Postoperative Stereotactic Body Radiotherapy for Spinal Metastases and the Impact of Epidural Disease Grade

Neurosurgery ◽  
2019 ◽  
Vol 85 (6) ◽  
pp. E1111-E1118 ◽  
Author(s):  
Majed Alghamdi ◽  
Arjun Sahgal ◽  
Hany Soliman ◽  
Sten Myrehaug ◽  
Victor X D Yang ◽  
...  
Keyword(s):  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Spinal Metastases ◽  
Retrospective Chart Review ◽  
Vertebral Compression Fractures ◽  
Low Grade ◽  
High Grade ◽  
Hardware Failure ◽  
Spinal Segments ◽  
The Impact

Abstract BACKGROUND Postoperative stereotactic body radiotherapy (pSBRT) is an emerging indication for spinal metastases (SM). OBJECTIVE To report our experience with pSBRT for SM. METHODS A retrospective chart review was performed for prospectively collected data of patients treated between September 2008 to December 2015 with pSBRT and followed with serial spinal MRIs every 2 to 3 mo until death or last follow-up. Univariate and multivariable analyses were performed to identify predictive factors. RESULTS A total of 83 spinal segments in 47 patients treated with a median dose of 24 Gy in 2 fractions were included, with mostly lung and breast primaries. A total of 59.3% had preoperative high-grade epidural disease (ED) and 39.7% were unstable. The 12-mo cumulative incidence of local failure was 17% for all segments, and 33.3%, 21.8%, and 0% in segments with postoperative high-grade, low-grade, and no ED, respectively. Downgrading preoperative ED was predictive of better local control (P = .03). The grade of postoperative ED was also predictive for local control (P < .0001), as was a longer interval between prior radiotherapy and pSBRT in those previously irradiated (P = .004). The 12-mo overall survival rate was 55%. One case of radiculopathy, 3 vertebral compression fractures, and no cases of myelopathy, hardware failure, or skin breakdown were observed. CONCLUSION pSBRT is an effective and safe treatment. The association between downgrading preoperative ED and better local control following pSBRT is confirmed and supports the concept of separation surgery.

Mature Imaging-Based Outcomes Supporting Local Control for Complex Reirradiation Salvage Spine Stereotactic Body Radiotherapy

Neurosurgery ◽  
2020 ◽  
Vol 87 (4) ◽  
pp. 816-822 ◽  
Author(s):  
Jay S Detsky ◽  
Timothy K Nguyen ◽  
Young Lee ◽  
Eshetu Atenafu ◽  
Pejman Maralani ◽  
...  
Keyword(s):  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Primary Outcome ◽  
Vertebral Compression Fracture ◽  
Spinal Metastases ◽  
Compression Fracture ◽  
Neurological Deficits ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Spinal Segments

Abstract BACKGROUND Upon progression after upfront radiotherapy to spinal metastases, low-dose re-irradiation conventional external beam radiation (cEBRT) provides limited clinical benefit. Spine stereotactic body radiotherapy (SBRT) allows for dose escalation in the salvage setting with the potential for improved local control. OBJECTIVE To report mature clinical and imaging-based outcomes for salvage SBRT. METHODS A retrospective review was undertaken of consecutive patients with spinal metastases treated with re-irradiation spine SBRT having failed either cEBRT (n = 60 with 1 prior course and n = 17 with 2 or more prior cEBRT courses), or prior SBRT (n = 6) to the same spinal segment. The primary outcome was local failure (LF), and secondary outcomes included overall survival (OS) and the rate of vertebral compression fracture (VCF). RESULTS A total of 43 patients with 83 spinal segments treated with salvage SBRT were reviewed. The crude risk of LF was 18%, and actuarial LF rates at 6, 12, and 24 mo were 7%, 14%, and 19%, respectively. The presence of extensive paraspinal disease (hazard ratio [HR] = 7.1, 95% CI 1.5-34) significantly predicted for LF. The median OS was 13.2 (95% CI 6.1-16.3) mo, and the presence of neurological deficits (HR = 4.7, 95% CI 1.8-12.1) and brain metastases (HR = 2.6, 95% CI 1.1-6.3) were significant prognostic factors. The crude risk of VCF was 4%, and radiation myelopathy was not observed. CONCLUSION These data support the safety and efficacy of spinal re-irradiation with SBRT including patients with prior SBRT and multiple courses of prior cEBRT.

scholarly journals A prospective multicentre feasibility study of stereotactic body radiotherapy in Japanese patients with spinal metastases

2019 ◽  
Vol 49 (11) ◽  
pp. 999-1003 ◽  
Author(s):  
Kei Ito ◽  
Tomohisa Furuya ◽  
Naoto Shikama ◽  
Keiji Nihei ◽  
Hiroshi Tanaka ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Stereotactic Body Radiotherapy ◽  
Treatment Protocol ◽  
Spinal Metastases ◽  
Japanese Patients ◽  
Vertebral Compression Fractures ◽  
Attractive Alternative ◽  
Spinal Segments ◽  
Grade 3 ◽  
Present Trial

Abstract Objective Stereotactic body radiotherapy has emerged as an attractive alternative to conventional radiotherapy for spinal metastases. However, it has limitations, including the need for advanced techniques and specific adverse effects. The present trial aimed to validate the feasibility and safety of stereotactic body radiotherapy in Japanese patients with spinal metastases. Methods Patients with one or two spinal metastases received stereotactic body radiotherapy of 24 Gy in two fractions. The primary endpoint was the proportion of severe adverse effects (≥ grade 3) in patients within 6 months after spine stereotactic body radiotherapy. Adverse effects were evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4. The treatment protocol was considered feasible and tolerable if the proportion of severe adverse effects was 10% or less. Results Overall, 20 spinal segments in 20 patients who registered between March 2014 and October 2015 were included. Minor and major deviations were observed in the planning of 2 and 0 cases, respectively. The treatment completion rate was 100%. The median follow-up after registration was 24.5 (range: 1–61) months. Although four patients experienced acute grade 2 adverse effects, no grade 3 or higher adverse effects were observed within 6 months after spine stereotactic body radiotherapy. Vertebral compression fractures were observed in two patients (14 and 16 months after stereotactic body radiotherapy). The local control and pain response rates at 6 months were 100 and 83%, respectively. Conclusion This study demonstrated the feasibility and safety of spine stereotactic body radiotherapy in Japanese patients with spinal metastases.

scholarly journals Impact of Pathological Stratification on the Clinical Outcomes of Advanced Well-Differentiated/Dedifferentiated Liposarcoma Treated with Trabectedin

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1453
Author(s):  
Chiara Fabbroni ◽  
Giovanni Fucà ◽  
Francesca Ligorio ◽  
Elena Fumagalli ◽  
Marta Barisella ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Proportional Hazards ◽  
Case Series ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Low Grade ◽  
High Grade ◽  
Retrospective Case ◽  
Well Differentiated ◽  
The Impact

Background. We previously showed that grading can prognosticate the outcome of retroperitoneal liposarcoma (LPS). In the present study, we aimed to explore the impact of pathological stratification using grading on the clinical outcomes of patients with advanced well-differentiated LPS (WDLPS) and dedifferentiated LPS (DDLPS) treated with trabectedin. Patients: We included patients with advanced WDLPS and DDLPS treated with trabectedin at the Fondazione IRCCS Istituto Nazionale dei Tumori between April 2003 and November 2019. Tumors were categorized in WDLPS, low-grade DDLPS, and high-grade DDLPS according to the 2020 WHO classification. Patients were divided in two cohorts: Low-grade (WDLPS/low-grade DDLPS) and high-grade (high-grade DDLPS). Results: A total of 49 patients were included: 17 (35%) in the low-grade cohort and 32 (65%) in the high-grade cohort. Response rate was 47% in the low-grade cohort versus 9.4% in the high-grade cohort (logistic regression p = 0.006). Median progression-free survival (PFS) was 13.7 months in the low-grade cohort and 3.2 months in the high-grade cohort. Grading was confirmed as an independent predictor of PFS in the Cox proportional-hazards regression multivariable model (adjusted hazard ratio low-grade vs. high-grade: 0.45, 95% confidence interval: 0.22–0.94; adjusted p = 0.035). Conclusions: In this retrospective case series, sensitivity to trabectedin was higher in WDLPS/low-grade DDLPS than in high-grade DDLPS. If confirmed in larger series, grading could represent an effective tool to personalize the treatment with trabectedin in patients with advanced LPS.

Endoscopic Surveillance Practice for Barrett's Oesophagus in Scotland and Early Experience in Implementing Local Guidelines

2003 ◽  
Vol 48 (2) ◽  
pp. 43-45 ◽  
Author(s):  
E F Shen ◽  
S Gladstone ◽  
G Milne ◽  
S Paterson-Brown ◽  
I D Penman
Keyword(s):  
Early Experience ◽  
High Grade Dysplasia ◽  
Low Grade ◽  
High Grade ◽  
Wide Variability ◽  
Low Grade Dysplasia ◽  
Surveillance Practice ◽  
Four Quadrant ◽  
The Impact

Management of columnar lined oesophagus (CLO; Barrett s oesophagus) is controversial. We prospectively audited surveillance practices in Scotland and prospectively assessed the impact of introducing local guidelines for Barrett s surveillance in Edinburgh. Most respondents were gastroenterologists. The majority take random, not four quadrant, biopsies from the CLO. In Edinburgh during 2000, 80 patients underwent surveillance. The guideline protocol was not followed in 30 (37.5%) patients. Follow up of patients without dysplasia generally conformed to the guidelines. Follow up of patients with low grade dysplasia was highly variable while management of those with high grade dysplasia followed the guidelines. Overall we found a wide variability in the management and surveillance of CLO. Early experience suggests that implementation of guidelines is helpful but there is still variation in practice.

Applying the Paris System for Reporting Urine Cytology Increases the Rate of Atypical Urothelial Cells in Benign Cases: A Need for Patient Management Recommendations

2016 ◽  
Vol 61 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Rosario Granados ◽  
Joanny A. Duarte ◽  
Teresa Corrales ◽  
Encarnación Camarmo ◽  
Paloma Bajo
Keyword(s):  
False Positive Rate ◽  
Urine Cytology ◽  
Urinary Cytology ◽  
Low Grade ◽  
High Grade ◽  
Abnormal Cytology ◽  
Positive Rate ◽  
High Grade Carcinoma ◽  
Management Recommendations ◽  
The Impact

The Paris System (TPS) for reporting urinary cytology attempts to unify the terminology in this field. Objectives: To analyze the impact of adopting TPS by measuring nomenclature agreement and cytohistological correlation. Materials and Methods: Voided urine liquid-based cytology samples corresponding to 149 biopsy-proven cases (76 high-grade carcinomas, 40 low-grade carcinomas, and 33 benign lesions), were reclassified by the same pathologist using TPS. Diagnostic agreement and sensitivity for both nomenclature systems was measured. Results: When using TPS, the rate of atypical samples increased 8 times (from 3 to 24.2%) in benign cases, 10 times (from 2.5 to 25%) in low-grade carcinomas, and 2.4 times (from 6.6 to 15.8%) in high-grade carcinomas. The false-positive rate (abnormal cytology in negative or low-grade carcinoma cases) increased from 11 to 34.2%. Sensitivity was higher (63 vs. 49%) with TPS at the expense of a lower specificity (73 vs. 91%). The agreement between both nomenclatures was moderate for negative and high-grade carcinoma cases (k = 0.42 and 0.56, respectively) and weak for low-grade tumors (k = 0.35). Conclusions: Adopting TPS for reporting urine cytology results in a considerable increase in atypical diagnoses, improving sensitivity but lowering specificity. Appropriate management recommendations for patients with an atypical cytological diagnosis are required.

Patterns of recurrence after stereotactic radiosurgery for treatment of meningiomas

2013 ◽  
Vol 35 (6) ◽  
pp. E14 ◽  
Author(s):  
Elizabeth N. Kuhn ◽  
Glen B. Taksler ◽  
Orrin Dayton ◽  
Amritraj G. Loganathan ◽  
Tamara Z. Vern-Gross ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Local Control ◽  
Retrospective Chart Review ◽  
Distant Recurrence ◽  
High Grade ◽  
Who Grade ◽  
Distant Failure ◽  
Grade Ii ◽  
Male Sex ◽  
Multifocal Disease

Object The purpose of this study was to evaluate patterns of failure after stereotactic radiosurgery (SRS) for meningiomas and factors that may influence these outcomes. Methods Based on a retrospective chart review, 279 patients were treated with SRS for meningiomas between January 1999 and March 2011 at Wake Forest Baptist Health. Disease progression was determined using serial imaging, with a minimum follow-up of 6 months (median 34.2 months). Results The median margin dose was 12.0 Gy (range 8.8–20 Gy). Local control rates for WHO Grade I tumors were 96.6%, 84.4%, and 75.7% at 1, 3, and 5 years, respectively. WHO Grade II and III tumors had local control rates of 72.3%, 57.7%, and 52.9% at 1, 3, and 5 years, respectively. Tumors without pathological grading had local control rates of 98.7%, 97.6%, and 94.2% at 1, 3, and 5 years, respectively. Of the local recurrences, 63.1% were classified as marginal (within 2 cm of treatment field). The 1-, 3-, and 5-year rates of distant failure were 6.5%, 10.3%, and 16.6%, respectively, for Grade I tumors and 11.4%, 17.2%, and 22.4%, respectively, for Grade II/III tumors. Tumors without pathological grading had distant failure rates of 0.7%, 3.2%, and 6.5% at 1, 3, and 5 years, respectively. Wilcoxon analysis revealed that multifocal disease (p < 0.001) and high-grade histology (WHO Grade II or III; p < 0.001) were significant predictors of local recurrence. Additionally, male sex was a significant predictor of distant recurrence (p = 0.04). Multivariate analysis also showed that doses greater than or equal to 12 Gy were associated with improved local control (p = 0.015). Conclusions In this patient series, 12 Gy was the minimum sufficient margin dose for the treatment of meningiomas. Male sex is a risk factor for distant failure, whereas high-grade histology and multifocal disease are risk factors for local failure.

Morbidity profile following aggressive resection of parietal lobe gliomas

2012 ◽  
Vol 116 (6) ◽  
pp. 1182-1186 ◽  
Author(s):  
Nader Sanai ◽  
Juan Martino ◽  
Mitchel S. Berger
Keyword(s):  
Classification System ◽  
Tumor Volume ◽  
Parietal Lobe ◽  
Tumor Resection ◽  
High Rate ◽  
Low Grade ◽  
High Grade ◽  
Language Pathways ◽  
The Impact ◽  
Glioma Classification

Object The impact of parietal lobe gliomas is typically studied in the context of parietal lobe syndromes. However, critical language pathways traverse the parietal lobe and are susceptible during tumor resection. The authors of this study reviewed their experience with parietal gliomas to characterize the impact of resection and the morbidity associated with language. Methods The study population included adults who had undergone resection of parietal gliomas of all grades. Tumor location was identified according to a proposed classification system for parietal region gliomas. Low- and high-grade tumors were volumetrically analyzed using FLAIR and T1-weighted contrast-enhanced MR imaging. Results One hundred nineteen patients with parietal gliomas were identified—34 with low-grade gliomas and 85 with high-grade gliomas. The median patient age was 45 years, and most patients (53) presented with seizures, whereas only 4 patients had an appreciable parietal lobe syndrome. The median preoperative tumor volume was 31.3 cm3, the median extent of resection was 96%, and the median postoperative tumor volume was 0.9 cm3. Surprisingly, the most common early postoperative neurological deficit was dysphasia (16 patients), not weakness (12 patients), sensory deficits (14 patients), or parietal lobe syndrome (10 patients). A proposed parietal glioma classification system, based on surgical anatomy, was predictive of language deficits. Conclusions This is the largest reported experience with parietal lobe gliomas. The findings suggested that parietal language pathways are compromised at a surprisingly high rate. The proposed parietal glioma classification system is predictive of postoperative morbidity associated with language and can assist with preoperative planning. Taken together, these data emphasize the value of identifying language pathways when operating within the parietal lobe.

scholarly journals The Impact of Blastocyst Grade on Singleton Birthweight in Fresh Transplanted Cycles

2021 ◽  
Author(s):  
Qiongyao Shi ◽  
Senlin Shi ◽  
Wenyan Song ◽  
Feifei Zhao ◽  
Haixia Jin ◽  
...  
Keyword(s):  
Birth Weight ◽  
Live Birth ◽  
Cell Mass ◽  
The Other ◽  
Low Grade ◽  
High Grade ◽  
Significant Difference ◽  
Group A ◽  
Grade 3 ◽  
The Impact

Abstract Background: A retrospectively cohort study was performed to compare the birth weight of different blastocyst grades in fresh transplantation cycle and explore the related factors affecting the birth weight. Methods: The 1301 fresh cycles of single blastocyst transplantation and single live birth profile were analyzed,four groups were divided according to the grade of transplanted blastocyst. There are 170 cycles in group A with AA blastocyst grade, 312 cycles in group B with AB/BA blastocyst grade, 559 cycles in group C with BB/CA/AC blastocyst grade and 260 cycles in group D with BC/CB blastocyst grade. Comparison were made among four groups of birth weight, general conditions, fertilization rate, embryo rate, cleavage rate and D5,D6 blastocyst formation rate and other laboratory indicators. And then comparison were performed among the birth weight of different groups which were divided by the degree of blastocyst expansion, and the classification of inner cell mass(ICM) and the trophectoderm(TE). Results: The study shows that the birth weight of group A is significantly higher than that of the other three groups (P < 0.05). And the high quality embryo rate and blastocyst rate of group A are significantly higher than those of the other three groups (P < 0.05). What’s more, the clinical pregnancy rate, implantation rate and live birth rate of high grade blastocyst are higher, but there are no significant difference in abortion rate. The birth weight of the degree of blastocyst expansion in grade 3 and below is significantly lower than that of those with grade 3 and above (P < 0.05). The birth weight of grade A of ICM is significantly higher than that of grade B (P < 0.05). The birth weight of grade B of TE is significantly heavier than that of grade C (P < 0.05). Conclusions: Our results indicate that high grade blastocyst transplantation can achieve better pregnancy outcome. Different blastocyst grades affect birth weight, and low grade blastocyst transplantation is associated with a single birth weight loss.

Screening for gastrointestinal disease

2018 ◽  
Author(s):  
Satish Keshav ◽  
Alexandra Kent
Keyword(s):  
Colorectal Cancer ◽  
Early Detection ◽  
Advanced Disease ◽  
Gastrointestinal Disease ◽  
Hepatocellular Cancer ◽  
High Grade Dysplasia ◽  
Low Grade ◽  
High Grade ◽  
The Impact

This chapter discusses screening for gastrointestinal disease, including Barrett’s oesophagus (BO), colorectal cancer, and hepatocellular cancer (HCC). In patients with BO, approximately 5% will develop dysplasia, and 10%–50% of the low-grade dysplasias will progress to high-grade dysplasia or adenocarcinoma within 2–5 years. Thus, screening for BO has been developed to reduce the development of adenocarcinoma via the early detection of high-grade dysplasia or cancer in situ. The main aim of colorectal cancer screening is the early detection of polyps and cancers, at a time when treatment is likely to be more effective. Similarly, early detection of HCC is advantageous, as the prognosis in advanced disease is very poor. This chapter describes the current processes of screening for these diseases, and the impact of this screening, as well as screening for gastrointestinal cancer in specific groups.

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