Gamma Knife Radiosurgery for Treatment of Brain Metastases during the COVID-19 Outbreak.
Identifieur interne : 000944 ( Main/Curation ); précédent : 000943; suivant : 000945Gamma Knife Radiosurgery for Treatment of Brain Metastases during the COVID-19 Outbreak.
Auteurs : Francesco Maria Crisà [Italie] ; Filippo Leocata [Italie] ; Virginia Maria Arienti [Italie] ; Marco Picano [Italie] ; Luca Berta [Italie] ; Hae Song Mainardi [Italie] ; Angelo Filippo Monti [Italie] ; Francesco Musca [Italie] ; Silvia Colombo [Italie] ; Mauro Palazzi [Italie] ; Alessandro La Camera [Italie]Source :
- Stereotactic and functional neurosurgery [ 1423-0372 ] ; 2020.
Descripteurs français
- KwdFr :
- Adulte d'âge moyen (MeSH), Betacoronavirus (MeSH), Femelle (MeSH), Humains (MeSH), Infections à coronavirus (MeSH), Italie (MeSH), Mâle (MeSH), Pandémies (MeSH), Pneumopathie virale (MeSH), Radiochirurgie (méthodes), Récidive tumorale locale (chirurgie), Résultat thérapeutique (MeSH), Sujet âgé (MeSH), Tumeurs du cerveau (radiothérapie), Tumeurs du cerveau (secondaire), Études rétrospectives (MeSH).
- MESH :
- chirurgie : Récidive tumorale locale.
- méthodes : Radiochirurgie.
- radiothérapie : Tumeurs du cerveau.
- secondaire : Tumeurs du cerveau.
- Adulte d'âge moyen, Betacoronavirus, Femelle, Humains, Infections à coronavirus, Italie, Mâle, Pandémies, Pneumopathie virale, Résultat thérapeutique, Sujet âgé, Études rétrospectives.
- Wicri :
- geographic : Italie.
English descriptors
- KwdEn :
- Aged (MeSH), Betacoronavirus (MeSH), Brain Neoplasms (radiotherapy), Brain Neoplasms (secondary), Coronavirus Infections (MeSH), Female (MeSH), Humans (MeSH), Italy (MeSH), Male (MeSH), Middle Aged (MeSH), Neoplasm Recurrence, Local (surgery), Pandemics (MeSH), Pneumonia, Viral (MeSH), Radiosurgery (methods), Retrospective Studies (MeSH), Treatment Outcome (MeSH).
- MESH :
- geographic : Italy.
- methods : Radiosurgery.
- radiotherapy : Brain Neoplasms.
- secondary : Brain Neoplasms.
- surgery : Neoplasm Recurrence, Local.
- Aged, Betacoronavirus, Coronavirus Infections, Female, Humans, Male, Middle Aged, Pandemics, Pneumonia, Viral, Retrospective Studies, Treatment Outcome.
Abstract
INTRODUCTION
The WHO declared 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a public health emergency of international concern. The National and Regional Health System has been reorganized, and many oncological patients died during this period or had to interrupt their therapies. This study summarizes a single-centre experience, during the COVID-19 period in Italy, in the treatment of brain metastases with Gamma Knife stereotactic radiosurgery (GKRS).
METHODS
We retrospectively analysed our series of patients with brain metastases who underwent GKRS at the Niguarda Hospital from February 24 to April 24, 2020.
RESULTS
We treated 30 patients with 66 brain metastases. A total of 22 patients came from home and 8 patients were admitted to the emergency room for urgent neurological symptoms. Duration of stay was limited to 0-1 day in 17 patients. We chose to treat a cluster of 9 patients, whose greater lesion exceeded 10 cm3, with 2-stage modality GKRS to minimize tumour recurrence and radiation necrosis.
CONCLUSION
Due to the COVID-19 pandemic, the whole world is at a critical crossroads about the use of health care resources. During the COVID-19 outbreak, the deferral of diagnostic and therapeutic procedures and a work backlog in every medical specialty are the natural consequences of reservation of resources for COVID-19 patients. GKRS improved symptoms and reduced the need for open surgeries, allowing many patients to continue their therapeutic path and sparing beds in ICUs. Neurosurgeons have to take into account the availability of stereotactic radiosurgery to reduce hospital stay, conciliating safety for patients and operators with the request for health care coming from the oncological patients and their families.
DOI: 10.1159/000510271
PubMed: 32726792
PubMed Central: PMC7490500
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Italy</wicri:regionArea></affiliation></author><author><name sortKey="Leocata, Filippo" sort="Leocata, Filippo" uniqKey="Leocata F" first="Filippo" last="Leocata">Filippo Leocata</name><affiliation wicri:level="1"><nlm:affiliation>Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Arienti, Virginia Maria" sort="Arienti, Virginia Maria" uniqKey="Arienti V" first="Virginia Maria" last="Arienti">Virginia Maria Arienti</name><affiliation wicri:level="1"><nlm:affiliation>Radiotherapy, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Radiotherapy, ASST Grande Ospedale Metropolitano Niguarda, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Picano, Marco" sort="Picano, Marco" uniqKey="Picano M" first="Marco" last="Picano">Marco Picano</name><affiliation wicri:level="1"><nlm:affiliation>Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Berta, Luca" sort="Berta, Luca" uniqKey="Berta L" first="Luca" last="Berta">Luca Berta</name><affiliation wicri:level="1"><nlm:affiliation>Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Mainardi, Hae Song" sort="Mainardi, Hae Song" uniqKey="Mainardi H" first="Hae Song" last="Mainardi">Hae Song Mainardi</name><affiliation wicri:level="1"><nlm:affiliation>Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Monti, Angelo Filippo" sort="Monti, Angelo Filippo" uniqKey="Monti A" first="Angelo Filippo" last="Monti">Angelo Filippo Monti</name><affiliation wicri:level="1"><nlm:affiliation>Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Musca, Francesco" sort="Musca, Francesco" uniqKey="Musca F" first="Francesco" last="Musca">Francesco Musca</name><affiliation wicri:level="1"><nlm:affiliation>Cardiology IV, A. De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Cardiology IV, A. De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Colombo, Silvia" sort="Colombo, Silvia" uniqKey="Colombo S" first="Silvia" last="Colombo">Silvia Colombo</name><affiliation wicri:level="1"><nlm:affiliation>Clinical Management Staff, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Clinical Management Staff, ASST Grande Ospedale Metropolitano Niguarda, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Palazzi, Mauro" sort="Palazzi, Mauro" uniqKey="Palazzi M" first="Mauro" last="Palazzi">Mauro Palazzi</name><affiliation wicri:level="1"><nlm:affiliation>Radiotherapy, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Radiotherapy, ASST Grande Ospedale Metropolitano Niguarda, Milan</wicri:regionArea></affiliation></author><author><name sortKey="La Camera, Alessandro" sort="La Camera, Alessandro" uniqKey="La Camera A" first="Alessandro" last="La Camera">Alessandro La Camera</name><affiliation wicri:level="1"><nlm:affiliation>Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan</wicri:regionArea></affiliation></author></analytic><series><title level="j">Stereotactic and functional neurosurgery</title><idno type="eISSN">1423-0372</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term><term>Betacoronavirus (MeSH)</term><term>Brain Neoplasms (radiotherapy)</term><term>Brain Neoplasms (secondary)</term><term>Coronavirus Infections (MeSH)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Italy (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Neoplasm Recurrence, Local (surgery)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (MeSH)</term><term>Radiosurgery (methods)</term><term>Retrospective Studies (MeSH)</term><term>Treatment Outcome (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte d'âge moyen (MeSH)</term><term>Betacoronavirus (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Infections à coronavirus (MeSH)</term><term>Italie (MeSH)</term><term>Mâle (MeSH)</term><term>Pandémies (MeSH)</term><term>Pneumopathie virale (MeSH)</term><term>Radiochirurgie (méthodes)</term><term>Récidive tumorale locale (chirurgie)</term><term>Résultat thérapeutique (MeSH)</term><term>Sujet âgé (MeSH)</term><term>Tumeurs du cerveau (radiothérapie)</term><term>Tumeurs du cerveau (secondaire)</term><term>Études rétrospectives (MeSH)</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Italy</term></keywords><keywords scheme="MESH" qualifier="chirurgie" xml:lang="fr"><term>Récidive tumorale locale</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Radiosurgery</term></keywords><keywords scheme="MESH" qualifier="méthodes" xml:lang="fr"><term>Radiochirurgie</term></keywords><keywords scheme="MESH" qualifier="radiotherapy" xml:lang="en"><term>Brain Neoplasms</term></keywords><keywords scheme="MESH" qualifier="radiothérapie" xml:lang="fr"><term>Tumeurs du cerveau</term></keywords><keywords scheme="MESH" qualifier="secondaire" xml:lang="fr"><term>Tumeurs du cerveau</term></keywords><keywords scheme="MESH" qualifier="secondary" xml:lang="en"><term>Brain Neoplasms</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Neoplasm Recurrence, Local</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Betacoronavirus</term><term>Coronavirus Infections</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Pandemics</term><term>Pneumonia, Viral</term><term>Retrospective Studies</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte d'âge moyen</term><term>Betacoronavirus</term><term>Femelle</term><term>Humains</term><term>Infections à coronavirus</term><term>Italie</term><term>Mâle</term><term>Pandémies</term><term>Pneumopathie virale</term><term>Résultat thérapeutique</term><term>Sujet âgé</term><term>Études rétrospectives</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Italie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>INTRODUCTION</b></p><p>The WHO declared 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a public health emergency of international concern. The National and Regional Health System has been reorganized, and many oncological patients died during this period or had to interrupt their therapies. This study summarizes a single-centre experience, during the COVID-19 period in Italy, in the treatment of brain metastases with Gamma Knife stereotactic radiosurgery (GKRS).</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>We retrospectively analysed our series of patients with brain metastases who underwent GKRS at the Niguarda Hospital from February 24 to April 24, 2020.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>We treated 30 patients with 66 brain metastases. A total of 22 patients came from home and 8 patients were admitted to the emergency room for urgent neurological symptoms. Duration of stay was limited to 0-1 day in 17 patients. We chose to treat a cluster of 9 patients, whose greater lesion exceeded 10 cm3, with 2-stage modality GKRS to minimize tumour recurrence and radiation necrosis.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>Due to the COVID-19 pandemic, the whole world is at a critical crossroads about the use of health care resources. During the COVID-19 outbreak, the deferral of diagnostic and therapeutic procedures and a work backlog in every medical specialty are the natural consequences of reservation of resources for COVID-19 patients. GKRS improved symptoms and reduced the need for open surgeries, allowing many patients to continue their therapeutic path and sparing beds in ICUs. Neurosurgeons have to take into account the availability of stereotactic radiosurgery to reduce hospital stay, conciliating safety for patients and operators with the request for health care coming from the oncological patients and their families.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Curated" Owner="NLM"><PMID Version="1">32726792</PMID><DateCompleted><Year>2020</Year><Month>10</Month><Day>07</Day></DateCompleted><DateRevised><Year>2020</Year><Month>10</Month><Day>07</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1423-0372</ISSN><JournalIssue CitedMedium="Internet"><Volume>98</Volume><Issue>5</Issue><PubDate><Year>2020</Year></PubDate></JournalIssue><Title>Stereotactic and functional neurosurgery</Title><ISOAbbreviation>Stereotact Funct Neurosurg</ISOAbbreviation></Journal><ArticleTitle>Gamma Knife Radiosurgery for Treatment of Brain Metastases during the COVID-19 Outbreak.</ArticleTitle><Pagination><MedlinePgn>319-323</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1159/000510271</ELocationID><Abstract><AbstractText Label="INTRODUCTION">The WHO declared 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a public health emergency of international concern. The National and Regional Health System has been reorganized, and many oncological patients died during this period or had to interrupt their therapies. This study summarizes a single-centre experience, during the COVID-19 period in Italy, in the treatment of brain metastases with Gamma Knife stereotactic radiosurgery (GKRS).</AbstractText><AbstractText Label="METHODS">We retrospectively analysed our series of patients with brain metastases who underwent GKRS at the Niguarda Hospital from February 24 to April 24, 2020.</AbstractText><AbstractText Label="RESULTS">We treated 30 patients with 66 brain metastases. A total of 22 patients came from home and 8 patients were admitted to the emergency room for urgent neurological symptoms. Duration of stay was limited to 0-1 day in 17 patients. We chose to treat a cluster of 9 patients, whose greater lesion exceeded 10 cm3, with 2-stage modality GKRS to minimize tumour recurrence and radiation necrosis.</AbstractText><AbstractText Label="CONCLUSION">Due to the COVID-19 pandemic, the whole world is at a critical crossroads about the use of health care resources. During the COVID-19 outbreak, the deferral of diagnostic and therapeutic procedures and a work backlog in every medical specialty are the natural consequences of reservation of resources for COVID-19 patients. GKRS improved symptoms and reduced the need for open surgeries, allowing many patients to continue their therapeutic path and sparing beds in ICUs. Neurosurgeons have to take into account the availability of stereotactic radiosurgery to reduce hospital stay, conciliating safety for patients and operators with the request for health care coming from the oncological patients and their families.</AbstractText><CopyrightInformation>© 2020 S. Karger AG, Basel.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Crisà</LastName><ForeName>Francesco Maria</ForeName><Initials>FM</Initials><AffiliationInfo><Affiliation>Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy, francesco.crisa@unimi.it.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Università degli Studi di Milano, Milan, Italy, francesco.crisa@unimi.it.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Leocata</LastName><ForeName>Filippo</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Arienti</LastName><ForeName>Virginia Maria</ForeName><Initials>VM</Initials><AffiliationInfo><Affiliation>Radiotherapy, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Picano</LastName><ForeName>Marco</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Berta</LastName><ForeName>Luca</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mainardi</LastName><ForeName>Hae Song</ForeName><Initials>HS</Initials><AffiliationInfo><Affiliation>Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Monti</LastName><ForeName>Angelo Filippo</ForeName><Initials>AF</Initials><AffiliationInfo><Affiliation>Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Musca</LastName><ForeName>Francesco</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Cardiology IV, A. De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Colombo</LastName><ForeName>Silvia</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Clinical Management Staff, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Palazzi</LastName><ForeName>Mauro</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Radiotherapy, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>La Camera</LastName><ForeName>Alessandro</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>07</Month><Day>29</Day></ArticleDate></Article><MedlineJournalInfo><Country>Switzerland</Country><MedlineTA>Stereotact Funct Neurosurg</MedlineTA><NlmUniqueID>8902881</NlmUniqueID><ISSNLinking>1011-6125</ISSNLinking></MedlineJournalInfo><SupplMeshList><SupplMeshName Type="Disease" UI="C000657245">COVID-19</SupplMeshName><SupplMeshName Type="Organism" UI="C000656484">severe acute respiratory syndrome coronavirus 2</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="N">Betacoronavirus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001932" MajorTopicYN="N">Brain Neoplasms</DescriptorName><QualifierName UI="Q000532" MajorTopicYN="Y">radiotherapy</QualifierName><QualifierName UI="Q000556" MajorTopicYN="N">secondary</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D018352" MajorTopicYN="Y">Coronavirus Infections</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007558" MajorTopicYN="N" Type="Geographic">Italy</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009364" MajorTopicYN="N">Neoplasm Recurrence, Local</DescriptorName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="Y">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011024" MajorTopicYN="Y">Pneumonia, Viral</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016634" MajorTopicYN="N">Radiosurgery</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">Brain metastases</Keyword><Keyword MajorTopicYN="Y">COVID-19</Keyword><Keyword MajorTopicYN="Y">Gamma Knife</Keyword><Keyword MajorTopicYN="Y">Radiosurgery</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>05</Month><Day>22</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>07</Month><Day>12</Day></PubMedPubDate><PubMedPubDate 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