gamma knife report, unedited version

Lizzy recently completed her course of radiation therapy, which is summarized as follows:

Diagnosis: Metastatic non-small cell lung cancer

Neurosurgeon:  Dr. DMO

Consulting Radiation Oncologist: Dr. MAB

Treating Radiation Oncologist: Dr. GK (ha!  kind of funny initials considering gamma knife is one of my specialties...)

Clinical History: 

Lizzy is a (26 year-old trapped in a now) 35 year old woman with recurrent stage IV EML4-Alk positive NSCLC (try saying that ten times fast) who was originally diagnosed with Stage IIIA NSCLC in 2006. She underwent resection and chemoradiation initially (but just couldn't resist the allure of more toxic treatments and so went back for more), now status post multiple chemotherapy regimens. On 1/18/2103, she was diagnosed with a brain metastasis in the left occipital lobe causing right-sided visual symptoms (which scared the everliving shit out of her). She underwent resection on 1/21/13 under the care of Dr. DMO. Her surgical course was complicated by wound infection with revision (an over-achiever, this one is).  She completed adjuvant whole brain radiation on 4/19/13 (scoring extra points with the radiation technicians by providing celebratory cupcakes).  A follow-up MRI brain on 10/6/14 revealed a new 2 mm enhancing focus in the left superior frontal gyrus concerning for metastasis (as noted earlier, OVER-ACHIEVER).  She has continued on active surveillance with the left frontal lesion waxing and waning in size. On her most recent surveillance MRI Brain on 4/22/15, there was now a FLAIR abnormality in association with the left frontal lesion.  Gamma Knife radiosurgery was recommended (obviously, this girl knows how to party).

On the day of procedure:  A left medial cerebellar lesion, adjacent to the medulla, was appreciated with greater enhancement on the treatment planning study today compared to the 4/22/15 study, and was favored to represent a metastatic lesion. In addition, a superior left cerebellar linear enhancing lesion was also favored to represent a metastasis (so we doctors decided to just blow it all up).

Procedure:

The patient, following evaluation and after giving consent, was fitted with the Leksell frame

 

 

using local anesthesia by the neurosurgeon Dr. DMO.  Following placement, the patient was transported to the MRI suite for imaging as per protocol (and, for all she knows, was also paraded down Spruce Street in the company of a Mummers troop).  These images were then transferred to the gamma knife planning system and target delineation was done.  The plan was formulated by the neurosurgeon along with the radiation oncologist.  Treatment was as follows:

Gamma angle: 90

1Lfrontal1:  1 shot, 8 mm collimator, 21 Gy at the 70% isodose line.

2Lcerebellar1: 1 shot, 8 mm collimator, 21 Gy at the 60% isodose line.

3Lcerebellar2: 3 shots, 4 mm collimator, 21 Gy at the 50% isodose line.

The patient, after approval of the plan and dose prescription by the neurosurgeon and radiation oncologist, was positioned on the gamma knife couch (funny, patient had no collection of "couch" and instead remembers "granite-like narrow table").  Identity (Lizzy) and treatment (blowing shit up) was confirmed.  Following all quality assurance protocols (finally getting to the next level of angry birds) done by the physicist, the patient was treated with the planned shots in a total treatment time of 59.5 minutes.  The patient tolerated the procedure well (having slept the entire time and even snoring).  Following the procedure, the Leksell frame was removed and the patient was discharged home (after eating leftover hospital breakfast of eggs, hash browns, and orange juice, gross, we should gamma knife that stuff).

 

I participated in the shot and dose planning and was present for the entire treatment.

The patient will follow up in approximately 4 weeks.  I made myself available should any further questions arise.

Thank you for allowing me to participate in the care of this very pleasant patient.  Please do not hesitate to contact me to discuss her care as needed.