scholarly journals 10031-RT-02 Results of reactor-based BNCT for 44 cases of recurrent and refractory high-grade meningiomas and road to accelerator based BNCT

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii11-ii11
Author(s):  
Shin-Ichi Miyatake ◽  
Shinji Kawabata ◽  
Masahiko Wanibuchi ◽  
Satoshi Takai ◽  
Koji Takeuchi ◽  
...  
Keyword(s):  
Treatment Failure ◽  
External Beam Radiotherapy ◽  
Clinical Results ◽  
Local Tumor Control ◽  
Prolonged Survival ◽  
Tumor Control ◽  
High Grade ◽  
Particle Radiation ◽  
Failure Patterns ◽  
Grade 3

Abstract Introduction: High-grade meningioma (HGM) is difficult clinical entity to treat. Especially recurrent HGM after some radiotherapy has very miserable prognosis. For example median overall survival (mOS) of recurrent HGM after radiotherapy is reported as 2 years. We applied tumor-selective particle radiation BNCT using nuclear reactor for 44 recurrent HGMs. Methods: From 2005 to 2019, we treated 44 recurrent and refractory HGMs by reactor-based BNCT. The patients’ WHO grades are grade 2:20 cases, grade 3:24 cases. Prior to BNCT, totally 114 times operations and 72 times SRS and 14 times external beam radiotherapy were applied for them. OS, tumor shrinkage, causes of treatment failure were analyzed. Results: Median follow-up was 26.0 months. MOS after BNCT was 29.6 (95% CI:16.1–40.4) months. Grade 2 and 3 showed mOS as 44.4 (27.4-) and 21.55 (10.6–30.6) months, respectively and there is statistically significance (p=0.0009). All treated tumor showed rapid shrinkage on MRI. Treatment failure patterns are local recurrence, out of field recurrence, systemic metastasis, CSF dissemination, as 35.5%, 20.6%, 17.6%, 8.8 %, respectively. These results showed good local tumor control and prolonged survival for recurrent HGM cases. Conclusions: Our cases were heavily treated with repetitive surgeries and repetitive radiotherapy. In addition the rate of grade 3 patients was extremely high. In a word our cases seemed to have poor prognosis. In spite of these poor condition, reactor-based BNCT exerted good local control and prolonged survival for recurrent and refractory HGMs. Depending on the clinical results, PMDA gave us the permission to apply investigator-lead clinical trial for recurrent and refractory HGMs using accelerator-based BNCT with financial support from AMED (one of the agency of Japanese government). In our talk, let us open some results from this trial.

Dose-escalated external beam radiotherapy in unresectable hepatocellular carcinoma.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 267-267
Author(s):  
H. D. Skinner ◽  
H. J. Sharp ◽  
A. O. Kaseb ◽  
M. M. Javle ◽  
J. Vauthey ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Viral Hepatitis ◽  
External Beam Radiotherapy ◽  
Progression Free Survival ◽  
Residual Tumor ◽  
Local Tumor Control ◽  
Tumor Control ◽  
External Beam ◽  
Grade 3 ◽  
One Year

267 Background: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Data regarding the use of external beam radiotherapy is limited in patients from populations without endemic viral hepatitis. We examine the outcomes for patients treated with external beam radiotherapy in the modern era at a single institution. Methods: A total of 29 patients with localized HCC treated from 2000 to 2009 were reviewed. Patients with metastatic disease at the time of radiation were excluded. Median radiation dose was 50 Gy (range 30-75 Gy) with a median biologically effective dose (BED) of 80.6 (range 60-138.6). Median tumor size at the time of radiation was 5.2 cm (range 2-25 cm). Results: Median residual tumor following radiation was 80% (range 27%-278%), with a median residual α-fetoprotein of 47% (range 0.8%-8240%). Estimated one-year overall survival (OS) and in-field progression-free survival (PFS) rates for the study population were 56% and 79%, respectively. One year OS in patients treated to a BED <75 was 18% vs. 69% in patients treated to a BED ≥75 (p=0.002). One year in-field PFS rate (60% vs. 88%, p=0.023) and biochemical PFS duration (median 6.5 vs. 1.6 mos., p=0.001) were also significantly improved in patients treated to a BED ≥75. Grade 3 toxicity was seen in only 13.8% of patients. Conclusions: In a population without endemic viral hepatitis, unresectable HCC demonstrates significant response toexternal beam radiotherapy with minimal toxicity. Furthermore, our findings suggest that increased BED is associated with improved survival and local tumor control. No significant financial relationships to disclose.

scholarly journals Nervous System Hemangiopericytoma

2019 ◽  
Vol 47 (1) ◽  
pp. 18-29 ◽  
Author(s):  
Or Cohen-Inbar
Keyword(s):  
Nervous System ◽  
Tumor Volume ◽  
External Beam Radiotherapy ◽  
Progression Free Survival ◽  
Mass Effect ◽  
Local Tumor Control ◽  
Volume Control ◽  
Tumor Control ◽  
Local Tumor ◽  
Hybrid Surgery

Abstract:The management of patients harboring central nervous system (CNS) hemangiopericytomas (HPCs) is a partially answered challenge. These are rare locally aggressive lesions, with potential for local recurrence, distal neural metastasis (DNM), and extraneural metastasis (ENM). Resection, when feasible, remains the initial treatment option, providing histological diagnosis and immediate relief of tumor-related mass effect. Patients receiving surgery alone or surgery and external beam radiotherapy (EBRT) show improved overall survival (OS) and progression-free survival as compared to those undergoing a biopsy alone (p = 0.01 and p = 0.02, respectively). Yet, in many instances, patient and tumor-related parameters preclude complete resection. EBRT or stereotactic radiosurgery (SRS) shares a significant role in achieving local tumor control, not shown to impact OS in HPC patients. The benefits of SRS/EBRT are clearly limited to improved local tumor volume control and neurologic function, not affecting DNM or ENM development. SRS provides acceptable rates of local tumor volume control coupled with treatment safety and a patient-friendly apparatus and procedure. Single-session SRS is most effective for lesions measuring <2 cm in their largest diameter (10 cm3 volume), with prescription doses of at >15 Gy. Systemic HPC disease is managed with various chemotherapeutic, immunotherapeutic, and anti-angiographic agents, with limited success. We present a short discussion on CNS HPCs, focusing our discussion on available evidence regarding the role of microsurgical resection, EBRT, SRS, chemotherapy, and immunotherapy for upfront, part of adoptive hybrid surgery approach or for recurrent HPCs.

LOCAL TUMOR CONTROL WITH SALVAGE CRYOTHERAPY FOR LOCALLY RECURRENT PROSTATE CANCER AFTER EXTERNAL BEAM RADIOTHERAPY

2001 ◽  
Vol 165 (3) ◽  
pp. 867-870 ◽  
Author(s):  
JONATHAN I. IZAWA ◽  
PAUL PERROTTE ◽  
GRAHAM F. GREENE ◽  
SHELLIE SCOTT ◽  
LAWRENCE LEVY ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
External Beam Radiotherapy ◽  
Local Tumor Control ◽  
Tumor Control ◽  
External Beam ◽  
Recurrent Prostate Cancer ◽  
Local Tumor ◽  
Salvage Cryotherapy ◽  
Locally Recurrent

scholarly journals STMO-17 Treatment outcome of photodynamic therapy using talaporfin sodium for recurrent high-grade glioma

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi14-vi14
Author(s):  
Makoto Ohno ◽  
Daisuke Kawauchi ◽  
Yoshiharu Hayashi ◽  
Kaishi Satomi ◽  
Yasuji Miyakita ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Treatment Outcome ◽  
Treatment Outcomes ◽  
High Grade Glioma ◽  
Local Tumor Control ◽  
Tumor Control ◽  
High Grade ◽  
Local Tumor ◽  
Limit Of Quantification ◽  
Talaporfin Sodium

Abstract Objective: Photodynamic therapy (PDT) using Talaporfin Sodium (TS) is a novel therapeutic strategy to improve local tumor control in high-grade glioma. TS is a photosensitizer that accumulates in tumor cells and produces highly toxic free radicals by intraoperative irradiation of laser with a 664nm wavelength. However, little is known about the treatment outcomes of PDT in recurrent high-grade gliomas (rHGG). In this study, we investigated the treatment outcome of PDT in rHGG and evaluated the correlation between intratumoral TS accumulation and outcomes. Methods: We included 21 patients with rHGG and 22 tumors, who were treated by PDT between June 2016 and March 2021. TS was transvenously administered 22–26 hours before PDT. Intratumoral TS concentrations were measured by liquid chromatography using frozen tissue. Results: The rHGGs included 10 glioblastoma, IDH1/2-wildtype (GBM, IDH1/2-WT: 45.5%), 3 GBM, IDH1/2-mutant (GBM, IDH1/2-Mut: 13.6%), 7 anaplastic oligodendroglioma, IDH1/2-Mut/codel (AO, IDH1/2-Mut/codel: 31.8%), 1 anaplastic astrocytoma, IDH1/2-WT (AA, IDH1/2-WT: 4.5%), 1 high-grade astrocytoma, IDH1/2-WT (4.5%). The median local progression free survival (PFS) time after PDT was 3.6 months and the median survival time from PDT was 19.4 months. The intratumoral TS concentrations of 7 tumors (TS(-): 31.8%) were below the limit of quantification, and the intratumoral TS concentrations of the remaining 15 tumors (TS(+)) were 43.5 ng/mg-protein (14.7–132 ng/mg-protein). The intratumoral TS concentrations were not significantly associated with IDH1/2 mutation status, cellularity, tumor grade, and pattern of enhancement. The median PFS from PDT tended to be longer in TS(+) than in TS(-) (TS(+): 6.3 vs TS(-): 1.4 months, p = 0.054). Conclusions: We found that the intratumoral TS concentrations were heterogeneous and 31.8% were below the limit of quantification. TS(+) tended to have better local tumor control than TS(-), suggesting the intratumoral TS accumulation have an impact of treatment outcomes of PDT.

Outcomes of hypofractionated palliative radiotherapy for choroidal metastases.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 194-194
Author(s):  
Ezra Hahn ◽  
Juan Pablo Velazquez-Martin ◽  
Sohel Somani ◽  
Pedro Salazar ◽  
Daniela Domville ◽  
...  
Keyword(s):  
Overall Survival ◽  
Visual Acuity ◽  
Tumor Regression ◽  
External Beam Radiotherapy ◽  
Palliative Radiotherapy ◽  
Local Tumor Control ◽  
Cancer Center ◽  
Tumor Control ◽  
Local Tumor ◽  
Fractionation Schedule

194 Background: External beam radiotherapy (RT) is an effective palliative treatment for choroidal metastases aimed at preserving vision and obtaining local tumor control. Delivery of 30-40 Gy in 2 Gy daily fractions is a standard approach in many centers. At our center, a shorter, more convenient schedule of 20 Gy in 5 fractions has been used in this palliative setting. This study reports the efficacy and toxicity of this hypofractionated RT approach. Methods: We conducted a retrospective review of patients treated in the Ocular Oncology clinic at Princess Margaret Cancer Center who received RT (20 Gy in 5 fractions) for choroidal metastases between January 1, 1999 and November 30, 2012. Primary outcome measures were change in visual acuity and tumor response. Secondary outcomes included toxicities of RT, tumor control, and overall survival from the date of choroidal metastases diagnosis. Results: A total of 55 patients with 71 involved eyes were included. Decreased vision was the presenting symptom in 43 eyes (61%). Visual acuity improved from a median of 20/70 to 20/40 between baseline assessment and last follow-up, and remained stable or improved in 56 eyes (80%). On ultrasound, tumor regression was observed in 64 eyes (91%) with complete response in 47 eyes (67%). Metastases progressed in 4 eyes (6%) despite RT with 1 eye requiring enucleation. Median survival after diagnosis of choroidal metastases was 13 months with estimated overall survival at 1, 2, and 3 years to be 50% (36-62), 23% (12-35), and 8% (3-18), respectively. Forty-nine patients (89%) did not experience any acute complications. Mild acute toxicities included transitory dryness in 5 patients and episcleritis in 1 patient. Cataracts developed in 4 eyes (6%), retinopathy in 1 eye, optic neuropathy in 7 eyes (10%), pigmentary maculopathy in 5 eyes (7%), and neovascular glaucoma in 1 eye. Conclusions: A short fractionation schedule of 20 Gy in 5 fractions is a well-tolerated treatment that effectively preserves vision and gains local tumor control for many patients with choroidal metastases. This hypofractionated approach would help reduce the burden of a longer treatment course in this palliative patient population.

scholarly journals ACT-02 BORON NEUTRONS CAPTURE THERAPY FOR RECURRENT HIGH-GRADE MENINGIOMAS, FROM REACTOR TO ACCELERATOR

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii13-ii13
Author(s):  
Shin-Ichi Miyatake ◽  
Shinji Kawabata ◽  
Masahiko Wanibuchi ◽  
Minoru Suzuki ◽  
Yoshinori Sakurai ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Progression Free Survival ◽  
Best Supportive Care ◽  
Tumor Control ◽  
High Grade ◽  
Particle Radiation ◽  
Medical College ◽  
Positron Emission ◽  
Risk Patients

Abstract INTRODUCTION Recurrent high-grade meningiomas (rHGM) are difficult to control. We have applied tumor-selective particle radiation, reactor-based boron neutron capture therapy (BNCT) with excellent tumor control. METHODS Forty-six recurrent and treatment-refractory high grade meningiomas were treated with reactor-based BNCT by Osaka Medical College (OMC) and Kyoto University Research Reactor team collaboratively until February 2019. Tumor shrinkage, overall survival (OS), progression free survival (PFS), Lesion/Normal (L/N) ratio in boronophenylalanine positron emission tomography (BPA-PET) and causes of treatment failures are analyzed. RESULTS Subjects had been almost always treated heavily, high-risk patients for prognosis. They were received surgery 3 times and some radiotherapy 2 times averagely, prior to BNCT. All cases responded well and markedly shrunk by BNCT. The mean L/N ratio in BPA-PET was 4.0 which is higher than glioblastomas. Two-year PFS was 49.0% (95% CI: 28.84–66.49). Unfortunately follow-up was insufficient and 2 year OS was very similar to 2 year PFS. Treatment failures were observed as recurrence out of fields of neutron irradiation, systemic metastasis and in field local recurrence almost equally. SUMMARY AND PROSPECTS Median PFS and OS of rHGM are 5 months and 2 years respectively in literatures. We achieved relatively favorable results by reactor-based BNCT. On the other hand, we performed accelerator-based BNCT clinical trial for recurrent glioblastomas steadily first in the world. Based on these backgrounds, we applied investigator-lead, clinical trial of accelerator-based BNCT for rHGM as RCT design. Government (PMDA and AMED) has approved our proposal. We start this trial with the primary endpoint as PFS, from August 2019. Treatment arm is BNCT and control one is best-supportive care. If the subjects in control arm show progress disease in follow-up, they can be treated by BNCT as rescue treatments. We will introduce details of this trial in our presentation.

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