scholarly journals Stereotactic Radiosurgery Associated Neurotoxicity

2003 ◽  
Vol 2 (2) ◽  
pp. 147-151 ◽  
Author(s):  
William H. St. Clair ◽  
Curtis A. Given
Keyword(s):  
Stereotactic Radiosurgery ◽  
Therapeutic Option ◽  
Treatment Plan ◽  
Three Dimensional ◽  
Reference Points ◽  
Therapeutic Modality ◽  
High Dose ◽  
Lesion Volume ◽  
Three Dimensional Mapping ◽  
Effective Therapeutic Option

Stereotactic radiosurgery (SRS) is an evolving therapeutic modality for well demarcated intracranial lesions. Since the inception of stereotactic radiosurgery the types of parenchymal CNS lesions addressed by this mode of treatment has increased. All modern stereotactic radiosurgical procedures employ several common features. Patients are fitted with a stereotactic head frame or fiducial markers followed by radiographic imaging which allows for external reference points and three-dimensional mapping of the intracranial lesion. Armed with this information a highly conformal treatment plan is developed to deliver a high dose of radiation to a sharply defined target, with rapid dose fall-off outside the lesion volume. While an extremely effective therapeutic option, SRS is not without risk of neurotoxicity, with radiation necrosis being the most commonly recognized complication. The neurotoxic effects of SRS are reviewed and discussed.

scholarly journals Image-guided radiosurgery in the treatment of spinal metastases

2001 ◽  
Vol 11 (6) ◽  
pp. 1-7 ◽  
Author(s):  
Martin J. Murphy ◽  
Steven Chang ◽  
Iris Gibbs ◽  
Quynh-Tu Le ◽  
David Martin ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Therapeutic Option ◽  
Spinal Metastases ◽  
Target Volume ◽  
Outpatient Setting ◽  
Spinal Tumors ◽  
High Dose ◽  
Radiation Beam ◽  
Image Guided ◽  
Frameless Radiosurgery

Object The authors describe a new method for treating metastatic spinal tumors in which noninvasive, image-guided, frameless stereotactic radiosurgery is performed. Stereotactic radiosurgery delivers a high dose of radiation in a single or limited number of fractions to a lesion while maintaining delivery of a low dose to adjacent normal structures. Methods Image-guided radiosurgery was developed by coupling an orthogonal pair of real-time x-ray cameras to a dynamically manipulated robot-mounted linear accelerator that guides the radiation beam to treatment sites associated with radiographic landmarks. This procedure can be conducted in an outpatient setting without the use of frame-based skeletal fixation. The system relies on skeletal landmarks or implanted fiducial markers to locate treatment targets. Four patients with spinal metastases underwent radiosurgery with total prescription doses of 1000 to 1600 cGy in one or two fractions. Alignment of the treatment dose with the target volume was accurate to within 1.5 mm. During the course of each treatment fraction, patient movement was less than 0.5 mm on average. Dosimetry was highly conformal, with a demonstrated ability to deliver 1600 cGy to the perimeter of an irregular target volume while keeping exposure to the cord itself below 800 cGy. Conclusions These experiences indicate that frameless radiosurgery is a viable therapeutic option for metastatic spine disease.

Comparison of three-dimensional conformal irradiation techniques for prostate cancer using a low-energy (6 MV) photon beam

2010 ◽  
Vol 10 (2) ◽  
pp. 91-101
Author(s):  
Christina Armpilia ◽  
Christos Antypas ◽  
Anna Zygogianni ◽  
Myrsini Balafouta ◽  
John Kouvaris ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Treatment Plan ◽  
Three Dimensional ◽  
Low Energy ◽  
Photon Beam ◽  
High Dose ◽  
Prostate Radiotherapy ◽  
Energy Beam ◽  
Dose Volume Histograms ◽  
Femoral Heads

AbstractPurpose: To evaluate composite coplanar and non-coplanar three-dimensional conformal techniques (3D-CRT) for external-beam prostate radiotherapy using a low-energy (6 MV) photon beam.Methods and Materials: For treatment-planning purposes, three different planning target volumes (PTV) were defined for ten patients with prostate cancer and as follows: PTV1 (pelvis), PTV2 (prostate + seminal vesicles + 1 cm margin) and PTV3 (prostate + 1 cm margin). Conformal techniques of 2, 3, 4, 5 (coplanar) and 6 (non-coplanar) field techniques have been considered and combined to produce five different plan combinations (i.e. techniques A, B, C, D and E). Treatment plans were generated with a prescription dose of 75 Gy to PTV3, 65 Gy to PTV2 and 45 Gy to PTV1 and were assessed on the basis of 3D dose distributions and dose-volume histograms (DVHs). Normal tissue-dose constraints for the relevant organs at risk (OARs), that is, rectum, bladder and femoral heads, were also considered.Results: Findings show that all five treatment-plan combinations result in adequate PTV coverage and acceptable OAR irradiated volumes. The greatest rectal spacing in the high-dose region is achieved by technique C; all techniques achieve this, except for technique A, and give approximately the same fraction of volume (of rectum) that receives a dose of 50 Gy (V50) and 60 Gy (V60). When considering the bladder, techniques B, D and E give the best bladder sparing with small absolute differences, whereas technique A results in the lowest dose for femoral heads. Technique E appears to give the best compromise for all three considered OARs, provided the PTV is adequately covered.Conclusions: Even though the optimum photon-beam energy for conformal prostate radiotherapy is greater than 10 MV, our study shows that a good sparing of OAR can be achieved even with a lower-energy beam (6 MV) and the appropriate plan combination and that the dose to prostate can be as high as 75 Gy.

scholarly journals Efficacy of Rituximab in a Systemic Lupus Erythematosus Patient Presenting with Diffuse Alveolar Hemorrhage

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Gabriela Montes-Rivera ◽  
Grissel Ríos ◽  
Luis M. Vilá
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Therapeutic Option ◽  
Acute Onset ◽  
Diffuse Alveolar Hemorrhage ◽  
Alveolar Hemorrhage ◽  
High Dose ◽  
Systemic Lupus ◽  
Effective Therapeutic Option ◽  
Life Threatening

Diffuse alveolar hemorrhage (DAH) is a life-threatening complication of systemic lupus erythematosus (SLE). Although infrequent, its mortality is very high. While there are no established therapeutic guidelines, DAH has been traditionally managed with high-dose intravenous (IV) corticosteroids, cyclophosphamide, and plasma exchange. The efficacy of alternative therapies such as rituximab has been described only in a few cases. Herein, we report a 25-year-old Hispanic man who presented with acute-onset SLE manifested by polyarthralgia, nephritis, seizures, pancytopenia, severe hypocomplementemia, and elevated anti-dsDNA antibodies. His disease course was complicated by DAH. His condition was refractory to high-dose intravenous (IV) methylprednisolone pulses, IV cyclophosphamide, and plasmapheresis. Given the lack of clinical response, he was started on IV rituximab 375 mg/m2 weekly for a total of four courses. He rapidly improved after the first two doses. Over the next seven months, he did not present recurrent pulmonary symptoms. Follow-up chest computed tomography did not show residual abnormalities. This case, together with other reports, suggests that rituximab is an effective therapeutic option for DAH in SLE.

scholarly journals Stereotactic Radiosurgery pada Benign Skull Base Tumor

2016 ◽  
Vol 10 (1) ◽  
pp. 35
Author(s):  
HENRY KODRAT ◽  
RIMA NOVIRIANTHY
Keyword(s):  
Skull Base ◽  
Stereotactic Radiosurgery ◽  
Point Of View ◽  
Therapeutic Modality ◽  
Treatment Modalities ◽  
High Dose ◽  
Skull Base Tumor ◽  
Fractionated Radiotherapy ◽  
Conventional Dose ◽  
Stereotactic Navigation

ABSTRACTTotal removal is difficult to be performed in skull base tumors because its location is surrounded by important structures such as nerves and blood vessels. Therefore, radiotherapy is one of treatment modalities that has been proven efficacy. Simultaneous with the development of imaging technology and advancement of radiobiology, radiosurgery is an emerging therapeutic modality. Radiosurgery is radiotherapy method which delivers high doseirradiation in single fraction. Rational use of stereotactic radiosurgery on benign skull base tumor is from radiobiology point of view; there is no advantage can be achieved from conventional dose fractionated radiotherapy compared with high dose. However, if we want to delivered high dose radiation, we must apply rigid immobilization, target definition using stereotactic navigation and image guidance verification. Radiosurgery can only be delivered in small intracranial lesion.ABSTRAKReseksi total kadang sulit dilakukan pada tumor yang terletak pada dasar tengkorak. Hal ini disebabkan lokasinya dikelilingi oleh struktur saraf dan pembuluh darah penting. Oleh karena itu, radioterapi merupakan salah satu modalitas terapi yang sudah terbukti maanfaatnya. Sejalan dengan perkembangan teknologi pencitraan dan kemajuan pengetahuan radiobiologi, radiosurgery merupakan modalitas terapi yang melejit penggunannya. Radiosurgery adalah metode pemberian radioterapi dengan dosis tinggi dan diberikan dalam fraksi tunggal. Rasional penggunaan stereotactic radiosurgery pada tumor jinak dasar tengkorak adalah karena dari sudut pandang radiobiologi, tidak ada kelebihan dariradioterapi dengan dosis konvensional dibandingkan dengan dosis tinggi. Namun, untuk pemberian dosis tinggi diwajibkan imobilisasi yang rigid dan lokalisasi yang akurat dengan menggunakan navigasi stereotaktik dan verifikasi dengan panduan pencitraan radiologi. Radiosurgery hanya dapat diberikan pada kelainan intrakranial yang berukuran kecil.

scholarly journals Linear accelerator-based stereotactic radiosurgery in recurrent glioblastoma: A single center experience

2011 ◽  
Vol 68 (11) ◽  
pp. 961-966 ◽  
Author(s):  
Sait Sirin ◽  
Kaan Oysul ◽  
Serdar Surenkok ◽  
Omer Sager ◽  
Ferrat Dincoglan ◽  
...  
Keyword(s):  
Single Dose ◽  
Stereotactic Radiosurgery ◽  
Planning Target Volume ◽  
Linear Accelerator ◽  
Therapeutic Option ◽  
Target Volume ◽  
Recurrent Glioblastoma ◽  
High Dose ◽  
Combined Modality Treatment ◽  
Karnofsky Performance Score

Background/Aim. Management of patients with recurrent glioblastoma (GB) comprises a therapeutic challenge in neurooncology owing to the aggressive nature of the disease with poor local control despite a combined modality treatment. The majority of cases recur within the highdose radiotherapy field limiting the use of conventional techniques for re-irradiation due to potential toxicity. Stereotactic radiosurgery (SRS) offers a viable noninvasive therapeutic option in palliative treatment of recurrent GB as a sophisticated modality with improved setup accuracy allowing the administration of high-dose, precise radiotherapy. The aim of the study was to, we report our experience with single-dose linear accelerator (LINAC) based SRS in the management of patients with recurrent GB. Methods. Between 1998 and 2010 a total of 19 patients with recurrent GB were treated using single-dose LINAC-based SRS. The median age was 47 (23-65) years at primary diagnosis. Karnofsky Performance Score was ? 70 for all the patients. The median planning target volume (PTV) was 13 (7-19) cc. The median marginal dose was 16 (10-19) Gy prescribed to the 80%-95% isodose line encompassing the planning target volume. The median follow-up time was 13 (2-59) months. Results. The median survival was 21 months and 9.3 months from the initial GB diagnosis and from SRS, respectively. The median progression-free survival from SRS was 5.7 months. All the patients tolerated radiosurgical treatment well without any Common Toxicity Criteria (CTC) grade > 2 acute side effects. Conclusion. Single-dose LINAC-based SRS is a safe and well- tolerated palliative therapeutic option in the management of patients with recurrent GB.

scholarly journals The dark side of the moon: severe therapy-resistant asthma in children

2015 ◽  
Vol 77 (2) ◽  
Author(s):  
F.M. De Benedictis ◽  
I. Carloni ◽  
A. Bush
Keyword(s):  
Severe Asthma ◽  
Inhaled Corticosteroids ◽  
Therapeutic Option ◽  
Treatment Plan ◽  
Dark Side ◽  
High Dose ◽  
Adherence To Treatment ◽  
Pediatric Diseases ◽  
International Collaborations ◽  
Evidence Based Treatments

Problematic severe asthma is the term used to describe children whose asthma is not responsive to standard therapy with high-dose inhaled corticosteroids and additional controllers. These children need to be assessed by a step-wise systematic protocol in order to confirm the diagnosis, evaluate co-morbidities, assess the adherence to treatment, and finally evaluate the basic management. More than half of these children have “difficult-to-treat asthma”, which improves if the basic management is correct. Children whose asthma remains uncontrolled despite resolution of any reversible factors are termed “severe therapy-resistant” asthmatics; for them, an individualised treatment plan is developed after a detailed and invasive protocol of investigation. Therapeutic options for these patients can be divided into medications used in lower doses for children with less severe asthma, and those used in other pediatric diseases but not for asthma. Most treatments are unlicensed and there is a lack of high-quality evidence. Children with recurrent severe exacerbations, in particular in the context of good baseline asthma control, are particularly difficult to treat, and there is no evidence on which therapeutic option to recommend. International collaborations, using standard protocols of investigation, are needed to better understand mechanisms of severe therapy-resistant asthma and to deliver evidence-based treatments in the future.

scholarly journals Stereotactic radiosurgery for hemangiomas and ependymomas of the spinal cord

2003 ◽  
Vol 15 (5) ◽  
pp. 1-5 ◽  
Author(s):  
Stephen I. Ryu ◽  
Daniel H. Kim ◽  
Steven D. Chang
Keyword(s):  
Spinal Cord ◽  
Stereotactic Radiosurgery ◽  
Therapeutic Option ◽  
Spinal Tumors ◽  
High Dose ◽  
Significant Treatment ◽  
Conventional Radiation ◽  
Conformal Treatment ◽  
Dose Radiation

Object The optimal treatment for intramedullary spinal tumors is controversial, because both resection and conventional radiation therapy are associated with potential morbidity. Stereotactic radiosurgery can theoretically deliver highly conformal, high-dose radiation to surgically untreatable lesions while simultaneously mitigating radiation exposure to large portions of the spinal cord. The purpose of this study was to evaluate the authors' initial experience with frameless stereotactic radiosurgery for intramedullary spinal tumors. Methods Between 1998 and 2003, 10 intramedullary spinal tumors were treated with stereotactic radiosurgery at the authors' institution. Seven hemangioblastomas and three ependymomas were treated in four men and three women. These patients either had recurrent tumors, had undergone several previous surgeries, had medical contraindications to surgery, or had declined open resection. Conformal treatment planning delivered a prescribed dose of 1800 to 2500 cGy (mean 2100 cGy) to the lesions in one to three stages. No significant treatment-related complications have been recorded. The mean radiographic and clinical follow-up duration was 12 months (range 1–24 months). One ependymoma and two hemangioblastomas were smaller on follow-up neuroimaging. The remaining tumors were stable at the time of follow-up imaging. Conclusions Stereotactic radiosurgery for intramedullary spinal tumors is feasible and safe in selected cases and may prove to be another therapeutic option for these challenging lesions.

scholarly journals Complete and Fast Recovery from Idiopathic Facial Paralysis Using Laser-Photobiomodulation

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
João Paulo Colesanti Tanganeli ◽  
Simone Saldanha Ignácio de Oliveira ◽  
Tamiris da Silva ◽  
Kristianne Porta Santos Fernandes ◽  
Lara Jansiski Motta ◽  
...  
Keyword(s):  
Facial Paralysis ◽  
Therapeutic Option ◽  
Bell’S Palsy ◽  
Good Choice ◽  
Therapeutic Modality ◽  
Bell's Palsy ◽  
Effective Therapeutic Option ◽  
Negative Effect ◽  
Therapeutic Measures ◽  
Systemic Side Effects

Idiopathic facial paralysis, also known as Bell’s palsy, exerts a negative effect on the quality of life. Although the prognosis is good in the majority of cases, a significant percentage of affected individuals may have sequelae that can negatively affect their lives. The use of therapeutic measures as early as possible can improve the prognosis. This article describes the successful use of laser-photobiomodulation as a single therapy in a patient with Bell’s palsy and confirms the possibility of using this therapeutic modality as a good choice, since it is a therapy that is painless, comfortable, and without systemic side effects. The findings demonstrate that the adequate use of laser-photobiomodulation can be an effective therapeutic option for patients with Bell’s palsy, regardless of the age, shortening the recovery time obtained with conventional therapies and avoiding sequelae. Further studies are needed for the establishment of adequate protocols.

Stereotactic radiosurgery for patients with newly diagnosed glioblastoma multiforme (GBM): comparison with intra-operative radiotherapy and evaluation of prognostic factors

2007 ◽  
Vol 6 (03) ◽  
pp. 143-152 ◽  
Author(s):  
Masayuki Matsuo ◽  
Jun Shinoda ◽  
Kazuhiro Miwa ◽  
Hirohito Yano ◽  
Toru Iwama ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Glioblastoma Multiforme ◽  
Stereotactic Radiosurgery ◽  
Therapeutic Modality ◽  
Management Approach ◽  
Tumour Resection ◽  
High Dose ◽  
Newly Diagnosed ◽  
Local Irradiation ◽  
Newly Diagnosed Glioblastoma

AbstractThe goals of this study were (1) to compare, in a single institute, the clinical results of patients with newly diagnosed glioblastoma multiforme (GBM) treated with stereotactic radiosurgery (SRS), which has been incorporated into the initial management approach, with thosein-patientstreated with intra-operative radiotherapy (IORT) and (2) to assess whether these local irradiation boost therapies are prognostic factors on survival analysis. One hundred and twenty adult patients with supratentorial GBM had undergone tumour resection or biopsy and had received external beam radiotherapy (EBRT). Of them, 31 underwent IORT, 29 underwent SRS, and the remaining 60 had no local high-dose irradiation boost. The local irradiation boost led to clearly better results on survival of GBM patients. Furthermore, SRS is less invasive and allows for meticulous target planning of the irradiation boost, and was superior to IORT in terms of survival prolongation as well as suppression of local tumour recurrence/progression at the primary site in this series. In addition, SRS was a significant, positive prognostic factor for survival as well as gross-total resection of the tumour, and could be an alternative therapeutic modality to IORT for GBM.

Azacitidine to Consolidate and Deepen the Therapeutic Response Achieved by Intensive Induction Treatment in a Young Patient Affected by NPM1mut-AML Who Has Become Ineligible for High-Dose Consolidation

Chemotherapy ◽  
2022 ◽  
pp. 1-5
Author(s):  
Natalia Cenfra ◽  
Gianfranco Lapietra ◽  
Salvatore Perrone ◽  
Maria Teresa Voso ◽  
Mariadomenica Divona ◽  
...  
Keyword(s):  
Young Patient ◽  
Residual Disease ◽  
Therapeutic Option ◽  
Young Patients ◽  
Low Risk ◽  
Induction Treatment ◽  
High Dose ◽  
Npm1 Mutation ◽  
Effective Therapeutic Option ◽  
Molecular Landscape

Acute myeloid leukemia (AML) is the most common leukemia in adults. In spite of the most recent discoveries about the molecular landscape of this disease, the treatment of elderly and unfit young patients continues to be a great challenge. The hypomethylating agents (HMA) still represent an effective therapeutic option for these categories, especially for the low-risk subgroups. We report the case of a young patient with NPM1<sup>mut</sup>-AML who underwent a first cycle of intensive induction treatment, achieving a complete remission, but suffered from a serious life-threatening neurologic toxicity. Due to the ineligibility to further lines of intensive chemotherapy, we decided to consolidate the response with azacitidine, administered according to the regular schedule. The minimal residual disease (MRD), monitored through the NPM1 mutation at diagnosis, progressively decreased and became undetectable after 36 cycles of hypomethylating therapy. After 1 year from discontinuation of azacitidine, MRD remains undetectable. Therefore, HMA might still represent a feasible and effective option for patients with low-risk AML, especially when the standard chemotherapy is not indicated, or as maintenance therapy in nontransplantable patients.

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