scholarly journals Open surgery for ventricular tachycardia following failed stereotactic radiation treatment: a bailout when a parachute hasn’t helped

2021 ◽  
Author(s):  
Piotr Futyma ◽  
Dhiraj Gupta
Keyword(s):  
Ventricular Tachycardia ◽  
Open Surgery ◽  
Radiation Treatment ◽  
Stereotactic Radiation

Stereotactic radiation treatment for recurrent nonbenign meningiomas

2007 ◽  
Vol 106 (5) ◽  
pp. 846-854 ◽  
Author(s):  
Carlos A. Mattozo ◽  
Antonio A. F. De Salles ◽  
Ivan A. Klement ◽  
Alessandra Gorgulho ◽  
David McArthur ◽  
...  
Keyword(s):  
Radiation Treatment ◽  
Progression Free Survival ◽  
Malignant Progression ◽  
World Health ◽  
Who Grade ◽  
Stereotactic Radiation ◽  
Grade Ii ◽  
Health Organization ◽  
Grade Iii

Object The authors analyzed the results of stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) for the treatment of recurrent meningiomas that were described at initial resection as showing aggressive, atypical, or malignant features (nonbenign). Methods Twenty-five patients who underwent SRS and/or SRT for nonbenign meningiomas between December 1992 and August 2004 were included. Thirteen of these patients underwent treatment for multiple primary or recurrent lesions. In all, 52 tumors were treated. All histological sections were reviewed and reclassified according to World Health Organization (WHO) 2000 guidelines as benign (Grade I), atypical (Grade II), or anaplastic (Grade III) meningiomas. The median follow-up period was 42 months. Seventeen (68%) of the cases were reclassified as follows: WHO Grade I (five cases), Grade II (11 cases), and Grade III (one case). Malignant progression occurred in eight cases (32%) during the follow-up period; these cases were considered as a separate group. The 3-year progression-free survival (PFS) rates for the Grades I, II, and III, and malignant progression groups were 100, 83, 0, and 11%, respectively (p < 0.001). In the Grade II group, the 3-year PFS rates for patients treated with SRS and SRT were 100 and 33%, respectively (p = 0.1). After initial treatment, 22 new tumors required treatment using SRS or SRT; 17 (77%) of them occurred inside the original resection cavity. Symptomatic edema developed in one patient (4%). Conclusions Stereotactic radiation treatment provided effective local control of “aggressive” Grade I and Grade II meningiomas, whereas Grade III lesions were associated with poor outcome. The outcome of cases in the malignant progression group was intermediate between that of the Grade II and Grade III groups, with the lesions showing a tendency toward malignancy.

Stereotactic radiation treatment planning with volumetric modulated arc therapy: Impact of duodenal sparing on pancreatic tumor coverage.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 301-301
Author(s):  
R. Kumar ◽  
J. Kang ◽  
J. M. Herman ◽  
R. Tuli ◽  
T. M. Pawlik ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Treatment Planning ◽  
Radiation Treatment ◽  
Volumetric Modulated Arc Therapy ◽  
High Dose ◽  
Stereotactic Radiation ◽  
Radiation Delivery ◽  
Delivery Times ◽  
Arc Therapy ◽  
The Difference

301 Background: Volumetric modulated arc therapy (VMAT) allows for intensity-modulated radiation delivery with faster treatment times and fewer delivered monitor units (MU). The dose-limiting structure for pancreatic stereotactic body radiation therapy (SBRT) is the duodenum. We evaluate VMAT dose distribution, delivery times, and the effect of duodenal sparing (DS) for pancreas SBRT. Methods: Plans of 15 patients with unresectable pancreatic cancer (14 head/1 tail) were selected. VMAT treatment planning with the “SmartArc” function of Pinnacle v. 8.9 was used to plan one fraction of 25 Gy to the PTV (gross tumor + 2 mm expansion) normalized to the 80% isodose line. Two VMAT SBRT plans were conducted for each case; the first did not attempt to spare the duodenum (non DS) while the second did (DS). Constraints were stomach/duodenum any point max <30 Gy (for DS plan), liver D50 < 5 Gy, ipsilateral kidney D25 < 5 Gy, cord Dmax < 5 Gy and stomach D4 < 22.5 Gy. Results: Gross tumor volume ranged from 58.4cm3 to 320.3 cm3. The average overlap volume between PTV and the duodenum was 8.4 cm3. In 10/15 non-DS plans, the duodenal Dmax exceeded 30 Gy. With DS optimization, only 1/15 plans exceeded the 30 Gy threshold. These differences were statistically significant (p<0.001). Typical MU and delivery times, as calculated by the planning software, were 5494 MU and 775 secs vs. 5296 MU and 703 secs for the DS and non-DS plans, respectively. The difference in delivery times was significant (p=0.01), but amounted to only 1.2 min on average. The average duodenal Dmax for non-DS plans was 30.4Gy, D4% was 23.4 Gy. With DS, the average Dmax was reduced to 28.1Gy and D4% to <19.7 Gy (p<0.001). As expected, VMAT plans with greater overlap between the duodenum and PTV had a higher duodenal Dmax. Conclusions: This study demonstrates the feasibility of VMAT for high-dose SBRT treatment of pancreatic cancer incorporating constraints to limit the dose to the duodenum. Future studies will evaluate whether VMAT with fractionated SBRT results in improved duodenal sparing more efficiently than traditional IMRT. No significant financial relationships to disclose.

scholarly journals Stereotactic radiation treatment for benign meningiomas

2007 ◽  
Vol 23 (4) ◽  
pp. E5 ◽  
Author(s):  
Andrew E. H. Elia ◽  
Helen A. Shih ◽  
Jay S. Loeffler
Keyword(s):  
Stereotactic Radiosurgery ◽  
Stereotactic Radiotherapy ◽  
Radiation Treatment ◽  
Optic Chiasm ◽  
External Beam Radiation ◽  
Tumor Control ◽  
Beam Radiation ◽  
Stereotactic Radiation ◽  
Clinical Scenarios ◽  
Toxicity Equivalent

✓Meningiomas are the second most common primary tumor of the brain. Gross-total resection remains the preferred treatment if achievable with minimal morbidity. For incompletely resected or inoperable benign meningiomas, 3D conformal external-beam radiation therapy can provide durable local tumor control in 90 to 95% of cases. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) are highly conformal techniques, using steep dose gradients and stereotactic patient immobilization. Stereotactic radiosurgery has been used as an alternative or adjuvant therapy to surgery for meningiomas in locations, such as the skull base, where operative manipulation may be particularly difficult. Stereotactic radiotherapy is useful for larger meningiomas (> 3–3.5 cm) and those closely approximating critical structures, such as the optic chiasm and brainstem. Although SRS has longer follow-up than SRT, both techniques have excellent 5-year tumor control rates of greater than 90% for benign meningiomas. Stereotactic radiotherapy has toxicity equivalent to that of radiosurgery, despite its biased use for larger meningiomas with more complicated volumes. Reported rates of imaging-documented regression are higher for radiosurgery, but neurological recovery is relatively good with both techniques. Stereotactic radiosurgery and fractionated SRT are complementary techniques appropriate for different clinical scenarios.

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