CyberKnife Frameless Radiosurgery for the Treatment of Extracranial Benign Tumors

2005 ◽  
Vol 4 (5) ◽  
pp. 571-576 ◽  
Author(s):  
Ajay K. Bhatnagar ◽  
Peter C. Gerszten ◽  
Cihat Ozhasaglu ◽  
William J. Vogel ◽  
Shalom Kalnicki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Local Control ◽  
Late Toxicity ◽  
Foramen Magnum ◽  
Local Control Rate ◽  
External Beam Radiation ◽  
Benign Tumors ◽  
Beam Radiation ◽  
Frameless Radiosurgery

Limited data exists for the use of radiosurgery for benign extracranial tumors. The purpose of this study was to evaluate the feasibility, toxicity, and local control of patients with benign extracranial lesions treated with the CyberKnife Frameless Radiosurgery System. From September 2001 thru January 2004, 59 benign tumors in 44 patients were treated using the CyberKnife a frameless image-guided radiosurgery system. Of these tumors, there were 21 neurofibromas, ten schwannomas, eight meningiomas, eight hemangioblastomas, seven paragangliomas, two hemangiopericytomas, one pseudotumor, one ependymoma, and one arteriovenous malformation (AVM). The anatomic locations of these tumors were spinal (25 cervical, four thoracic, 14 lumbar, and two sacral), neck (eight), orbital (three), brainstem (one), and foramen magnum (one). All patients were treated in a single fraction except three lesions were treated in a fractionated manner. The median treatment delivery time per fraction was 59 minutes (range 11–194). Twenty three lesions initially underwent surgical resection. Ten lesions received prior external beam radiation with a median dose 48 Gy (range 40–54 Gy), and one lesion received two prior CyberKnife treatments for a total dose of 32 Gy to the 80% isodose line. The median follow-up was eight months (range 1–25 months). Acute and late toxicity was graded using the National Cancer Institute Common Toxicity Criteria (CTC) scale. Symptomatic response was documented as “improved,” “stable,” or “progression”. The median tumor dose delivered was 16.0 Gy to the 80% isodose line (range 10–31 Gy). The median tumor volume was 4.3 cc (range 0.14–98.6 cc). The median spinal cord volume receiving more than 8 Gy was 0.035 cc (range 0–2.5 cc) and the median maximum spinal cord dose 11.5 Gy (range 0–19.8 Gy). There were no patients that suffered a significant (Grade 3, 4, or 5) acute toxicity. There was no observed late toxicity. 78% of patients experienced an improvement of their pre-treatment symptoms while only one patient experienced symptom progression. Of the 26 patients who underwent follow-up imaging, the local control rate was 96%. This study suggests that CyberKnife Radiosurgery is a safe and efficacious treatment modality for benign tumors, even for those patients with recurrent previously irradiated lesions.

Combined brachytherapy and external beam radiation for prostate cancer in a community setting

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16147-e16147
Author(s):  
G. J. Kubicek ◽  
G. J. Kubicek ◽  
S. Brown ◽  
S. Redfield
Keyword(s):  
Prostate Cancer ◽  
External Beam Radiotherapy ◽  
Treatment Options ◽  
Community Setting ◽  
Late Toxicity ◽  
Biochemical Failure ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation

e16147 Background: Prostate cancer is the most common male malignancy, and there is no one standard treatment modality. One treatment option is the combination of external beam radiotherapy and permanent transperineal brachytherapy seed implant Methods: Retrospective review of prostate cancer and side effect outcomes at a single institution in the community setting. All patients were treated with a combination of low dose rate transperineal brachytherapy seed placement and external beam radiation. Results: A total of 897 patients were analyzed, 781 had a minimum follow-up of one year. Median pre-treatment PSA was 8.1 (range 0.3 to 106) and the median Gleason score was 6. With a median follow-up of 3.6 years, 33 (3.4 %) patients had biochemical failure based on the phoenix definition of Nadir + 2. Not including impotence, acute toxicity greater than or equal to Grade 2 was seen in 115 patients (102 GU and 13 GI) and 193 patients had late toxicity greater than or equal to Grade 2 (155 GU and 38 GI). 563 patients received hormone therapy prior to or concurrent with the radiation. Conclusions: This is the largest series reporting on the outcome of combination brachytherpay implant and external beam radiation in the treatment of prostate cancer. Combination treatment using brachytherapy and external beam radiation is well tolerated, with a low rate of biochemical failure and should be considered one of the treatment options for prostate cancer. No significant financial relationships to disclose.

Robotic radiosurgery of liver metastases of solid tumors

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15049-e15049
Author(s):  
S. Stintzing ◽  
R. T. Hoffmann ◽  
V. Heinemann ◽  
M. Kufeld ◽  
A. Muacevic
Keyword(s):  
Liver Metastases ◽  
Real Time ◽  
Solid Tumors ◽  
Local Control ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Image Guided ◽  
Tumor Tracking ◽  
Robotic Radiosurgery

e15049 Background: The number of patients (pts) suffering from isolated liver metastases is growing. Although surgical excision is the treatment of choice many pts do not qualify for surgery. So local ablative techniques like radiofrequency ablation, laser induced thermal ablation therapy, brachytherapy and different external beam radiation therapies have been employed. We here report the therapeutic efficacy of a robotic radiosurgery device for local control of liver metastases of solid tumors. Methods: Patients with liver metastases not qualifying for surgery were treated with single session radiosurgery (24 Gy) using robotic image-guided real-time tumor tracking. In a prospective analysis, follow-up was done by MRI scanning at two months after the treatment, and subsequently at 3-month intervals to evaluate local control. For inclusion into the radiosurgery treatment protocol, tumor volumes had to be smaller than 80cc. Results: 27 pts (median age 62 years) with a total of 43 target lesions were evaluated. 17 pts were treated with single, 10 pts with multiple targets. Metastases (n=27) originated from: colon (12), rectum (2), pancreas (2), lung (1), bladder (2), malignant melanoma (1), stomach (1), cholangiocellular carcinoma (2), breast (1), ovary (1), appendix (1) and endometrium (1). Median tumor volume was 21cc (range 2.2–79.3). Median KPS was 100% (range 80–100). The median follow up was 12 months. 23 pts (85%) reached local control of the disease, 4 pts (15%) had local recurrence. Grade 2–4 adverse events due to cyberknife treatment were not observed. Conclusions: Robotic radiosurgery with image-guided real-time tumor tracking of liver metastases is a new and promising treatment approach for pts not eligible for surgical resection and might enhance the possibilities of multidisciplinary oncological treatment concepts. No significant financial relationships to disclose.

scholarly journals Analysis of local control rate and toxicity of radiotherapy dose of cervical cancer.

2019 ◽  
Vol 5 (suppl) ◽  
pp. 136-136
Author(s):  
Hanyi Zhang ◽  
Shun Lu ◽  
Chang Sun ◽  
Jin Yi Lang
Keyword(s):  
Cervical Cancer ◽  
Local Control ◽  
Univariate Analysis ◽  
Local Control Rate ◽  
External Beam Radiation ◽  
Youden Index ◽  
High Dose ◽  
Advanced Cervical Cancer ◽  
Beam Radiation ◽  
Radiotherapy Dose

136 Background: The standard of care for treatment of advanced cervical cancer is the combination of external beam radiation therapy (EBRT) and intracavitary brachytherapy with cisplatin based concurrent chemotherapy. Radiotherapy plays a crucial role in treatment of cervical cancer. Recent GEC-ESTRO guidelines recommend that the dose to 90% (D90) of the high-risk clinical target volume (HRCTV) in cervical cancer be at least 85Gy with higher doses for poor response to radiotherapy. This study was aim to analyze our institution’s patients with locally advanced cervical cancer in regards to whether higher brachytherapy dose delivery lead to a better outcome, and to investigate the proper dose to balance the local control rate and toxicity. Methods: A total of 262 patients with local advanced cervical cancer treated at a single institution were retrospectively analyzed for the association between dosimetry and outcomes. Youden index was used to identify the optimal cut-off point of continuous tumor parameters and divide patients into subgroups. Significance of radiotherapy dose parameters on OS, PFS, LRFS and DMFS and toxicity was evaluated. Results: In the univariate analysis, for both HR-CTV and LR-CTV, the high dose group (EQD2 D90 >75Gy, LR-CTV>68Gy, respectively) have a better LRFS than low-dose groups (P<0.05). LR-CTV remains significance after adjusted for age and FIGO stage. Moreover, in the high-dose LR-CTV group, there is no association between dose of LR-CTV and LRFS was found, however, higher dose of HR-CTV significant associated with higher ratio of side effect was found. In addition, no association of dose of HR-CTV or LR-CTV and OS were found for all patients. Conclusions: Our results showed that dose of LR-CTV may be a useful prognostic factor of LRFS of patients with cervical cancer. Moreover, after D90 of LR-CTV reaches 68Gy, increasing dose did not show a better LRFS but lead to higher ratio of toxicity, supporting that LR-CTV at 68Gy might be a safety and efficacy dose of radiotherapy to the patients with cervical cancer. However, further improved in dose had no significant benefit on local control rate, and it might increase the risks of toxicity.

Spinal laser interstitial thermal therapy: single-center experience and outcomes in the first 120 cases

2020 ◽  
pp. 1-10
Author(s):  
Dhiego C. A. Bastos ◽  
Rafael A. Vega ◽  
Jeffrey I. Traylor ◽  
Amol J. Ghia ◽  
Jing Li ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Local Control ◽  
Thoracic Spine ◽  
Adjuvant Radiotherapy ◽  
Neurological Complications ◽  
Thermal Therapy ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Laser Interstitial Thermal Therapy ◽  
Hazard Ratios

OBJECTIVEThe objective of this study was to present the results of a consecutive series of 120 cases treated with spinal laser interstitial thermal therapy (sLITT) to manage epidural spinal cord compression (ESCC) from metastatic tumors.METHODSThe electronic records of patients treated from 2013 to 2019 were analyzed retrospectively. Data collected included demographic, pathology, clinical, operative, and imaging findings; degree of epidural compression before and after sLITT; length of hospital stay; complications; and duration before subsequent oncological treatment. Independent-sample t-tests were used to compare means between pre- and post-sLITT treatments. Survival was estimated by the Kaplan-Meier method. Multivariate logistic regression was used to analyze predictive factors for local recurrence and neurological complications.RESULTSThere were 110 patients who underwent 120 sLITT procedures. Spinal levels treated included 5 cervical, 8 lumbar, and 107 thoracic. The pre-sLITT Frankel grades were E (91.7%), D (6.7%), and C (1.7%). The preoperative ESCC grade was 1c or higher in 92% of cases. Metastases were most common from renal cell carcinoma (39%), followed by non–small cell lung carcinoma (10.8%) and other tumors (35%). The most common location of ESCC was in the vertebral body (88.3%), followed by paraspinal/foraminal (7.5%) and posterior elements (4.2%). Adjuvant radiotherapy (spinal stereotactic radiosurgery or conventional external beam radiation therapy) was performed in 87 cases (72.5%), whereas 33 procedures (27.5%) were performed as salvage after radiotherapy options were exhausted. sLITT was performed without need for spinal stabilization in 87 cases (72.5%). Post-sLITT Frankel grades were E (85%), D (10%), C (4.2%), and B (0.8%); treatment was associated with a median decrease of 2 ESCC grades. The local control rate at 1 year was 81.7%. Local control failure occurred in 25 cases (20.8%). The median progression-free survival was not reached, and overall survival was 14 months. Tumor location in the paraspinal region and salvage treatment were independent predictors of local recurrence, with hazard ratios of 6.3 and 3.3, respectively (p = 0.01). Complications were observed in 22 cases (18.3%). sLITT procedures performed in the lumbar and cervical spine had hazard ratios for neurological complications of 15.4 and 17.1 (p < 0.01), respectively, relative to the thoracic spine.CONCLUSIONSsLITT is safe and provides effective local control for high-grade ESCC from vertebral metastases in the thoracic spine, particularly when combined with adjuvant radiotherapy. The authors propose considering sLITT as an alternative to open surgery in selected patients with spinal metastases.

scholarly journals Feasibility of Proton Beam Therapy as a Rescue Therapy in Heavily Pre-Treated Retinoblastoma Eyes

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1862
Author(s):  
Eva Biewald ◽  
Tobias Kiefer ◽  
Dirk Geismar ◽  
Sabrina Schlüter ◽  
Anke Manthey ◽  
...  
Keyword(s):  
Proton Beam ◽  
Rescue Therapy ◽  
Therapeutic Option ◽  
Proton Beam Therapy ◽  
External Beam Radiation ◽  
Time Interval ◽  
Beam Radiation ◽  
Primary Tumors ◽  
Increased Risk

Despite the increased risk of subsequent primary tumors (SPTs) external beam radiation (EBRT) may be the only therapeutic option to preserve a retinoblastoma eye. Due to their physical properties, proton beam therapy (PBT) offers the possibility to use the effectiveness of EBRT in tumor treatment and to decisively reduce the treatment-related morbidity. We report our experiences of PBT as rescue therapy in a retrospectively studied cohort of 15 advanced retinoblastoma eyes as final option for eye-preserving therapy. The average age at the initiation of PBT was 35 (14–97) months, mean follow-up was 22 (2–46) months. Prior to PBT, all eyes were treated with systemic chemotherapy and a mean number of 7.1 additional treatments. Indication for PBT was non-feasibility of intra-arterial chemotherapy (IAC) in 10 eyes, tumor recurrence after IAC in another 3 eyes and diffuse infiltrating retinoblastoma in 2 eyes. Six eyes (40%) were enucleated after a mean time interval of 4.8 (1–8) months. Cataract formation was the most common complication affecting 44.4% of the preserved eyes, yet 77.8% achieved a visual acuity of >20/200. Two of the 15 children treated developed metastatic disease during follow-up, resulting in a 13.3% metastasis rate. PBT is a useful treatment modality as a rescue therapy in retinoblastoma eyes with an eye-preserving rate of 60%. As patients are at lifetime risk of SPTs consistent monitoring is mandatory.

Preliminary results of linear accelerator radiosurgery for acoustic schwannomas

1996 ◽  
Vol 85 (6) ◽  
pp. 1013-1019 ◽  
Author(s):  
William M. Mendenhall ◽  
William A. Friedman ◽  
John M. Buatti ◽  
Francis J. Bova
Keyword(s):  
Stereotactic Radiosurgery ◽  
Local Control ◽  
Linear Accelerator ◽  
Local Control Rate ◽  
Magnetic Resonance Images ◽  
High Rate ◽  
Content Type ◽  
Treatment Volume ◽  
Fine Print

✓ In this paper the authors evaluate the results of linear accelerator (LINAC)—based stereotactic radiosurgery for acoustic schwannomas. Fifty-six patients underwent LINAC-based stereotactic radiosurgery for acoustic schwannomas at the University of Florida between July 1988 and November 1994. Each patient was followed for a minimum of 1 year or until death; no patient was lost to follow up. One or more follow-up magnetic resonance images or computerized tomography scans were obtained in 52 of the 56 patients. Doses ranged between 10 and 22.5 Gy with 69.6% of patients receiving 12.5 to 15 Gy. Thirty-eight patients (68%) were treated with one isocenter and the dose was specified to the 80% isodose line in 71% of patients. Fifty-five patients (98%) achieved local control after treatment. The 5-year actuarial local control rate was 95%. At the time of analysis, 48 patients were alive and free of disease, seven had died of intercurrent disease, and one was alive with disease. Complications developed in 13 patients (23%). The likelihood of complications was related to the dose and treatment volume: 10 to 12.5 Gy to all volumes, three (13%) of 23 patients; 15 to 17.5 Gy to 5.5 cm3 or less, two (9%) of 23 patients; 15 to 17.5 Gy to more than 5.5 cm3, five (71%) of seven patients; and 20 to 22.5 Gy to all volumes, three (100%) of three patients. Linear accelerator—based stereotactic radiosurgery results in a high rate of local control at 5 years. The risk of complications is related to the dose and treatment volume.

scholarly journals Treatment Compliance as a Major Barrier to Optimal Cervical Cancer Treatment in Guatemala

2019 ◽  
pp. 1-5 ◽  
Author(s):  
Abigail S. Zamorano ◽  
Joaquin Barnoya ◽  
Eduardo Gharzouzi ◽  
Camaryn Chrisman Robbins ◽  
Emperatriz Orozco ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Access To Care ◽  
Cancer Treatment ◽  
Patient Population ◽  
Treatment Compliance ◽  
External Beam Radiation ◽  
Cervical Cancer Patient ◽  
Beam Radiation ◽  
Lost To Follow Up

PURPOSE Despite being the only hospital to provide comprehensive cervical cancer treatment to many medically underserved Guatemalan women, no assessment of the cervical cancer patient population at the Guatemala Cancer Institute has been performed. To understand the demographics of the patient population, their treatment outcomes, and access to care, we sought to assess treatment compliance of patients with cervical cancer at the Guatemala Cancer Institute and its effects on patient outcomes. METHODS A retrospective chart review was conducted of patients with cervical cancer between 2005 and 2007 and assessed for follow-up through December 2015. Demographics and clinical characteristics were tabulated. A Kaplan-Meier curve to model compliance was generated. RESULTS Ninety-two patients with invasive cancer were analyzed. Most presented with squamous cell carcinoma (73%) and at locally advanced stages (IIB, 51%; IIIB, 33%). Most (75 of 92, 81.5%) initiated treatment after diagnosis, but 18.5% (17 of 92) were lost to follow-up before treatment initiation. For treatment, 97% received external beam radiation, 84% brachytherapy, and 4% concomitant chemotherapy. Nearly 20% of patients were lost to follow-up in the first 6 months and 65% in the first 5 years. Of the 67 patients who completed treatment, only 15 (16% of the initial cohort) were diagnosed with a recurrence. No deaths were recorded. CONCLUSION The low recurrence rate and no documented deaths suggest a correlation with the low compliance rate and poor follow-up. This finding highlights the need to examine more fully the barriers to compliance and access to care among this population to optimize the treatment of cervical cancer.

scholarly journals Lymphopenia Is Associated with Gross Target Volumes and Fractions in Hepatocellular Carcinoma Patients Treated with External Beam Radiation Therapy and Also Indicates Worse Overall Survival

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Hai-Ge Zhang ◽  
Ping Yang ◽  
Tao Jiang ◽  
Jian-Ying Zhang ◽  
Xue-Juan Jin ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Cox Regression ◽  
External Beam Radiation ◽  
Rank Test ◽  
Beam Radiation ◽  
Kaplan Meier ◽  
Target Volumes ◽  
The Relationship

Purpose. To investigate whether lymphocyte nadir induced by radiation is associated with survival and explore its underlying risk factors in patients with hepatocellular carcinoma (HCC). Methods. Total lymphocyte counts were collected from 184 HCC patients treated by radiotherapy (RT) with complete follow-up. Associations between gross tumor volumes (GTVs) and radiation-associated parameters with lymphocyte nadir were evaluated by Pearson/Spearman correlation analysis and multiple linear regression. Kaplan–Meier analysis, log-rank test, as well as univariate and multivariate Cox regression were performed to assess the relationship between lymphocyte nadir and overall survival (OS). Results. GTVs and fractions were negatively related with lymphocyte nadir (p<0.001 and p=0.001, respectively). Lymphocyte nadir and Barcelona Clinic Liver Cancer (BCLC) stage were independent prognostic factors predicting OS of HCC patients (all p<0.001). Patients in the GTV ≤55.0 cc and fractions ≤16 groups were stratified by lymphocyte nadir, and the group with the higher lymphocyte counts (LCs) showed longer survival than the group with lower LCs (p<0.001 and p=0.006, respectively). Patient distribution significantly differed among the RT fraction groups according to BCLC stage (p<0.001). However, stratification of patients in the same BCLC stage by RT fractionation showed that the stereotactic body RT (SBRT) group achieved the best survival. Furthermore, there were significant differences in lymphocyte nadir among patients in the SBRT group. Conclusions. A lower lymphocyte nadir during RT was associated with worse survival among HCC patients. Smaller GTVs and fractions reduced the risk of lymphopenia.

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