scholarly journals Local treatment failure after globe-conserving therapy for choroidal melanoma

2013 ◽  
Vol 97 (7) ◽  
pp. 804-811 ◽  
Author(s):  
Melinda Y Chang ◽  
Tara A McCannel
Keyword(s):  
Treatment Failure ◽  
Local Treatment ◽  
Choroidal Melanoma

scholarly journals Detecting Progression of Treated Choroidal Melanomas: Is Ultrasonography Necessary?

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5832
Author(s):  
Guy S. Negretti ◽  
Umiya Harley ◽  
Amit K. Arora ◽  
Gordon Hay ◽  
Mandeep S. Sagoo ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Tumour Progression ◽  
Local Treatment ◽  
Choroidal Melanoma ◽  
Fundus Photography ◽  
Wide Field ◽  
Increased Risk ◽  
Choroidal Melanomas ◽  
Colour Photography ◽  
The Media

Prompt detection and treatment of local treatment failure after radiotherapy for choroidal melanoma optimises any opportunities for conserving vision and the eye, possibly reducing an increased risk of metastatic disease. Long-term surveillance is therefore required but is hampered by the perceived need to perform ultrasonography, which may not be available at a patient’s local hospital. The aim of this study was to determine whether local treatment failure can reliably be detected with colour fundus photography alone, and, if so, in which patients. Patients were included in the study if diagnosed with local treatment failure between April 2016 and February 2021 after eye-conserving therapy for choroidal melanoma. Wide-field colour and fundal autofluorescence (FAF) images, optical coherence tomography (OCT), and ultrasonography (US) were analysed by two of the authors (GN and UH). The cohort included 87 patients with local treatment failure. In 75 patients with clear media, tumour progression was detected by colour photography alone in 74 (98.7%) patients. Sensitivity was not increased by the addition of either OCT or AF. One patient with clear media developed extraocular extension detected with US without visible change in the intraocular part of the tumour. In the other 12 patients, US was required because of opaque media and a consequently poor fundal view. Local treatment failure after radiotherapy for choroidal melanoma is detected in 98.7% of cases with colour photography when the media are clear. Ultrasonography is useful when photography is prevented by opaque media or tumours having locations in the far periphery.

scholarly journals Cavity-directed radiosurgery as adjuvant therapy after resection of a brain metastasis

2011 ◽  
Vol 114 (6) ◽  
pp. 1585-1591 ◽  
Author(s):  
Courtney A. Jensen ◽  
Michael D. Chan ◽  
Thomas P. McCoy ◽  
J. Daniel Bourland ◽  
Allan F. deGuzman ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Resolution ◽  
Brain Metastasis ◽  
Mr Imaging ◽  
Brain Metastases ◽  
Treatment Failure ◽  
Local Treatment ◽  
Resection Cavity ◽  
Kaplan Meier ◽  
Cause Specific Survival

Object As a strategy to delay or avoid whole-brain radiotherapy (WBRT) after resection of a brain metastasis, the authors used high-resolution MR imaging and cavity-directed radiosurgery for the detection and treatment of further metastases. Methods Between April 2001 and October 2009, 112 resection cavities in 106 patients with no prior WBRT were treated using radiosurgery directed to the tumor cavity and for any synchronous brain metastases detected on high-resolution MR imaging at the time of radiosurgical planning. A median dose of 17 Gy to the 50% isodose line was prescribed to the gross tumor volume, defined as the rim of enhancement around the resection cavity. Patients were followed up via serial imaging, and new brain metastases were generally treated using additional radiosurgery, with salvage WBRT typically reserved for local treatment failure at a resection cavity, numerous failures, or failures occurring at short time intervals. Local and distant treatment failures were determined based on imaging results. Kaplan-Meier curves were generated to estimate local and distant treatment failure rates, overall survival, neurological cause–specific survival, and time delay to salvage WBRT. Results Radiosurgery was delivered to the resection cavity alone in 57.5% of patients, whereas 24.5% of patients also received treatment for 1 synchronous metastasis, 11.3% also received treatment for 2 synchronous metastases, and 6.6% also received treatment for 3–10 additional lesions. The median overall survival was 10.9 months. Overall survival at 1 year was 46.8%. The local tumor control rate at 1 year was 80.3%. The disease control rate in distant regions of the brain at 1 year was 35.4%, with a median time of 6.9 months to distant failure. Thirty-nine of 106 patients eventually received salvage WBRT, and the median time to salvage WBRT was 12.6 months. Kaplan-Meier estimates showed that the rate of requisite WBRT at 1 year was 45.9%. Neurological cause–specific survival at 1 year was 50.1%. Leptomeningeal failure occurred in 8 patients. One patient had treatment failure within the resection tract. Seven patients required reoperation: 2 for resection cavity recurrence, 3 for radiation necrosis, 1 for hydrocephalus, and 1 for a CSF cutaneous fistula. On multivariate analysis, a preoperative tumor diameter > 3 cm was predictive of local treatment failure. Conclusions Cavity-directed radiosurgery combined with high-resolution MR imaging detection and radiosurgical treatment of synchronous brain metastases is an effective strategy for delaying and even foregoing WBRT in most patients. This technique provides acceptable local disease control, although distant treatment failure remains significant.

Salvage endoscopic submucosal dissection for the treatment of esophageal squamous cell carcinoma after local treatment failure with chemotherapy, radiotherapy, or chemoradiotherapy.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 148-148
Author(s):  
Toshiro Iizuka ◽  
Daisuke Kikuchi ◽  
Shu Hoteya ◽  
Akihiro Yamada ◽  
Mitsuru Kaise
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Treatment Failure ◽  
Endoscopic Submucosal Dissection ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Local Treatment ◽  
Submucosal Dissection ◽  
The Mean

148 Background: Chemotherapy (CT), radiotherapy (RT), and chemoradiotherapy (CRT) are efficacious treatment options for esophageal squamous cell carcinoma (ESCC). However, local treatment failure remains a major problem. In this study, we applied endoscopic submucosal dissection (ESD) for the treatment of ESCC after local treatment failure with CT, RT, or CRT. The efficacy, safety, and feasibility of salvage ESD were assessed. Methods: Between 2008 and 2014, 611 patients underwent ESD for superficial ESCC in our hospital. Of them, 14 required salvage ESD: 7 for local treatment failure after CT, 4 after CRT, and 3 after RT. Each patient was treated with CT using 5-fluorouracil + cisplatin or RT, which consisted of >50 Gy of irradiation with or without concurrent CT. The following clinical findings were confirmed in all patients: no evidence of lymph node or distant metastasis after treatment, and an endoscopically resectable lesion. Results: The male to female ratio was 11:3 and the mean age was 64.9 (44-81) years. Clinical stages before treatment were T1b/T2/T3/T4 in 10/1/2/1, N0/1 in 7/7, and M0/1 in 13/1, respectively. The mean tumor size was 18.6 mm, and the mean procedure time was 45.7 min. En bloc resection was achieved in 100% of cases, and the R0 resection rate was 78.6%. Histopathological assessment of specimens taken at salvage ESD revealed that 6 lesions (42.9%) had invaded the submucosal layer and had been resected noncuratively because of a positive vertical margin (n = 2) or positive lymphovascular invasion (n = 5). No immediate or delayed complications, including major bleeding or perforation, and no ESD-related deaths occurred. At a mean follow-up period of 26.5 (range, 5–55) months, local recurrence had developed at the treatment site in 2 patient. Overall, 10 patients were still alive. The remaining 4 had developed lymph node metastasis, 2 of whom had died from it. Conclusions: Salvage ESD is an option for ESCC patients with local treatment failure after CT, RT, or CRT.

Gamma knife surgery for the treatment of intracranial metastases from breast cancer

2005 ◽  
Vol 103 (2) ◽  
pp. 218-223 ◽  
Author(s):  
Sharad Goyal ◽  
Dheerendra Prasad ◽  
Frank Harrell ◽  
Julie Matsumoto ◽  
Tyvin Rich ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Failure ◽  
Gamma Knife ◽  
Local Treatment ◽  
Multivariable Analysis ◽  
Gamma Knife Surgery ◽  
Content Type ◽  
Cox Regression Analysis ◽  
Single Lesion ◽  
Fine Print

Object. The goal of this study was to evaluate the effectiveness and limitations of gamma knife surgery (GKS) in the treatment of intracranial breast carcinoma lesions. Methods. A retrospective analysis of the GKS database at the University of Virginia Health System identified 43 patients with a total of 84 lesions who were treated between 1989 and 2000. All patients who received treatment were included in this study. Imaging studies were available in 35 patients with 67 treated lesions. The overall duration of median survival was 13 months (95% confidence interval [CI] 7–16 months) after radiosurgery. A univariable Cox regression analysis revealed that a single lesion (p = 0.035), a high Karnofsky Performance Scale (KPS) score (p = 0.019), and a high Score Index for Radiosurgery (SIR) in Brain Metastases (p = 0.036) were associated with a significantly lengthened time to local treatment failure. The median duration of survival for patients grouped according to the SIR as low, middle, and high was 3, 8, and 21 months, respectively (p = 0.00033). A multivariable analysis showed that a high KPS score (p = 0.006), a high SIR (p = 0.014), and advanced age (0.038) were predictive of survival. The 1-, 2-, 3-, and 5-year survival rates were 49, 23, 12, and 2%, respectively. The overall median time to local treatment failure was 10 months (95% CI 6–14 months) after GKS. A univariable analysis demonstrated that a single lesion, higher KPS score, and a higher SIR were associated with a significantly longer time until local treatment failure. A multivariable analysis showed that a higher KPS score and SIR and patients who had received chemotherapy were associated with a significantly longer time to local treatment failure. Neuroimaging scores given for the enhancement pattern (ring-enhancing, heterogeneous, and homogeneous signal), amount of necrosis (none, < 50%, and > 50%), and mass effect (none, mild, moderate, and severe) of each treated lesion did not correlate with survival or local treatment failure. Conclusions. The SIR and the KPS score are prognostic factors in patients whose intracranial breast cancer metastases are treated with GKS. The SIR, which includes the KPS score, patient age, systemic disease status, largest lesion volume, and number of lesions, can be used to identify those patients with breast cancer metastasis who would benefit from GKS better than KPS score alone. The contribution of whole-brain radiation therapy to GKS with regard to local tumor control or survival could not be identified.

Failure Pattern and Factors Predictive of Local Failure in Rhabdomyosarcoma: A Report of Group III Patients on the Third Intergroup Rhabdomyosarcoma Study

2004 ◽  
Vol 22 (10) ◽  
pp. 1902-1908 ◽  
Author(s):  
Moody D. Wharam ◽  
Jane Meza ◽  
James Anderson ◽  
John C. Breneman ◽  
Sarah S. Donaldson ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Treatment Failure ◽  
Cumulative Incidence ◽  
Cox Model ◽  
Local Treatment ◽  
Local Failure ◽  
Subtotal Resection ◽  
Group Iii ◽  
The Third ◽  
Failure Risk

Purpose To analyze patterns of failure and factors predictive of local treatment failure in children enrolled on the third Intergroup Rhabdomyosarcoma Study who had either biopsy only or subtotal resection of their primary tumor, had no distant metastases, and received radiation therapy for local control. Patients and Methods Treatment failure was categorized as local, regional nodal, or distant metastatic. The 5-year cumulative risk of failure was estimated for each category and factors predictive of local failure risk were determined using the Cox model and binary recursive partitioning. Results The estimated 5-year cumulative incidence rates by failure category were: total local (with or without concurrent regional or distant failure), 19%; total regional nodal, 2%; total distant, 11%; and death from toxicity or unknown recurrence type, 4%. Lymph node involvement at diagnosis was the single factor most predictive of increased total local failure risk (5-year cumulative incidence 32%) compared with children with negative nodes or unknown node status (16%). No significant effect on local failure risk was observed by total radiotherapy dose over the prescribed range of 41.4 Gy to 50.4 Gy. For all patients (N = 405), the estimated 5-year failure-free survival and overall survival were, respectively, 70% and 78%. Conclusion Local failure after radiotherapy for group III rhabdomyosarcoma patients is the predominant type of relapse. Involved lymph nodes at diagnosis predict a higher risk of local and distant treatment failure compared with patients whose lymph nodes are negative.

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