Patterns of Recurrence After Surgery Alone Versus Preoperative Chemoradiotherapy and Surgery in the CROSS Trials

2014 ◽  
Vol 32 (5) ◽  
pp. 385-391 ◽  
Author(s):  
Vera Oppedijk ◽  
Ate van der Gaast ◽  
Jan J.B. van Lanschot ◽  
Pieter van Hagen ◽  
Rob van Os ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Gastroesophageal Junction ◽  
Preoperative Chemoradiotherapy ◽  
Target Volume ◽  
Patients With Cancer ◽  
Target Volumes ◽  
Cancer Of The Esophagus ◽  
Recurrence Patterns ◽  
Patterns Of Recurrence

Purpose To analyze recurrence patterns in patients with cancer of the esophagus or gastroesophageal junction treated with either preoperative chemoradiotherapy (CRT) plus surgery or surgery alone. Patients and Methods Recurrence pattern was analyzed in patients from the previously published CROSS I and II trials in relation to radiation target volumes. CRT consisted of five weekly courses of paclitaxel and carboplatin combined with a concurrent radiation dose of 41.4 Gy in 1.8-Gy fractions to the tumor and pathologic lymph nodes with margin. Results Of the 422 patients included from 2001 to 2008, 418 were available for analysis. Histology was mostly adenocarcinoma (75%). Of the 374 patients who underwent resection, 86% were allocated to surgery and 92% to CRT plus surgery. On January 1, 2011, after a minimum follow-up of 24 months (median, 45 months), the overall recurrence rate in the surgery arm was 58% versus 35% in the CRT plus surgery arm. Preoperative CRT reduced locoregional recurrence (LRR) from 34% to 14% (P < .001) and peritoneal carcinomatosis from 14% to 4% (P < .001). There was a small but significant effect on hematogenous dissemination in favor of the CRT group (35% v 29%; P = .025). LRR occurred in 5% within the target volume, in 2% in the margins, and in 6% outside the radiation target volume. In 1%, the exact site in relation to the target volume was unclear. Only 1% had an isolated infield recurrence after CRT plus surgery. Conclusion Preoperative CRT in patients with esophageal cancer reduced LRR and peritoneal carcinomatosis. Recurrence within the radiation target volume occurred in only 5%, mostly combined with outfield failures.

Recurrence patterns after endovenous laser treatment of saphenous vein reflux

2016 ◽  
Vol 31 (7) ◽  
pp. 496-500 ◽  
Author(s):  
Ronald S Winokur ◽  
Neil M Khilnani ◽  
Robert J Min
Keyword(s):  
Laser Ablation ◽  
Varicose Veins ◽  
Endovenous Laser Ablation ◽  
Recurrent Varicose Veins ◽  
Saphenous Veins ◽  
Recurrence Patterns ◽  
Endovenous Laser Treatment ◽  
Saphenofemoral Junction ◽  
Patterns Of Recurrence

Introduction The patterns of recurrent varicose veins after endovascular ablation of the saphenous veins are not well described. Methods The current study describes the ultrasound defined recurrence patterns seen in 58 patients (79 limbs) who returned for evaluation of recurrent varicose veins from a cohort of 802 patients treated with endovenous laser ablation and subsequent sclerotherapy from March 2000 to March 2007 with clinical follow-up until May 2014. Findings The most common ultrasound defined recurrence patterns leading to the varicose veins were new reflux in the anterior accessory saphenous and small saphenous veins as well as recanalization of the treated saphenous segment. Neovascularization at the saphenofemoral junction and incompetent perforating veins as the source of the recurrent veins were not seen. Conclusions The patterns of recurrence following thermal ablation of saphenous veins are different to those seen after surgery. Specifically, new reflux in other saphenous veins is responsible for most recurrent varicose veins and neovascularity seems to be unusual following endovenous laser ablation.

scholarly journals Beware of Early Relapse in Rectal Cancer Patients Treated With Preoperative Chemoradiotherapy

2020 ◽  
Vol 36 (6) ◽  
pp. 382-389
Author(s):  
Seul Gi Oh ◽  
In Ja Park ◽  
Ji-hyun Seo ◽  
Young Il Kim ◽  
Seok-Byung Lim ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Locally Advanced ◽  
Radical Resection ◽  
Late Recurrence ◽  
Preoperative Chemoradiotherapy ◽  
Early Recurrence ◽  
Initial Recurrence ◽  
Recurrence Patterns

Purpose: Recurrence patterns in rectal cancer patients treated with preoperative chemoradiotherapy (PCRT) are needed to evaluate for establishing tailored surveillance protocol.Methods: This study included 2,215 patients with locally-advanced mid and low rectal cancer treated with radical resection between January 2005 and December 2012. Recurrence was evaluated according to receipt of PCRT; PCRT group (n = 1,258) and no-PCRT group (n = 957). Early recurrence occurred within 1 year of surgery and late recurrence after 3 years. The median follow-up duration was 65.7 ± 29 months.Results: The overall recurrence rate was similar between the PCRT and no-PCRT group (25.8% vs. 24.9%, P = 0.622). The most common initial recurrence site was the lungs in both groups (50.6% vs. 49.6%, P = 0.864), followed by the liver, which was more common in the no-PCRT group (22.5% vs. 33.6%, P = 0.004). Most of the recurrence occurred within 3 years after surgery in both groups (85.3% vs. 85.8%, P = 0.862). Early recurrence was more common in the PCRT group than in the no-PCRT group (43.1% vs. 32.4%, P = 0.020). Recurrence within the first 6 months after surgery was significantly higher in the PCRT group than in the no-PCRT group (18.8% vs. 7.6%, P = 0.003). Lung (n = 27, 44.3%) and liver (n = 22, 36.1%) were the frequent the first relapsed site within 6 months after surgery in PCRT group.Conclusion: Early recurrence within the first 1 year after surgery was more common in patients treated with PCRT. This difference would be considered for surveillance protocols and need to be evaluated in further studies.

Patterns of failure after adjuvant stereotactic body radiation therapy in patients with pancreatic cancer with close or positive margins.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 755-755
Author(s):  
Ankur Patel ◽  
Joshua L. Rodríguez-López ◽  
Nathan Bahary ◽  
Amer H. Zureikat ◽  
Steven A. Burton ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Target Volume ◽  
Patterns Of Failure ◽  
Positive Margins ◽  
Stereotactic Body Radiation ◽  
Kaplan Meier ◽  
Conventional Radiation ◽  
Target Volumes ◽  
Hypofractionated Radiation

755 Background: There is no consensus on treatment volumes for stereotactic body radiation (SBRT) in patients with pancreatic cancer (PCa). Herein, we report patterns of failure following adjuvant SBRT for close/positive margins in patients with pancreatic cancer, which may inform appropriate target volume design for SBRT. Methods: An IRB-approved retrospective review of patients with PCa treated with adjuvant SBRT for close/positive margins from 2009-2018 was conducted. Patterns of failure were assessed by review of imaging and were defined as local (LF), regional (RF), local and regional (LRF), or distant (DF). The Kaplan-Meier method was used to calculate long-term failure rates. In-field failures were defined as LFs completely within the PTV (planning target volume). The location of LFs was compared to the RTOG consensus volumes for adjuvant treatment of PCa to determine if conventional radiation volumes would have included the LF. Results: Seventy-six patients were treated with adjuvant SBRT for close (51.3%) or positive (48.7%) margins, with a median follow-up of 17.0 months (interquartile range [IQR] 7.4-28.3 mos.). Adjuvant SBRT was delivered at a median of 2.2 months after surgery (IQR 1.7-3.0 mos.). Most patients (81.6%) received 36 Gy in 3 fractions. The median PTV volume was 17.8 cc (IQR 12.3-25.2 cc). Upon examination of first failure sites, crude rates of isolated LF, isolated RF, isolated LRF, and DF +/- LF or RF were 9.2%, 6.6%, 2.6%, and 56.6% respectively; 2-year rates were 12.4%, 11.5%, 7.0%, and 66.5%, respectively. Thirty-two patients (42.1%) developed a LF at some point during follow-up. Of 28 LFs with available plans and imaging, 21.4% were in-field failures, while the remainder were completely outside (60.1%) or partially outside (17.9%) the PTV. Most LFs outside the PTV (90.9%) would have been encompassed by the RTOG consensus target volumes for postoperative conventional radiation. Conclusions: In patients with PCa who receive adjuvant SBRT for close/positive margins, the majority of LFs are outside the PTV. Future trials involving SBRT or hypofractionated radiation should consider expansion of treatment volumes if feasible.

Stereotactic Radiosurgery for Motor Cortex Region Arteriovenous Malformations

Neurosurgery ◽  
2001 ◽  
Vol 48 (1) ◽  
pp. 70-77 ◽  
Author(s):  
Constantinos G. Hadjipanayis ◽  
Elad I. Levy ◽  
Ajay Niranjan ◽  
Andrew D. Firlik ◽  
Douglas Kondziolka ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Target Volume ◽  
Complete Obliteration ◽  
Target Volumes ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract OBJECTIVE The optimal management of arteriovenous malformations (AVMs) in critical brain locations remains controversial. To reduce the risk of an AVM hemorrhage and to enhance the possibility of preserving neurological function, stereotactic radiosurgery was performed in 33 patients with newly diagnosed or residual AVMs located within the motor cortex. The role of embolization also was examined. METHODS During a 9-year study period, 33 patients with AVMs located primarily in the motor cortex region were treated with stereotactic radiosurgery. These patients were followed up radiographically for a minimum of 36 months, or less if obliteration was documented before 36 months had elapsed. Of the 33 patients, 9 underwent embolization and 1 underwent microsurgery before radiosurgery. Nine patients required a second radiosurgery. The mean AVM target volume was 4.35 cc, and the average radiation dose to the AVM margin was 20 Gy. The median follow-up was 36 months (range, 10–91 mo), and angiographic follow-up of eligible patients was performed 24 or 36 months after radiosurgery. RESULTS Results were stratified by radiosurgical target volumes: less than 3 cc (Group 1), 3 to 10 cc (Group 2), and greater than 10 cc (Group 3). Overall (including second radiosurgery), 13 (87%) of 15 patients in Group 1 had complete obliteration confirmed by angiography. Nine (64%) of 14 patients in Group 2 exhibited nidus obliteration, and one (25%) of four patients in Group 3 demonstrated obliteration on a magnetic resonance imaging scan. Eight patients (24%) underwent second-stage radiosurgery after angiography revealed a persistent AVM nidus; three patients demonstrated complete obliteration on follow-up angiography. The obliteration rate was higher (87%) for AVMs with less than 3 cc target volume and lower (56%) for those with target volumes larger than 3 cc. One patient experienced worsening neurological function after radiosurgery, and one died from delayed AVM hemorrhage during the latency period. No patient bled after angiographically confirmed AVM obliteration. CONCLUSION Stereotactic radiosurgery is a successful and safe management option for patients with motor cortex AVMs. The obliteration of AVMs and the attendant low morbidity rates indicate a primary role for radiosurgery in these patients. Staged radiosurgery may be necessary to increase obliteration rates for larger AVMs or for those that are not obliterated after the first procedure.

Patterns of recurrence in patients receiving conformal radiation for intracranial meningioma: a single-institution experience

2020 ◽  
pp. 1-7
Author(s):  
B. Rajkrishna ◽  
Balakrishnan Rajesh ◽  
Sebastian Patricia ◽  
B. Selvamani
Keyword(s):  
Conformal Radiotherapy ◽  
Target Volume ◽  
Tumour Resection ◽  
Subtotal Resection ◽  
Intracranial Meningioma ◽  
Who Grade ◽  
Time To Recurrence ◽  
Grade 3 ◽  
Patterns Of Recurrence

Abstract Aim: To evaluate the patterns of recurrence following postoperative conformal radiotherapy (RT) for intracranial meningioma. Materials and methods: Eighty-six patients who received conformal RT for intracranial meningiomas from 2014 to 2017 were retrospectively analysed. For documented recurrences, recurrence imaging was deformably co-registered to planning CT scan. In-field recurrence was defined as recurrence within the 90% isodose line, and out-of-field recurrences were those that occurred outside the 90% isodose line. We present the demographic details, surgical and RT details, outcomes and patterns of recurrence. Results: The median age was 46 years (range 17–72); 82·6% underwent surgery [46·5% had subtotal resection (STR), 43·7% gross tumour resection (GTR), 5·6% biopsy] and 17·4% had no surgery. Among these, 53·5% were WHO grade 2; 27·9% grade 1; and 1·2% grade 3 meningioma. Fifty per cent received stereotactic RT (SRT), 46·5% 3D conformal RT (3DCRT) and 3·5% intensity-modulated RT (IMRT). The mean clinical target volume (CTV) and planning target volume (PTV) margins were 4·5 mm (range 0–15) and 3·9 mm (range 1–5), respectively. The doses ranged from 54 to 59·4 Gy. The median follow-up after RT was 1·7 years (range 0·2–4·7). 17·4% were lost to follow-up, 5·4% had recurrence, and the median time to recurrence after completion of RT was 2 years (range 0·7–2·9). The 3-year recurrence-free rate was 81·5%. Three patients had in-field and two had in-field and out-of-field recurrence. Among the cases with recurrence, three received SRT, one 3DCRT and one IMRT. Four were grade 2 and one was grade 3 tumour, and the CTV margin ranged from 0 to 5 mm, and the PTV margin ranged from 3 to 5 mm. Conclusion: Local recurrence was seen in grade 2 and 3 meningiomas. SRT probably had more recurrence as they had lesser CTV margin. Increased CTV margin, escalated dose up to 59·4 Gy and 3DCRT/IMRT may be helpful in preventing local recurrences in grade 2 and grade 3 meningiomas.

scholarly journals CTNI-13. UPDATES ON CLINICAL OUTCOMES AND TUMOR RECURRENCE PATTERNS OF A HUMAN PILOT STUDY ASSESSING EFFICACY OF BELINOSTAT (PXD-101) COMBINING WITH CHEMORADIATION IN TREATING GLIOBLASTOMA

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii44-ii44
Author(s):  
Karen Xu ◽  
Vicki Huang ◽  
Karthik Ramesh ◽  
Saumya Gurbani ◽  
Eduard Schreibmann ◽  
...  
Keyword(s):  
Therapeutic Agent ◽  
Standard Of Care ◽  
Adjuvant Temozolomide ◽  
Initial Recurrence ◽  
Deacetylase Inhibitor ◽  
Brain Barrier Permeability ◽  
Target Volumes ◽  
Recurrence Patterns ◽  
The Mean

Abstract INTRODUCTION Glioblastoma (GBM) is highly aggressive with poor prognosis. Belinostat is a histone deacetylase inhibitor with blood–brain barrier permeability that has anti-GBM activity and may enhance effects of chemoradiation. Our institution conducted a clinical trial evaluating clinical efficacy of belinostat with standard-of-care therapy for GBMs. METHODS 13 and 14 patients were enrolled into cohort 1 (c1, control) or cohort 2 (c2, belinostat) with 12 in each group with sufficient follow-up MRIs for recurrence analysis. All patients received concurrent, adjuvant temozolomide and focal radiation therapy (RT). For c2 patients, the belinostat regimen (500-750mg/m2 1x/day x 5 days) was given over three cycles every 3 weeks (weeks -1, 2, and 5 of RT). RT margins of 5–10 mm and 3 mm were added to generate clinical tumor volumes and planning target volumes (PTVs). PTV1 (based on FLAIR MRI) and PTV2 (based on CE-T1w MRI) received 51 and 60 Gy, respectively, over 30 fractions. Volume at initial recurrence (rGTV) was contoured. RESULTS Mean age was 58.3 years for c1 and 51.1 years for c2. Patient/tumor characteristics were similar between cohorts. Median OS were 16.6 and 18.5 months for c1 and c2 (p=0.538), respectively. Average minimum, maximum and mean radiation dose to rGTV was 54.1 Gy, 64.2 Gy and 62 Gy, for c1, and 47.5 Gy, 57.6 Gy and 53.5 Gy, for c2 (p=0.322, 0.088 and 0.071), respectively. The mean overlap between rGTV and PTV1/PTV2 for c1 & c2 were 99.2% & 96.9%/99.8% & 78.7% (p=0.489/0.133), respectively. CONCLUSION Median OS was slightly longer for c2 though not statistically significant. rGTV in c1 received higher radiation doses and had more overlap with PTV2 than in c2. Out-of-field recurrence appears more likely in c2 suggesting better infield control with belinostat. This study highlights the potential of belinostat as a synergistic therapeutic agent for GBM treatment.

Potential Value of MR Spectroscopic Imaging for the Radiosurgical Management of Patients with Recurrent High-Grade Gliomas

2007 ◽  
Vol 6 (5) ◽  
pp. 375-382 ◽  
Author(s):  
Cynthia F. Chuang ◽  
Antoinette A. Chan ◽  
David Larson ◽  
Lynn J. Verhey ◽  
Michael McDermott ◽  
...  
Keyword(s):  
Survival Data ◽  
Gamma Knife Radiosurgery ◽  
Target Volume ◽  
Recurrent Glioblastoma ◽  
Resonance Spectroscopy ◽  
Recurrent Glioblastoma Multiforme ◽  
Target Volumes ◽  
Radiation Treatments ◽  
Metabolic Information

Previous studies have shown that metabolic information provided by 3D Magnetic Resonance Spectroscopy Imaging (MRSI) could affect the definition of target volumes for radiation treatments (RT). This study aimed to (i) investigate the effect of incorporating spectroscopic volumes as determined by MRSI on target volume definition, patient selection eligibility, and dose prescription for stereotactic radiosurgery treatment planning; (ii) correlate the spatial extent of pre-SRS spectroscopic abnormality and treatment volumes with areas of focal recurrence as defined by changes in contrast enhancement; and (iii) examine the metabolic changes following SRS to assess treatment response. Twenty-six patients treated with Gamma Knife radiosurgery for recurrent glioblastoma multiforme (GBM) were retrospectively evaluated. All patients underwent both MRI and MRSI studies prior to SRS. Follow-up MRI exams were available for all 26 patients, with MRI/MRSI available in only 15/26 patients. We observed that the initial CNI 2 contours extended beyond the pre-SRS CE in 25/26 patients ranging in volume from 0.8 cc to 18.8 cc (median 5.6 cc). The inclusion of the volume of CNI 2 extending beyond the CE would have increased the SRS target volume by 5–165% (median 23.4%). This would have necessitated decreasing the SRS prescription dose in 19/26 patients to avoid increased toxicity; the resultant treatment volume would have exceeded 20cc in five patients, thus possibly excluding those from RS treatment per our institutional practice. MRSI follow-up studies showed a decrease in Choline, stable Creatine, and increased NAA indicative of response to SRS in the majority of patients. When combined with patient survival data, metabolic information obtained during follow-up MRSI studies seemed to indicate the potential to help to distinguish necrosis from new/recurrent tumor; however, this should be further verified by biopsy studies.

Survival after pathologic complete response in patients with cancer of the esophagus or gastroesophageal junction.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e15084-e15084 ◽  
Author(s):  
Sjoerd M Lagarde ◽  
Maarten CJ Anderegg ◽  
Wernard A Borstlap ◽  
Suzanne S Gisbertz ◽  
Sybren L. Meijer ◽  
...  
Keyword(s):  
Gastroesophageal Junction ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Patients With Cancer ◽  
Cancer Of The Esophagus
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