2–23 Breast Cancer Metastases in Liver: Laser-Induced Interstitial Thermotherapy—Local Tumor Control Rate and Survival Data

17106 Background: Surgical resection remains the standard of care for solitary lung metastasis from colorectal cancer or primitive lung tumors. Nevertheless only a small part of patients can be radically resected. Thermal ablation is a mini-invasive local treatment that can be considered an alternative approach in non-resectable lesions or inoperable patients. Methods: We present a consecutive series of thirteen patients treated with LIT from March 2004 to March 2005. Nine patients had a small (maximum diameter smaller than 5 cm) non-resectable lung carcinoma while four patients had a solitary metastasis from colorectal cancer. Median age was 70-yrs (range 55–87), male-female ratio was 2:1. After mild sedation and local anaesthesia, optical fibers were inserted directly into the tumor with CT-guided percutaneous needle placement. Each optical fiber was connected to a neodymium:yttrium-aluminium-garnet (ND:YAG) laser, which delivers concentrated light at a wave-length of 1064 nm, with a 5-Watt power and a 1800-Joule energy per single fiber. A minimum of two and a maximum of four needles were used, with a 5 to 8 mm distance from one needle to another. Results: All the patients tolerated LIT procedure well, developing a minimal pneumothorax, which did not require any treatment. Easy manageable local side-effects occurred in two cases (a mild self-limiting haemoptysis and a pleural empyema). Post-treatment CT-scan demonstrated complete thermonecrosis in all the lesions smaller than 3 cm and almost complete in the bigger ones (3 to 5 cm). All the patients are still alive, with a local tumor control rate of 100% at radiological follow-up: no local progression was observed in 10 pts with a follow-up of at least 12 months and in 3 pts with a follow-up of at least 6 months. Conclusions: Percutaneous LIT permitted a complete ablation of lung metastases and lung carcinomas with an optimal local tumor control rate at 1-year and a low complication rate. Complete necrosis was achieved only in lesions with maximum diameter smaller than 3 cm. No significant financial relationships to disclose.

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Large intracranial metastatic tumors treated by Gamma Knife surgery: outcomes and prognostic factors

Journal of Neurosurgery ◽

10.3171/2013.9.jns131163 ◽

2014 ◽

Vol 120 (1) ◽

pp. 52-59 ◽

Cited By ~ 22

Author(s):

Cheng-Chia Lee ◽

Chun-Po Yen ◽

Zhiyuan Xu ◽

David Schlesinger ◽

Jason Sheehan

Keyword(s):

Brain Edema ◽

Local Tumor Control ◽

Small Cell ◽

Tumor Control ◽

Local Tumor ◽

Small Cell Lung ◽

Tumor Control Rate ◽

Large Brain ◽

Local Tumor Control Rate

Object The use of radiosurgery has been well accepted for treating small to medium-size metastatic brain tumors (MBTs). However, its utility in treating large MBTs remains uncertain due to potentially unfavorable effects such as progressive perifocal brain edema and neurological deterioration. In this retrospective study the authors evaluated the local tumor control rate and analyzed possible factors affecting tumor and brain edema response. Methods The authors defined a large brain metastasis as one with a measurement of 3 cm or more in at least one of the 3 cardinal planes (coronal, axial, or sagittal). A consecutive series of 109 patients with 119 large intracranial metastatic lesions were treated with Gamma Knife surgery (GKS) between October 2000 and December 2012; the median tumor volume was 16.8 cm3 (range 6.0–74.8 cm3). The pre-GKS Karnofsky Performance Status (KPS) score for these patients ranged from 70 to 100. The most common tumors of origin were non–small cell lung cancers (29.4% of cases in this series). Thirty-six patients (33.0%) had previously undergone a craniotomy (1–3 times) for tumor resection. Forty-three patients (39.4%) underwent whole-brain radiotherapy (WBRT) before GKS. Patients were treated with GKS and followed clinically and radiographically at 2- to 3-month intervals thereafter. Results The median duration of imaging follow-up after GKS for patients with large MBTs in this series was 6.3 months. In the first follow-up MRI studies (performed within 3 months after GKS), 77 lesions (64.7%) had regressed, 24 (20.2%) were stable, and 18 (15.1%) were found to have grown. Peritumoral brain edema as defined on T2-weighted MRI sequences had decreased in 79 lesions (66.4%), was stable in 21 (17.6%), but had progressed in 19 (16.0%). In the group of patients who survived longer than 6 months (76 patients with 77 MBTs), 88.3% of the MBTs (68 of 77 lesions) had regressed or remained stable at the most recent imaging follow-up, and 89.6% (69 of 77 lesions) showed regression of perifocal brain edema volume or stable condition. The median duration of survival after GKS was 8.3 months for patients with large MBTs. Patients with small cell lung cancer and no previous WBRT had a significantly higher tumor control rate as well as better brain edema relief. Patients with a single metastasis, better KPS scores, and no previous radiosurgery or WBRT were more likely to decrease corticosteroid use after GKS. On the other hand, higher pre-GKS KPS score was the only factor that showed a statistically significant association with longer survival. Conclusions Treating large MBTs using either microsurgery or radiosurgery is a challenge for neurosurgeons. In selected patients with large brain metastases, radiosurgery offered a reasonable local tumor control rate and favorable functional preservation. Exacerbation of underlying edema was rare in this case series. Far more commonly, edema and steroid use were lessened after radiosurgery. Radiosurgery appears to be a reasonable option for some patients with large MBTs.

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Clinical-pathologic study of early breast cancer treated by primary radiation therapy.

Journal of Clinical Oncology ◽

10.1200/jco.1983.1.3.184 ◽

1983 ◽

Vol 1 (3) ◽

pp. 184-189 ◽

Cited By ~ 53

Author(s):

J R Harris ◽

J L Connolly ◽

S J Schnitt ◽

R B Cohen ◽

S Hellman

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Local Recurrence ◽

Radiation Dose ◽

Primary Tumor ◽

Local Tumor Control ◽

Tumor Control ◽

Local Tumor ◽

Local Tumor Control Rate ◽

Tumor Area

We performed a clinical-pathologic review of 231 patients with early breast cancer treated by primary radiation therapy. There were 27 patients with infiltrating ductal carcinoma treated with excisional biopsy whose tumors showed a constellation of histologic features: moderate or marked intraductal carcinoma in the tumor, intraductal carcinoma in the adjacent tissue, and high nuclear grade. These patients had a 5-yr local tumor control rate of 61% compared to 96% for similar patients whose tumors did not show all three features. Radiation dose to the primary tumor area influenced the likelihood of local recurrence in these 27 patients: 15 of these patients received 6000 rads or more to the primary tumor area and had a 5-yr local tumor control rate of 84%, compared to 48% for the 12 patients who received less than 6000 rads. These results indicate that a subgroup of breast cancer patients can be identified that has a high risk of local recurrence when an insufficient radiation dose (i.e., less than 6000 rads) is delivered to the primary tumor area.

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Gamma Knife surgery combined with resection for treatment of a single brain metastasis: preliminary results

Journal of Neurosurgery ◽

10.3171/2010.8.gks101067 ◽

2010 ◽

Vol 113 (Special_Supplement) ◽

pp. 90-96 ◽

Cited By ~ 16

Author(s):

M. Yashar S. Kalani ◽

Aristotelis S. Filippidis ◽

Maziyar A. Kalani ◽

Nader Sanai ◽

David Brachman ◽

...

Keyword(s):

Survival Data ◽

Initial Treatment ◽

Median Survival Time ◽

Local Tumor Control ◽

Survival Duration ◽

Tumor Control ◽

Local Tumor ◽

Systemic Control ◽

Cranial Metastasis

Object Resection and whole-brain radiation therapy (WBRT) have classically been the standard treatment for a single metastasis to the brain. The objective of this study was to evaluate the use of Gamma Knife surgery (GKS) as an alternative to WBRT in patients who had undergone resection and to evaluate patient survival and local tumor control. Methods The authors retrospectively reviewed the charts of 150 patients treated with a combination of stereotactic radiosurgery and resection of a cranial metastasis at their institution between April 1997 and September 2009. Patients who had multiple lesions or underwent both WBRT and GKS were excluded, as were patients for whom survival data beyond the initial treatment were not available. Clinical and imaging follow-up was assessed using notes from clinic visits and MR imaging studies when available. Follow-up data beyond the initial treatment and survival data were available for 68 patients. Results The study included 37 women (54.4%) and 31 men (45.6%) (mean age 60 years, range 28–89 years). In 45 patients (66.2%) there was systemic control of the primary tumor when the cranial metastasis was identified. The median duration between resection and radiosurgery was 15.5 days. The median volume of the treated cavity was 10.35 cm3 (range 0.9–45.4 cm3), and the median dose to the cavity margin was 15 Gy (range 14–30 Gy), delivered to the 50% isodose line (range 50%–76% isodose line). The patients' median preradiosurgery Karnofsky Performance Scale (KPS) score was 90 (range 40–100). During the follow-up period we identified 27 patients (39.7%) with recurrent tumor located either local or distant to the site of treatment. The median time from primary treatment of metastasis to recurrence was 10.6 months. The patients' median length of survival (interval between first treatment of cerebral metastasis and last follow-up) was 13.2 months. For the patient who died during follow-up, the median time from diagnosis of cerebral metastasis to death was 11.5 months. The median duration of survival from diagnosis of the primary cancer to last follow-up was 30.2 months. Patients with a pretreatment KPS score ≥ 90 had a median survival time of 23.2 months, and patients with a pretreatment KPS score < 90 had a median survival time of 10 months (p < 0.008). Systemic control of disease at the time of metastasis was not predictive of increased survival duration, although it did tend to improve survival. Conclusions Although the debate about the ideal form of radiation treatment after resection continues, these findings indicate that GKS combined with surgery offers comparable survival duration and local tumor control to WBRT for patients with a diagnosis of a single metastasis.

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Molecular Predictors of Local Tumor Control in Early-Stage Breast Cancer

Seminars in Radiation Oncology ◽

10.1016/j.semradonc.2010.08.005 ◽

2011 ◽

Vol 21 (1) ◽

pp. 35-42 ◽

Cited By ~ 13

Author(s):

David T. Miyamoto ◽

Jay R. Harris

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Local Tumor Control ◽

Early Stage Breast Cancer ◽

Tumor Control ◽

Local Tumor

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Volumetric changes and clinical outcome for petroclival meningiomas after primary treatment with Gamma Knife radiosurgery

Journal of Neurosurgery ◽

10.3171/2017.7.jns17380 ◽

2018 ◽

Vol 129 (6) ◽

pp. 1623-1629 ◽

Cited By ~ 3

Author(s):

Zjiwar H. A. Sadik ◽

Suan Te Lie ◽

Sieger Leenstra ◽

Patrick E. J. Hanssens

Keyword(s):

Gamma Knife ◽

Clinical Symptoms ◽

Cranial Nerves ◽

Gamma Knife Radiosurgery ◽

Local Tumor Control ◽

Tumor Control ◽

Local Tumor ◽

Tumor Control Rate ◽

Petroclival Meningiomas

OBJECTIVEPetroclival meningiomas (PCMs) can cause devastating clinical symptoms due to mass effect on cranial nerves (CNs); thus, patients harboring these tumors need treatment. Many neurosurgeons advocate for microsurgery because removal of the tumor can provide relief or result in symptom disappearance. Gamma Knife radiosurgery (GKRS) is often an alternative for surgery because it can cause tumor shrinkage with improvement of symptoms. This study evaluates qualitative volumetric changes of PCM after primary GKRS and its impact on clinical symptoms.METHODSThe authors performed a retrospective study of patients with PCM who underwent primary GKRS between 2003 and 2015 at the Gamma Knife Center of the Elisabeth-Tweesteden Hospital in Tilburg, the Netherlands. This study yields 53 patients. In this study the authors concentrate on qualitative volumetric tumor changes, local tumor control rate, and the effect of the treatment on trigeminal neuralgia (TN).RESULTSLocal tumor control was 98% at 5 years and 93% at 7 years (Kaplan-Meier estimates). More than 90% of the tumors showed regression in volume during the first 5 years. The mean volumetric tumor decrease was 21.2%, 27.1%, and 31% at 1, 3, and 6 years of follow-up, respectively. Improvement in TN was achieved in 61%, 67%, and 70% of the cases at 1, 2, and 3 years of follow-up, respectively. This was associated with a mean volumetric tumor decrease of 25% at the 1-year follow-up to 32% at the 3-year follow-up.CONCLUSIONSGKRS for PCMs yields a high tumor control rate with a low incidence of neurological deficits. Many patients with TN due to PCM experienced improvement in TN after radiosurgery. GKRS achieves significant volumetric tumor decrease in the first years of follow-up and thereafter.

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