Validated Tumor Graft Model Reveals Delayed Local Recurrence of Renal Cell Tumors After High-Dose Single Fraction Ablative Radiation Therapy

2014 ◽  
Vol 90 (1) ◽  
pp. S801-S802
Author(s):  
D. Kim ◽  
M. Bhuiyan ◽  
V. Toffessi-Tcheuyap ◽  
A. Pavia-Jimenez ◽  
E. Holloman ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Recurrence ◽  
Renal Cell ◽  
High Dose ◽  
Single Fraction ◽  
Renal Cell Tumors

scholarly journals Long-Term Outcomes of High-Dose Single-Fraction Radiosurgery for Chordomas of the Spine and Sacrum

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Jenny Jin ◽  
John Berry-Candelabra ◽  
Y Josh Yamada ◽  
Daniel Higginson ◽  
Adam Schmitt ◽  
...  
Keyword(s):  
Local Recurrence ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
High Dose ◽  
En Bloc ◽  
Intralesional Resection ◽  
Single Fraction ◽  
Mobile Spine ◽  
Symptom Response

Abstract INTRODUCTION To evaluate outcomes of patients with primary chordomas treated with spine stereotactic radiosurgery (SRS) alone or in combination with surgery, drawing from a single-institution database to elucidate treatment options associated with durable radiographic control of these conventionally radioresistant tumors. Chordomas result in significant morbidity, with a high rate of local recurrence and potential for metastases. SRS as a primary treatment could save patients from extensive surgery. Spine SRS outcomes support exploration of its role in the durable control of these conventionally radioresistant tumors. METHODS Clinical records were reviewed for outcomes of patients with primary chordoma of the mobile spine and sacrum who underwent single-fraction SRS between 2006 and 2017. Radiographic local recurrence-free survival (LRFS), overall survival (OS), symptom response, and toxicity were assessed in relation to extent of surgery. RESULTS In total, 35 patients with de novo chordoma of the mobile spine (49%) and sacrum (51%) received SRS with a median post-SRS follow-up of 38.8 mo (range: 2.0-122.9). The median PTV dose was 24Gy (range: 18–24Gy). Overall, 12 patients (33%) underwent definitive SRS and 23 patients (66%) underwent surgery followed by adjuvant SRS. Surgical strategies included separation surgery prior to SRS, curettage/intralesional resection, and en bloc resection in 7, 6, and 10 patients, respectively. The 3- and 5-yr LRFS rates were 86.2% and 80.5% respectively. Among 32 patients receiving 24 Gy (91%), the 3- and 5-yr LRFS were 96.3% and 89.9%. The 3- and 5-yr OS rates were 90.0% and 84.3%. The symptom response rate to treatment was 88% for pain and radiculopathy. Extent or type of surgery was not associated with LRFS, OS, or symptom response rates (P > .05), but en bloc resection was associated with higher CTCAE v. 5.0 surgical toxicity compared to epidural decompression and curettage/intralesional resection (P = .03). The long-term = grade 2 SRS toxicity rate was 31%, including 17% grade 3 tissue necrosis, recurrent laryngeal nerve palsy, fracture, and secondary malignancy. CONCLUSION High-dose spine SRS offers the chance of durable radiographic control and effective symptom relief with acceptable toxicity for primary chordomas as either definitive or adjuvant therapy.

Comparison of simultaneous high dose stereotactic radiotherapy with normofractionated radiotherapy in patients with metastatic renal cell carcinoma under systemic therapy.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 467-467 ◽  
Author(s):  
Michael D. Staehler ◽  
Behr Lisa ◽  
Philipp Nuhn ◽  
Boris Schlenker ◽  
Ralf Wilkowski
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Cell Carcinoma ◽  
Systemic Therapy ◽  
Renal Cell ◽  
High Dose ◽  
Metastatic Lesions ◽  
Conventional Radiation ◽  
Conventional Radiation Therapy

467 Background: Conventional radiation therapy (RT) is considered ineffective in metastatic renal cell carcinoma (mRCC). There are data suggesting that this might be related to low doses per fraction and that higher doses could be more effective. We introduced hypofracationated high-dose radiation therapy in patients with an indication for radiotherapy an retrospectively compared the results to patients with a conventional radiation therapy. Methods: We identified 97 pts with mRCC and an indication for radiotherapy of metastatic lesions between 2007 and 2013. All pts underwent simultaneous systemic therapy based on targeted agents and systemic therapy. 83 pts had a hypofractionated high dose stereotactic radiation (HDRT) (5 Gy per fraction, 3 fractions per week, total 45 Gy) while 14 pts underwent conventional normo-fractionated radiotherapy (NDR) (1.8 Gy per fraction) as described elsewhere. Results: Median age was 64.1 years (27-86). 189 metastatic lesions were irradiated. 64% of the pts had clear cell histology, with 14% harboring papillary RCC type II and 11% other subentities. Median overall survival was significantly longer for pts after HDRT was 9.4 months (+/-9.4 months) and 4.5 months (+/- 3.4 months) after NDR (p=0.01). The multivariate cox regression analysis revealed the MSKCC risk score, HDR therapy and the disease free survival as positive predictors for survival. No grade III toxicities were found, with 24% of the patients experiencing grade 1 or 2 side effects, mainly diarrhea and fatigue. Conclusions: In mRCC HDRT with simultaneous systemic therapy is related to a better overall survival than NRT. HDRT in combination with targeted therapy should be regarded the standard of care if RT is indicated.

Interstitial high dose rate (HDR) brachytherapy for early stage breast cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10551-10551 ◽  
Author(s):  
S. Biggs ◽  
P. J. Anderson ◽  
R. Mark ◽  
T. Neumann ◽  
M. Nair
Keyword(s):  
Radiation Therapy ◽  
Local Recurrence ◽  
Dose Rate ◽  
Local Anesthesia ◽  
Conscious Sedation ◽  
Breast Conservation ◽  
High Dose Rate ◽  
High Dose ◽  
Cosmetic Results

10551 Background: External Beam Radiation Therapy (EBRT) has been the standard of care for breast conservation radiation therapy. Recent data indicates that Interstitial Implant and High Dose Rate (HDR) radiation afterloading compares favorably to EBRT in selected patients. Methods: Patients with Tis, T1, and T2 tumors measuring ≤ 3 cm, negative surgical margins, and negative axillary lymph nodes were judged to be candidates for Interstitial Implant. Results: Between 2000 and 2006, 112 patients underwent Interstitial HDR Implant under Stereotactic Mammographic guidance with conscious sedation and local anesthesia. Conscious sedation consisted of Morphine and Versed. Local anesthesia was given with a mixture of 1% Lidocaine, 0.25% Marcaine, 1:100,000 Epinephrine, and 4% Sodium Bicarbonate neutralizing solution. The implants were placed using a Template with from 3 to 6 planes, and 8 to 43 needles. Catheters were subsequently threaded thru the needles, and the needles removed. Catheter spacing was 1.0 to 1.5 cm. Radiation Treatment planning was performed using CT Scanning. Treatment volumes ranged from 25 cm3 to 359 cm3. The breast implant volume received 3400 cGy in 10 fractions via HDR prescribed to the Planning Target Volume, given BID over 5 days. The procedure was well tolerated. No patient required hospital admission. With a median follow-up 36 months (range 6–60 months), local recurrence occurred in 2.7% (3/112). Cosmetic results were good to excellent in 85.7% (96/112) of the patients. Wound healing complications developed in 7.1% (8/112). Three of these patients had received anthracycline based Chemotherapy. The other five had large (> 200 cm3) implant volumes and catheter spacing of 1.5 cm. Two patients healed after 6 months of conservative treatment. Surgery was required in six patients who developed fat necrosis. Conclusions: With median 36 month follow-up, Breast Conservation radiation therapy utilizing Interstitial HDR Implant has yielded local recurrence rates and cosmetic results which compare favorably to EBRT in selected patients. Treatment with anthracycline based Chemotherapy and large (> 200 cm3) implant volumes appear to be relative contraindications to Interstitial HDR Implant. Finally, catheter spacing of 1 cm yielded optimal dosimetry and minimized complications. No significant financial relationships to disclose.

Single-fraction radiosurgery for the treatment of renal cell carcinoma.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 590-590 ◽  
Author(s):  
Michael D. Staehler ◽  
Boris Schlenker ◽  
Alexander Karl ◽  
Annabel Spek ◽  
Alexander Muacevic
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Long Term Results ◽  
Tumor Control ◽  
High Dose ◽  
Short Term ◽  
Single Fraction

590 Background: We report on patients with renal cell carcinoma (RCC) who were treated with single fraction high-dose local stereotactic radiosurgery (SRS) using the robotic Cyberknife system to avoid nephrectomy and consecutive hemodialysis. Methods: Fifty-two patients with histologically confirmed RCC and median age of 63.6 years (43.6-86.5) with the indication for renal surgery and highest risk for consecutive hemodialysis were entered into a prospective case control study of single fraction SRS with 25Gy. Tumor response, renal function, survival, and adverse events were estimated every three months with a follow-up of at least six months. Results: R.E.N.A.L. score was low in 1, moderate in 30 and high in 21 patients. 28 patients had singular renal units. Median follow-up was 26.9 months (1.8 - 52.6). Local tumor control nine months after SRS was 98% (95% CI: 89-99%). 43 lesions showed a measurable tumor size reduction including six complete remissions and 33 partial remissions. Renal function remained stable with a median serum creatinine at baseline of 1.10 mg/dl (0.4 -2.0) and 1.11 mg/dl (0.8-2.2) at follow-up. In one patient grade I erythrodermia, in three patients grade I fatigue and in two patients grade I nausea occurred. In all patients nephrectomy was avoided. Conclusions: Single-fraction SRS as an outpatient procedure is a treatment modality with short-term safety and efficacy to avoid treatment-related loss of renal function and hemodialysis in selected patients with RCC. Short term follow up of oncological and functional results so far is excellent. Further studies are needed to determine the limits of SRS in this setting and long term results.

NEAR-COMPLETE PATHOLOGICAL RESPONSE OF CHORDOMA TO HIGH-DOSE SINGLE-FRACTION RADIOTHERAPY

Neurosurgery ◽  
2009 ◽  
Vol 64 (2) ◽  
pp. E389-E390 ◽  
Author(s):  
Abraham J. Wu ◽  
Mark H. Bilsky ◽  
Mark A. Edgar ◽  
Yoshiya Yamada
Keyword(s):  
Radiation Therapy ◽  
Pathological Response ◽  
High Dose ◽  
Recurrent Pain ◽  
Mechanical Instability ◽  
Complete Pathological Response ◽  
En Bloc ◽  
Single Fraction ◽  
Image Guided Radiation Therapy ◽  
Image Guided

Abstract OBJECTIVE High-dose, single-fraction radiotherapy, also known as radiosurgery, has theoretical advantages for the treatment of chordoma, which is considered resistant to conventional radiation therapy. Demonstration of biological effectiveness, as indicated by pathological response of a chordoma specimen after such radiotherapy, has not previously been reported. CLINICAL PRESENTATION A 72-year-old man presented with lower back pain and was found to have an L3 vertebral mass. Open biopsy yielded chordoma. He was considered for en bloc resection, but definitive radiation therapy was preferred owing to medical comorbidities and concern for field contamination from the previous biopsy. INTERVENTION The patient underwent single-fraction, high-dose, image-guided radiation therapy to the tumor. Two months later, he underwent kyphoplasty because of recurrent pain. A core biopsy performed at that time showed viable chordoma. Four months after treatment, he underwent L3 corpectomy because of symptoms of mechanical instability. Pathology now showed near-complete necrosis of the resected chordoma. CONCLUSION Preoperative, single-fraction radiotherapy for chordoma induced a near-complete pathological response in this patient. That the effect was seen at 4 months but not 2 months after treatment suggests a time-dependent effect. This case suggests a promising role for single-fraction, image-guided radiation therapy in the treatment of chordoma.

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