Treatment Outcomes in Spinal Metastatic Disease With Indeterminate Stability

Study Design: Retrospective cohort study. Objective: The purpose of this study was to compare outcomes between different treatment modalities for metastatic disease with indeterminate instability (Spinal Instability Neoplastic Score [SINS] 7-12). Methods: We retrospectively reviewed neurologically intact patients treated for spinal metastatic disease with a SINS of 7 to 12. The cohort was stratified by treatment approach: external beam radiation therapy alone (EBRT), surgery + EBRT (S+E), and cement augmentation + EBRT (K+E). Kaplan-Meier analysis was used to assess differences in length of survival (LOS) and ability to ambulate at time of death. Multivariate analysis was performed to assess adjusted LOS and ability to ambulate at time of death. Results: The cohort included 211 patients, S+E (n = 57), EBRT (n = 128), and K+E (n = 27). In the S+E group, the median LOS was 430 days, which was statistically longer than the median LOS for the EBRT group (121 days) and the K+E group (169 days). In the S+E group, 52 patients (91.2%) and in the K+E group 24 patients (92.3%) retained the ability to ambulate at their time of death compared to 99 patients (77.3%) of the EBRT patients ( P = .01). The overall rate of revision treatment at the spinal level initially treated was 17.5%, S+E (15.8%), EBRT (20.3%), and K+E (7.7%). Conclusions: The length of survival, ability to maintain ambulatory ability, and revision treatment rates were all improved following surgical management and radiation therapy compared to radiation therapy alone. The authors’ conclusion from these results are that patients with indeterminate spinal instability should be discussed in a multidisciplinary setting for the need of spinal stabilization in addition to radiation therapy.

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Tolerance of the Optic Apparatus in Single-Fraction Irradiation Using Stereotactic Radiosurgery

Neurosurgery ◽

10.1227/01.neu.0000367554.96981.26 ◽

2010 ◽

Vol 66 (4) ◽

pp. 688-695 ◽

Cited By ~ 47

Author(s):

Toshinori Hasegawa ◽

Tatsuya Kobayashi ◽

Yoshihisa Kida

Keyword(s):

Radiation Therapy ◽

Optic Neuropathy ◽

Survival Rates ◽

Gamma Knife Radiosurgery ◽

Progression Free Survival ◽

External Beam Radiation ◽

Beam Radiation ◽

Single Fraction ◽

Kaplan Meier ◽

Radiation Induced

Abstract OBJECTIVE To determine the limiting dose to the optic apparatus in single-fraction irradiation in patients with craniopharyngioma treated with gamma knife radiosurgery (GKRS). METHODS One hundred patients with 109 craniopharyngiomas treated with GKRS were evaluated with a median follow-up period of 68 months. Tumor volume varied from 0.1 to 36.0 (median, 3.3) cm3. Marginal doses varied from 10 to 18 (median, 11.4) Gy. Maximum dose to any part of the optic apparatus varied from 2 to 18 (median, 10) Gy. RESULTS The actuarial 5- and 10-year overall rates of survival of tumor progression after GKRS were 93% and 88%, respectively. Similarly, the actuarial 5- and 10-year progression-free survival rates were 62% and 52%, respectively. Among 94 patients in whom visual function was evaluable after GKRS, only 3 patients developed radiation-induced optic neuropathy, indicating an overall Kaplan-Meier radiation-induced optic neuropathy rate of 5%. Of these patients, 2 received 15 Gy or greater to the optic apparatus. Another patient who received 8 Gy or less had undergone previous fractionated radiation therapy with a biologically effective dose of 60 Gy. CONCLUSION The optic apparatus seems to be more tolerant of irradiation than previously thought. Careful dose planning is essential, particularly in patients who underwent prior external beam radiation therapy.

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Brachytherapy for Oesophageal Carcinoma: A Comprehensive Review of Literature and Techniques

Journal of Radiotherapy in Practice ◽

10.1017/s1460396920001120 ◽

2021 ◽

pp. 1-10

Author(s):

Rashi Kulshrestha ◽

Anil Gupta ◽

Daya Nand Sharma ◽

Kishore Singh

Keyword(s):

Radiation Therapy ◽

Poor Performance ◽

Oesophageal Carcinoma ◽

External Beam Radiation ◽

Surrounding Tissue ◽

Treatment Modalities ◽

Beam Radiation ◽

Tumour Control ◽

Local Tumour Control ◽

Multimodality Approach

Abstract Introduction: Oesophageal carcinoma is one of the fatal cancers mainly because of its rapid spread and poor prognosis. Treatment modalities involves a multimodality approach, including surgery, radiation therapy and chemotherapy. Radiation therapy includes brachytherapy in the form of intraluminal radiation therapy. Brachytherapy permits delivery of high tumouricidal doses to superficial cancerous growth of the oesophagus while delivering much lower doses to the surrounding tissue. It is mostly given in combination with external beam radiation in patients with poor performance scores not likely to tolerate an aggressive chemoradiation regimen or as a boost to concurrent chemoradiotherapy. It is very effective in terms of local tumour control as well as in relieving symptoms in advanced/recurrent disease. Intraoperative brachytherapy and seed brachytherapy have also been tried to address the nodal disease. Methods: We undertook a review of the available literature and techniques developed in the past three decades to emphasise the role of brachytherapy in curative or palliative settings in the treatment of oesophageal carcinoma. Conclusion: Oesophageal brachytherapy will remain a tangible treatment of oesophageal cancer, although it is less commonly used due to high expertise requirement, lack of established evidence, risk of life-threatening complications and lack of interest in brachytherapy. It offers quick and useful palliation for a prolonged period, along with good quality of life and superior dosimetry. Use of novel applicators may allow dose escalation and lower toxicity. Seed brachytherapy is also emerging as a promising option in nodal recurrences.

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Treatment of Urethral Strictures from Irradiation and Other Nonsurgical Forms of Pelvic Cancer Treatment

Advances in Urology ◽

10.1155/2015/476390 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

Iyad Khourdaji ◽

Jacob Parke ◽

Avinash Chennamsetty ◽

Frank Burks

Keyword(s):

Radiation Therapy ◽

Radiation Effects ◽

Treatment Strategies ◽

High Intensity Focused Ultrasound ◽

External Beam Radiation ◽

Treatment Modalities ◽

Beam Radiation ◽

Noninvasive Treatment ◽

Pelvic Malignancies ◽

Pelvic Cancer

Radiation therapy (RT), external beam radiation therapy (EBRT), brachytherapy (BT), photon beam therapy (PBT), high intensity focused ultrasound (HIFU), and cryotherapy are noninvasive treatment options for pelvic malignancies and prostate cancer. Though effective in treating cancer, urethral stricture disease is an underrecognized and poorly reported sequela of these treatment modalities. Studies estimate the incidence of stricture from BT to be 1.8%, EBRT 1.7%, combined EBRT and BT 5.2%, and cryotherapy 2.5%. Radiation effects on the genitourinary system can manifest early or months to years after treatment with the onus being on the clinician to investigate and rule-out stricture disease as an underlying etiology for lower urinary tract symptoms. Obliterative endarteritis resulting in ischemia and fibrosis of the irradiated tissue complicates treatment strategies, which include urethral dilation, direct-vision internal urethrotomy (DVIU), urethral stents, and urethroplasty. Failure rates for dilation and DVIU are exceedingly high with several studies indicating that urethroplasty is the most definitive and durable treatment modality for patients with radiation-induced stricture disease. However, a detailed discussion should be offered regarding development or worsening of incontinence after treatment with urethroplasty. Further studies are required to assess the nature and treatment of cryotherapy and HIFU-induced strictures.

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Management of post-radiation therapy complications among prostate cancer patients: A case series

Canadian Urological Association Journal ◽

10.5489/cuaj.492 ◽

2014 ◽

Vol 8 (9-10) ◽

pp. 632 ◽

Cited By ~ 7

Author(s):

Ryan Kendrick Flannigan ◽

Richard John Baverstock

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Radiation Therapy Oncology Group ◽

Case Series ◽

External Beam Radiation ◽

Treatment Modalities ◽

Beam Radiation ◽

Post Radiation ◽

Tract Infections

Introduction: Treating prostate cancer with radiation therapy (RT) is a viable option, albeit with its own profile of complications. We describe a unique Canadian report of a single surgeon (RJB) experience in the management of complex post-prostate cancer RT complications.Methods: We retrospectively analyzed patients who had previously received external beam radiation (XRT) or brachytherapy (BT) for prostate cancer referred to a single surgeon for persistent urologic related difficulties between 2005 and 2010. We used the Radiation Therapy Oncology Group (RTOG) morbidity grading system to assign each patient a 1 to 5 grade for their greatest complication.Results: In total, 15 patients were identified with a total of 43 RT-related complications. Of these 43 complications, 19 presented with obstruction, 8 with radiation failure or new bladder cancer, 6 with hematuria, 5 with intractable incontinence, and 5 with urinary tract infections. These patients required several investigations prior to treatment. Treatment of these complications used surgical, local and medical approaches. In the end, 1 patient had total incontinence, 3 improved their incontinence, 3 had self-catheterization and dilation, 1 voided well, 3 underwent cystectomy with ileo-conduits, 2 had chronic hematuria, and 2 passed away.Conclusion: These patients are heavily investigated and require significant resources, including patient visits, diagnostics and treatment modalities to optimize their condition. Cure is not always possible, but the aim to improve quality of life should guide management.

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CANCER INSIGHT: HALLMARKS AND THERAPEUTIC STRATEGIES

Asian Journal of Allied Health Sciences (AJAHS) ◽

10.52229/ajahs.v5i1.803 ◽

2021 ◽

Vol 5 (1) ◽

pp. 4-5

Author(s):

Muhammad Sulaiman Yousafzai

Keyword(s):

Radiation Therapy ◽

Targeted Therapy ◽

Cancer Cells ◽

Cell Biology ◽

Cancer Metastasis ◽

Cytotoxic Agents ◽

Host Cells ◽

External Beam Radiation ◽

Treatment Modalities ◽

Beam Radiation

Cancer metastasis is a complex, multistep process responsible for > 90% of cancer-related deaths. Cancer is the second leading cause of death globally and about 8.8 million people worldwide died from cancer (Liver (788 000), Lung (1.69 million) Colorectal (774 000), Stomach (754 000), Breast (571 000)) in 20151. That is nearly 1 in 6 of all global deaths. Lung, prostate, colorectal, stomach and liver cancer are the most common types of cancer in men, while breast, colorectal, lung, cervix and stomach cancer are the most common among women. During metastasis, the primary tumor seeds pioneer cells that move out, invade adjacent tissues, and then travel to distant sites where they may succeed in founding new colonies called secondary tumors . In the last few decades, a rich and complex body of knowledge has been generated in cancer, revealing cancer to be a disease involving dynamic changes in the genome. In 2000, Douglas Hanahan and Robert A. Weinberg reported six hallmarks of cancer. They include sustaining proliferative signaling, evading growth suppressors, resisting cell death, enabling replicative immortality, inducing angiogenesis, and activating invasion and metastasis. Underlying these hallmarks are genome instability, which generates the genetic diversity that expedites their acquisition, and inflammation. Cancer Initiation, detachment and organ-specific affinity of cancer cells to host cells in terms of the above mentioned hallmarks helped devise new potential therapies. To date, five cancer treatment modalities have been defined. Currently available cancer treatments include the traditional surgery (Cryosurgery, Lasers,Hyperthermia), radiotherapy (External Beam Radiation Therapy, Internal Radiation Therapy), and conventional chemotherapy (Oral, Intravenous (IV), Injection, Intrathecal, Intraperitoneal (IP), Intraarterial (IA), Topical), approaches and have been extended with two new modalities in recent decades: molecularly targeted therapy (MTT) ( Small -molecule drugs, antibodies ) and immunotherapy Monoclonal antibodies,, Adoptive cell transfer, Cytokines, Treatment Vaccines, Bacillus Calmette-Guérin (BCG)). The most important goal of targeted therapy or more advanced immune-based strategies is to eradicate cancer cells more specifically than traditional theraphies while maintaining an acceptable level of side effects and quality of life. Unfortunately, the newly developed targeted agents or techniques show a similar incidence and severity of toxicities as traditional cytotoxic agents do. With a full clarity of mechanism, cancer prognosis and treatment will become a rational science. It's a dream that one day the patchwork quilt of major fields like cell biology, genetics, histopathology, biochemistry, immunology, pharmacology and physics will detect and identify all stages of cancer progression and will be able to prevent incipient cancers from developing and will cure preexisting cancers.

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876: Critical Evaluation of the Temporal Change of Sexual Function After External Beam Radiation Therapy for Prostate Cancer

The Journal of Urology ◽

10.1016/s0022-5347(18)38125-4 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 232-232

Author(s):

Richard K. Valicenti ◽

Ed Pequignot

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Sexual Function ◽

Temporal Change ◽

Critical Evaluation ◽

External Beam Radiation Therapy ◽

External Beam Radiation ◽

External Beam ◽

Beam Radiation

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Pretreatment PSA Velocity and Risk of Death From Prostate Cancer Following External Beam Radiation Therapy

Yearbook of Pathology and Laboratory Medicine ◽

10.1016/s1077-9108(08)70364-5 ◽

2007 ◽

Vol 2007 ◽

pp. 179-180

Author(s):

R. Dhir

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

External Beam Radiation Therapy ◽

External Beam Radiation ◽

External Beam ◽

Beam Radiation ◽

Risk Of Death ◽

Psa Velocity

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Combined stereotactic split-course fractionated gamma knife radiosurgery and conventional radiation therapy for unfavorable gliomas: a phase I study

Journal of Neurosurgery ◽

10.3171/jns.2000.93.supplement_3.0037 ◽

2000 ◽

Vol 93 (supplement_3) ◽

pp. 37-41 ◽

Cited By ~ 10

Author(s):

William F. Regine ◽

Roy A. Patchell ◽

James M. Strottmann ◽

Ali Meigooni ◽

Michael Sanders ◽

...

Keyword(s):

Radiation Therapy ◽

Disease Progression ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

External Beam Radiation ◽

Low Grade ◽

Beam Radiation ◽

Content Type ◽

Group B ◽

Fine Print

Object. This investigation was performed to determine the tolerance and toxicities of split-course fractionated gamma knife radiosurgery (FSRS) given in combination with conventional external-beam radiation therapy (CEBRT). Methods. Eighteen patients with previously unirradiated, gliomas treated between March 1995 and January 2000 form the substrate of this report. These included 11 patients with malignant gliomas, six with low-grade gliomas, and one with a recurrent glioma. They were stratified into three groups according to tumor volume (TV). Fifteen were treated using the initial FSRS dose schedule and form the subject of this report. Group A (four patients), had TV of 5 cm3 or less (7 Gy twice pre- and twice post-CEBRT); Group B (six patients), TV greater than 5 cm3 but less than or equal to 15 cm3 (7 Gy twice pre-CEBRT and once post-CEBRT); and Group C (five patients), TV greater than 15 cm3 but less than or equal to 30 cm3 (7 Gy once pre- and once post-CEBRT). All patients received CEBRT to 59.4 Gy in 1.8-Gy fractions. Dose escalation was planned, provided the level of toxicity was acceptable. All patients were able to complete CEBRT without interruption or experiencing disease progression. Unacceptable toxicity was observed in two Grade 4/Group B patients and two Grade 4/Group C patients. Eight patients required reoperation. In three (38%) there was necrosis without evidence of tumor. Neuroimaging studies were available for evaluation in 14 patients. Two had a partial (≥ 50%) reduction in volume and nine had a minor (> 20%) reduction in size. The median follow-up period was 15 months (range 9–60 months). Six patients remained alive for 3 to 60 months. Conclusions. The imaging responses and the ability of these patients with intracranial gliomas to complete therapy without interruption or experiencing disease progression is encouraging. Excessive toxicity derived from combined FSRS and CEBRT treatment, as evaluated thus far in this study, was seen in patients with Group B and C lesions at the 7-Gy dose level. Evaluation of this novel treatment strategy with dose modification is ongoing.

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