Beobachtungszeit bis die Tumorrestgröße unter die Nachweisbarkeit des hochauflösenden MRT in der 3D-MPR Wichtung fiel betrug dabei im median 284,0 Tage (95% KI: 202,0- 365,0 Tage). In der T2w Wichtung des hochauflösenden MRT fiel bei 38 der 89 Patienten die Tumorgröße nach der stereotaktischen Präzisionsbestrahlung mit dem Gamma-Knife unter die Grenze der sicheren Nachweisbarkeit des Tumors. Dabei betrug die Zeit bis der Tumor nach kontinuierlicher Regression unter die Nachweisbarkeitsgrenze des hochauflösenden MRT in der T2w Wichtung fiel im median 279,5 Tage (95% KI: 186,0- 359,0 Tage). Im Gegensatz dazu ließ sich der Tumor nach kontinuierlicher Regression bei allen 89 Patienten mit dem Ultraschall nachweisen. Die maximale apikale Tumorhöhe der 37 Patienten, die sich mit dem MRT nicht mehr sicher nachweisen ließen, betrug im median 3,8mm (95% KI: 3,0- 4,6 mm). Bei den 38 Patienten, die nicht mehr sicher mit dem MRT in der T2w Wichtung nachgewiesen wurden, lag die maximale apikale Tumorhöhe im median bei 3,9 mm (95% KI: 3,0- 4,6 mm). Zusammenfassend ist somit festzuhalten, das ein Ansprechen von uvealen Melanom auf die stereotaktische Präzisionsbestrahlung mit dem Gamma-Knife im Sinne einer Tumorregression zuerst im hochauflösenden MRT gesichert werden kann, bevor dies mit dem Ultraschall möglich ist. Anderseits können Regression- und / oder Vernarbungszeichen uveale Melanome mit dem Ultraschall in der weiteren Verlaufkontrolle noch nachgewiesen werden, während diese bereits mit dem hochauflösenden MRT nicht mehr sicher möglich ist.

Von Juni 1997 bis April 2001 wurden 97 Patienten, die an einem unilateralen uvealen Melanom litten, mit dem Gamma-Knife radiochirurgisch behandelt. Die Melanome aller 97 Patienten waren aufgrund der Lokalisation oder der Größe für eine Therapie mit Ruthenium-Applikatoren nicht geeignet. Alle 97 Patienten, die sich der Therapie mit dem Gamma-Knife unterzogen, wurden in eine engmaschige Nachsorge aufgenommen. Bei der Nachsorge wurden in regelmäßigen Abständen klinische, echographische und neuroradiologische Untersuchungen durchgeführt. Die Daten der Patienten beziehen sich auf einen Zeitraum von median drei Jahren nach erstmalig erfolgter Bestrahlung mit dem Gamma-Knife. Bei 73 der 97 Patienten lagen Daten mit einem Jahr Nachbeobachtungszeit (median 12 Monate (Konfidenzintervall: 9-15 Monate)) nach erfolgter Bestrahlung vor. Alle 73 Patienten konnten bulbuserhaltend therapiert werden. Von einer lokalen Tumorkontrolle konnte bei 72 Patienten der 73 Patienten gesprochen werden. Die lokale Tumorkontrolle wurde als Stoppen der Tumorprogression oder als Tumorregression definiert. So war bei einem der 73 Patienten keine lokale Tumorkontrolle möglich. Im Echogramm konnte nun die maximale apikale Tumorhöhe im standardisierten A- Bild gemessen und mit den Ausgangswerten bei primärer Diagnosestellung verglichen werden. Bei primärer Diagnosestellung ließ sich ein Wert von median 8,0 mm festhalten. Bei einjähriger Nachbeobachtungszeit nach Bestrahlung mit dem Gamma-Knife war die maximale apikale Tumorhöhe auf den medianen Wert von 5,7 mm abgesunken. Bei 7 Patienten musste innerhalb des folgenden Jahres nach Behandlung mit dem Gamma-Knife eine Enukleation durchgeführt werden. Bei 33 Patienten lagen Daten mit zwei Jahren Nachbeobachtungszeit nach erfolgter Bestrahlung vor. Eine lokale Tumorkontrolle war bei allen 33 Patienten möglich. Auch im Echogramm konnte nun median ein deutlich Rückgang der maximalen apikalen Tumorhöhe verzeichnet werden. So war nun nach Ablauf der zweijährigen Nachbeobachtungszeit nach Bestrahlung mit dem Gamma-Knife die maximale apikale Tumorhöhe auf den medianen Wert von 4,3 mm abgesunken. Der Unterschied war statistisch hochsignifikant. Bei 1 Patienten musste innerhalb des folgenden Jahres eine Enukleation durchgeführt werden. Bei 15 Patienten lagen Daten mit drei Jahren Nachbeobachtungszeit nach erfolgter Bestrahlung vor. Eine lokale Tumorkontrolle war bei allen 15 Patienten möglich. Hier war ebenfalls ein deutlicher Rückgang der maximalen apikalen Tumorhöhe im Echogramm zu verzeichnen. So war die maximale apikale Tumorhöhe auf den medianen Wert von 4,6 mm abgesunken. Innerhalb des folgenden Jahres musste nun bei keinem der 15 Patienten eine Enukleation durchgeführt werden. Die klinischen Ergebnisse der 97 Patienten haben gezeigt, dass mittels einer stereotaktischen Präzisionsbestrahlung mit dem Gamma-Knife Patienten mit großen oder ungünstig gelegenen uvealen Melanomen, die nur durch eine Enukleation hätten behandelt werden können, in hohem Prozentsatz erfolgsversprechend bulbuserhaltend therapiert werden konnten. Die Wahrscheinlichkeit einer Enukleation war im ersten Jahr nach erfolgter Bestrahlung mit dem Gamma-Knife am größten und nahm in der Behandlungsserie in den folgenden Jahren rapide ab.

Das Akustikusneurinom ist mit ca. 6% der häufigste intrakranielle Tumor und hat eine jährliche Inzidenz von 1:100000. Die durchschnittliche Wachstumsrate beträgt 2 mm pro Jahr, wobei es auch Akustikusneurinome gibt, die sehr viel schneller wachsen können. Bei der Behandlung des Schwannoms stehen uns zwei Modalitäten zur Verfügung. Die konventionelle Chirurgie und die stereotaktische Radiochirurgie, zu der die Gamma-Knife Therapie und der Linearbeschleuniger zählen. Sorgfältig ausgesuchte Patienten können unter regelmäßiger Kontrolle beobachtet werden, das sogenannte „watch and wait“. Im Falle einer Größenprogredienz wäre eine der o.g. Therapiemodalitäten indiziert. Unter stereotaktischer Radiochirurgie versteht man die hochpräzise und punktförmig geführte Strahlenbehandlung mit einer sehr hohen Einzeldosis auf einen bestimmten Punkt, das Isozentrum. Aufgrund der speziellen und hochpräzisen Strahlenführung ist das Risiko der Verletzung gesunder Strukturen trotz Anwendung hoher Strahlendosen gering. Im Gegensatz zur Operation, bei der das Tumorgewebe entfernt wird, wird in der Strahlenchirurgie dosisabhängig Tumorgewebe inaktiviert, nekrotisiert bzw. durch Induktion charakteristischer, molekularer Prozesse, wie z. B. Apoptose eine Inaktivierung bzw. funktionelle Ausschaltung des Tumors erzielt. Als limitierender Faktor gilt ein maximaler Tumordurchmesser von 4 cm. Von 1994 bis 2000 wurden 182 Patienten im Gamma-Knife Zentrum München stereotaktisch behandelt. Das Follow-up endete im Juni 2004. 123 Patienten mit einem einseitigen Akustikusneurinom wurden primär stereotaktisch behandelt (Gruppe A). 59 Patienten waren primär mikrochirurgisch vorbehandelt und erhielten im Verlauf aufgrund eines Rezidives oder aufgrund anderer chirurgischer Umstände eine Gamma-Knife Bestrahlung (Gruppe B). Ziel dieser Arbeit war der Vergleich des Gehörs, der Fazialisfunktion, der Beeinträchtigung des N. trigeminus und des Auftretens von Tinnitus und Schwindel vor und nach einer Gamma-Knife Behandlung und die Auswertung des Verfahrens hinsichtlich der allgemeinen Behandlungsparameter. Patienten mit einer Neurofibromatose Typ II wurden nicht mit in die Auswertung einbezogen. Die Analyse ergab für die Gruppe A, dass sich bei 68,3% der Patienten das Gehör im Hauptsprachbereich durchschnittlich um 6 dBHL verschlechtert hatte. Bei 15 Patienten (23,8%) lag der Hörverlust über 20 dBHL. Patienten mit einem kleinen und intrameatal gelegenen AKN wiesen den größten Hörverlust auf. Bei keinem der Patienten hatte sich die Fazialisfunktion, ermittelt über die House-Brackmann Einteilung, verschlechtert. Sieben Patienten (5,8%) berichteten nach der Gamma-Knife Behandlung über ein neuaufgetretenes Trigeminusreizsymptom. Je größer der Tumor, umso wahrscheinlicher war eine Beteiligung des Nervus trigeminus. 4,2% der untersuchten Personen entwickelten einen Tinnitus nach der Bestrahlung. In 13,3% der Fälle trat ein Schwindel erstmalig nach der Behandlung auf, wobei das Alter der Patienten als Prädispositionsfaktor anzusehen war. Für die Gruppe B ergab die Analyse, dass sowohl im Tiefton-, als auch im Breitbandbereich der größte Hörverlust mit 20 dBHL bzw. 23 dBHL bei den intrameatal gelegenen Akustikusneurinomen lag. Bei zwei Patienten ist nach der Gamma-Knife Therapie eine Einschränkung des Nervus trigeminus beschrieben. Die Größe des Tumors, die Maximaldosis und die Anzahl der Zielpunkte bei diesen beiden Patienten lagen jeweils über dem Median der Gesamtgruppe. Nur bei einer Patienten ist nach der Bestrahlung das Symptom Schwindel neu aufgetreten. Die Funktion des Nervus fazialis hatte sich bei drei Patienten jeweils um eine Stufe nach House Brackmann verschlechtert. Die Operation ist gegenüber der Radiochirurgie wirksamer, da sie unabhängig von der Tumorgröße eingesetzt werden kann, wobei jedoch ein höheres Behandlungsrisiko akzeptiert werden muss. Die Radiochirurgie hat bei kleinen Akustikusneurinomen den Vorteil eines ambulanten, nicht invasiven Verfahrens, bei dem das Risiko von Fazialisparesen und Trigeminusreizsymptomen sehr gering ist. Betrachtet man den ökonomischen Aspekt, so ergeben sich für die Radiochirurgie deutlich niedrigere Kosten und eine schnellere Rückführung in das Berufsleben, als bei der Mikrochirurgie. Die Radiochirurgie bietet ebenso wie die Operation eine Chance, die Hörfähigkeit zu erhalten.

Charakteristisch für das Krankheitsbild der Akromegalie sind eine pathologisch erhöhte Sekretion des Wachstumshormons (STH) im Erwachsenenalter und dadurch bedingte metabolische und morphologische Auswirkungen. In 99% der Fälle wird das Wachstumshormon von einem Hypophysenadenom produziert. Die Manifestation einer Akromegalie und die Breite des klinischen Erscheinungsbildes entstehen durch die Kompression umliegender Strukturen durch das Hypophysenadenom und durch die biologische Wirkung der erhöhten STH- und IGF-I-Konzentrationen. Als Therapie der ersten Wahl gilt die mikrochirurgische transsphenoidale Entfernung des Hypophysenadenoms. Zur Sekundärbehandlung der Akromegalie stehen die medikamentöse Therapie, die konventionelle Radiotherapie und die Radiochirurgie (Gamma Knife) zur Verfügung. Ziel dieser retrospektiven Studie ist es, über die Ergebnisse der Gamma Knife-Therapie zu berichten. Wir berichten über 39 Patienten mit Akromegalie, die mit dem Gamma Knife im Gamma Knife Zentrum in München therapiert wurden. Der Median der Beobachtungszeit lag bei 1,4 Jahren (Range 0,5 – 4,3 Jahre). Der Median xULN (multiple of upper limit of normal) der IGF-I-Konzentration vor der Radiotherapie lag bei 1,9 (Range: 0,5 – 8,9 xULN). Nach der Gamma Knife–Therapie (GKTH) lag der Median der IGF-I–Konzentration bei 1,29 xULN (Range: 0,2 – 3,3 xULN; p< 0,001). Von 39 Patienten hatten 21 Patienten eine normale IGF-I-Konzentration. Vor der GKTH lag der Median des Adenomvolumens bei 1,5 cm3 (Range: 0,1 – 13,1 cm3). Am Ende der Beobachtungszeit lag der Median des Tumorvolumens bei 0,3 cm3 (Range: kein Resttumorgewebe – 8,3 cm3; p < 0,001). In der Studie wurde außerdem gezeigt, dass die Erfahrung des Radiochirurgen für den Therapieerfolg der Gamma Knife-Behandlung von großer Bedeutung ist. Zusammenfassend lässt sich feststellen, dass die Gamma Knife–Therapie effektiv die IGF-I-Konzentration senken kann. Am Ende der Beobachtungszeit hatten 54% der Patienten einen alters- und geschlechtsspezifischen IGF-I-Wert.

The new DIN (' Deutsche Industrie- Norm') 6875- 1, which is currently being finalised, deals with quality assurance ( QA) criteria and tests methods for linear accelerator and Gamma Knife stereotactic radiosurgery/ radiotherapy including treatment planning, stereotactic frame and stereotactic imaging and a system test to check the whole chain of uncertainties. Our existing QA program, based on dedicated phantoms and test procedures, has been refined to fulfill the demands of this new DIN. The radiological and mechanical isocentre corresponded within 0.2 mm and the measured 50% isodose lines were in agreement with the calculated ones within less than 0.5 mm. The measured absorbed dose was within 3%. The resultant output factors measured for the 14-, 8- and 4- mm collimator helmet were 0.9870 +/- 0.0086, 0.9578 +/- 0.0057 and 0.8741 +/- 0.0202, respectively. For 170 consecutive tests, the mean geometrical accuracy was 0.48 +/- 0.23 mm. Besides QA phantoms and analysis software developed in- house, the use of commercially available tools facilitated the QA according to the DIN 6875- 1 with which our results complied. Copyright (C) 2004 S. Karger AG, Basel.

Gamma knife radio surgery is surgery without a scalpel. The procedure combines radiation oncology and neurosurgery to treat lesions in the brain, including tumors. Among the upsides, there's no incision in the skull, the radiation can be given in a single outpatient setting, and there are no typical side effects like hair loss, and nausea and vomiting, that come with traditional radiation therapy. This week on the Mayo Clinic Q&A podcast, Dr. Bruce Pollock, a Mayo Clinic neurosurgeon, explains how gamma knife radiosurgery is performed. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy