Leksell gamma knife icon

Manufactured by Elekta

The Leksell Gamma Knife® Icon™ is a medical device designed for stereotactic radiosurgery. It uses multiple beams of gamma radiation to precisely target and treat lesions or tumors in the brain.

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Lab products found in correlation

32 channel head coil, by Philips (1 mentions) Leksell gammaplan, by Elekta (1 mentions) Synergy agility linac, by Elekta (1 mentions) Leksell gammaplan software, by Elekta (1 mentions) Leksell gamma knife perfexion, by Elekta (1 mentions)

5 protocols using leksell gamma knife icon

Stereotactic Radiotherapy for Brain Lesions

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Up to 2018, patients were treated with the LINAC Synergy Agility TM (Elekta A.B., Stockholm, Sweden) at the NKI. All patients underwent a computed tomography (CT) scan in a supine position using a mask for fixation (17) . CT scan was registered with a 1-mm-thick contrast-enhanced T1-weighted MRI-scan, which was used for the delineation of GTV. Planning target volume (PTV) was created by expanding GTV with 2 mm (18) . Dose prescribed to PTV was either 18-24 Gy in a single fraction, 21-27 Gy in 3 fractions, or 25-30 Gy in 5 fractions. A treatment plan was created to such that a minimum of 95% of PTV received 100% of the prescribed dose (17) .
As of February 2018, patients were treated with the Leksell Gamma Knife® Icon™ (Elekta A.B., Stockholm, Sweden). Immobilization was performed using a mask or rigid headframe. Patients received a dose of 18-25 Gy, with 99-100% coverage of the target and no setup margin was used (17) .

Albers E.A.C., de Ligt K.M., van de Poll-Franse L.V., Compter A., de Ruiter M.B, & Schagen S.B. (2023). Health-related quality of life after stereotactic radiosurgery in patients with brain metastases. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 31(12).

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GKRS Protocol for Brain Metastases

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All patients underwent GKRS using the Leksell Gamma Knife ICON (Elekta AB, Stockholm, Sweden). All patients underwent 3 Tesla magnetic resonance imaging (Philips Achieva, Netherlands) with 32-channel head coil. The scanning sequences included T1-weighted, T1-weighted with gadolinium enhancement, and T2-weighted images. All magnetic resonance imaging images were registered with Leksell Gamma Plan (LGP, Version 11.1.1), and any images with motion artifacts were excluded. The tumor volumes were calculated by LGP without margin. Generally, the prescription dose was determined by the recommendations from the dose escalation trial Radiation Therapy Oncology Group 90 to 05,^{[30 (link)]} considering individual patient conditions. For large BM (>10 cc), fractionated GRKS was selected based on the linear quadratic model.^{[31 (link),32 (link)]} The GKRS planning was determined through a consensus between the neurosurgeon and the medical physicist.

Moon H.C., Min B.J, & Park Y.S. (2023). Can we predict overall survival using machine learning algorithms at 3-months for brain metastases from non-small cell lung cancer after gamma knife radiosurgery?. Medicine, 103(5), e37084.

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Gamma Knife Radiosurgery for Brain Metastases

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All patients underwent GKS using Leksell Gamma Knife ICON (Elekta Instrument AB, Stockholm, Sweden). Treatment planning was performed using Leksell GammaPlan software (Elekta AB). BMs were defined on 1-mm thickness gadolinium-enhanced T1-weighted images, referring to the nonenhanced T1-, T2-weighted images, and black-blood contrast images. Out of the total 67 patients, 45 patients (67.2%) received single-fraction GKS, 18 patients (26.9%) received 3 fractions GKS, and 4 patients (6.0%) received 5 fractions GKS for consecutive days. A thermoplastic mask was generally applied for fractionated GKS, whereas a rigid stereotactic frame was used for single-fraction GKS. Data regarding the number of BMs, intracranial cumulative tumor volume (∑ TV), and prescription dose were extracted from the prospectively collected database. To ensure a fair comparison of the prescription dose among patients with varying numbers of fractions, the doses of patients receiving hypofractionation were converted to an equivalent single fraction dose, considering the biologically effective dose (BED) values. BED was estimated using a linear-quadratic model, assuming an α/β ratio of 10^{20 (link)}. In patients with multiple BMs, the mean prescription dose and BED were used for comparison.

Park H., Chung H.T., Kim J.W., Dho Y.S, & Lee E.J. (2023). A 3-month survival model after Gamma Knife surgery in patients with brain metastasis from lung cancer with Karnofsky performance status ≤ 70. Scientific Reports, 13, 13159.

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Stereotactic Radiotherapy for Brain Metastases

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Up till 2018, all patients at the NKI were treated with a LINAC Synergy Agility™ (Elekta A.B., Stockholm, Sweden). Patients underwent a computed tomography (CT) scan in a supine position using a mask for fixation [20 (link)]. The CT scan was registered with a 1-mm-thick contrast-enhanced T1-weighted MRI-scan, which was used for delineation of gross tumor volume (GTV) of BM. PTV was created by expanding GTV with 2 mm [14 (link)]. Dose prescribed to PTV was 18–24 Gy in a single fraction, 21–27 Gy in three fractions, or 25–30 Gy in five fractions. A treatment plan was created to such that a minimum of 95% of PTV received 100% of the prescribed dose [20 (link)].
Since February 2018, patients were treated with the Leksell Gamma Knife® Icon™ (Elekta A.B., Stockholm, Sweden). Immobilization was performed using a mask or rigid headframe. Patients received a dose of 18–25 Gy, with 99–100% coverage of the target and no setup margin was used [20 (link)].

Albers E.A., de Ruiter M.B., van de Poll-Franse L.V., Merckel L.G., Compter A, & Schagen S.B. (2022). Neurocognitive functioning after Gamma Knife and LINAC stereotactic radiosurgery in patients with brain metastases. Journal of Neuro-Oncology, 160(3), 649-658.

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Hypo-fractionated Radiosurgery for Metastatic Lesions

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Radiosurgery was performed with the Leksell Gamma Knife Perfexion from 2009 to 2015 or the Leksell Gamma Knife Icon (both Elekta AB, Stockholm, Sweden) from April 2016 onward. The 1.0-mm slices of T1-weighted and 2.0-mm slices of T2-weighted fluid-attenuated inversion recovery (FLAIR) contrast-enhanced MR images were obtained and transferred to the Leksell GammaPlan Software version 11.1.1 (Elekta AB). Patients with tumor volume larger than 10 cc, maximal tumor diameter > 3 cm and retreatment metastatic lesion were indicated for the hypo-fractionated radiotherapy^{33 (link)–35 (link)}. The gross target volume and clinical target volume were defined identically to the perimeter of T1 enhancement in MRI. The planning target volume or prescription isodose volume (PIV) was created with 0 mm margin in single or two fractionated radiosurgery and with 2 mm margin in three or four fractionated radiosurgery. The dosimetry planning was conducted in accordance with the Radiation Therapy Oncology Group 90–05 study guidelines^{36 (link),37 (link)}.
Among these indicators, PIV was used in the analysis as a radiosurgical factor. The irradiated volume, rather than the geometric volume of the tumor, has more potential to influence the clinical course of metastatic lesions.

Kim J.H., Choi J.W., Kong D.S., Seol H.J., Nam D.H., Ryu J.W., Kim S.T., Suh Y.L, & Lee J.I. (2022). Histopathology and surgical outcome of symptomatic treatment-related changes after gamma knife radiosurgery in patients with brain metastases. Scientific Reports, 12, 3013.

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