Multicentric randomized phase II trial of gamma knife surgery (GKS) versus image-guided, intensity-modulated radiation therapy (IG-IMRT) in patients with sacrococcygeal chordoma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 11033-11033
Author(s):  
Shun Lu ◽  
Jin Yi Lang ◽  
Weidong Wang ◽  
Mei Feng ◽  
Bingwen Zou ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Surgical Resection ◽  
Local Control ◽  
High Recurrence Rate ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Initial Surgery ◽  
First Choice ◽  
Significant Difference

11033 Background: Chordoma is a rare slow-growing neoplasm arisen from cellular remnants of the notochord. About 30% occur in the sacrococcygeal region. Surgical resection is recommended treatment. Due to the high recurrence rate, adjuvant radiation therapy was suggested to receive as an effective method to improve local control rates. Methods: Thirty eight patients were pathologically diagnosed as non-metastatic sacrococcygeal chordoma from Aug. 2003 to May. 2015 were recruited retrospectively to analysis. All patients received surgical resection after diagnosed. Initial surgery included subtotal resection (24% of patients), and gross total resection (76% of patients). Among these patients, 25 patients treated with adjuvant IG-IMRT, while 13 patients treated GKS after surgical resection. The median follow-up was 40 months (range, 6–151 month) for all patients, The PTV of IG-IMRT group received total doses were 60 Gy (range, 56-74Gy), delivered with 2-2.2 Gy/fraction, while GKS group underwent a total of 6-8 sessions treatment. Results: For the IG-IMRT group and the GKS group, the 5-year overall survival and local control rates were 87.5% and 67.7%, respectively. And 5-year local control rates were 35% and 22.2%, respectively. In total, 18 patients progressed locally: 11 were in the IG-IMRT group and 7 in the GKS group. In comparison with GKS group, the IG-IMRT group has a better overall recurrence-free survival (p = 0.03), the significance remained after adjusted for surgery results, age and gender. Moreover, there is no significant difference of overall survival was found between these two groups. Conclusions: We report favorable local control and adverse event rates following IG-IMRT, and suggested IG-IMRT is the first choice of adjuvant radiation therapy for sacrococcygeal chordoma treatment.

scholarly journals Radiation Therapy Improves Local Control in Juvenile Nasopharyngeal Angiofibroma following Disease Progression after Embolization and Surgical Resection: A Case Report

2021 ◽  
pp. 739-745
Author(s):  
Zane Blank ◽  
Richard Sleightholm ◽  
Beth Neilsen ◽  
Michael Baine ◽  
Chi Lin
Keyword(s):  
Radiation Therapy ◽  
Disease Progression ◽  
Surgical Resection ◽  
Local Control ◽  
Benign Neoplasm ◽  
Good Prognosis ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Adjuvant Radiation ◽  
Nasopharyngeal Angiofibroma ◽  
Presenting Symptoms

Juvenile nasopharyngeal angiofibroma (JNA) is a relatively uncommon, benign neoplasm of the nasopharynx that can be very difficult to diagnose early due to inconspicuous and seemingly harmless presenting symptoms. Early diagnosis and treatment of JNA are essential for a good prognosis. JNA typically responds well to radiation therapy (RT), but when it does not, the most appropriate next course of action has not been readily defined due to the limited occurrence and experience with this neoplasm. Herein, we describe a JNA patient, who continued to progress after surgery and 36 Gy of adjuvant radiation, but after an additional 14.4 Gy, he has remained in remission for over 2 years. An 11-year-old boy who presented with JNA underwent treatment with embolization and surgical resection. Unfortunately, the tumor progressed within 2 months of surgical intervention and he required RT for adequate local control. While undergoing RT, he again demonstrated signs of progression; so his radiation regimen was increased from 3,600 cGy in 20 fractions to 5,040 cGy in 28 fractions. Since completing RT, the tumor has continued to decrease in size, and the patient is stable and has been without signs of disease progression for over 24 months now. Thus, escalating the radiation regimen to 5,040 cGy may improve local control in rapidly progressive JNA.

Patterns of failure after radical cystectomy for pT3-4 bladder cancer: Implications for adjuvant radiation therapy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 370-370
Author(s):  
Abhinav V. Reddy ◽  
Joseph J. Pariser ◽  
Shane M. Pearce ◽  
Ralph R. Weichselbaum ◽  
Norm D. Smith ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Radiation Therapy ◽  
Radical Cystectomy ◽  
Multivariable Analysis ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Risk Patients ◽  
Pn Stage

370 Background: In patients with muscle-invasive bladder cancer, local-regional failure (LF) has been reported to occur in up to 20% of patients following radical cystectomy. The goals of this study were to describe patterns of LF, as well as assess factors associated with LF in a cohort of patients with pT3-4 bladder cancer. This information may have implications towards the use of adjuvant radiation therapy. Methods: Patients with pathologic T3-4 N0-1 bladder cancer were examined from an institutional radical cystectomy database. Preoperative demographics and pathologic characteristics were examined. Outcomes included overall survival and LF. Local-regional failures were defined using follow-up imaging reports and scans, and the locations of LF were characterized. Variables were tested by univariate and multivariable analysis for association with LF and overall survival. Results: 334 patients had pT3-4 and N0-1 disease after radical cystectomy and bilateral pelvic lymph node dissection. Of these, 46% received perioperative chemotherapy. The median age was 71 and median follow up was 11 months. On univariate analysis, margin status, pT stage, pN stage, and gender were all associated with LF (p < 0.05), however, on multivariable analysis, only pT and pN stage were significantly associated with LF (p < 0.01). Three strata of risk were defined, including low-risk patients with pT3N0 disease, intermediate-risk patients with pT3N1 or pT4N0 disease, and high-risk patients with pT4N1 disease, who had 2-year incidence of LF of 12%, 33%, and 72%, respectively. The most common sites of pelvic relapse included the external/internal iliac LNs and obturator LN regions. Notably, 34% of patients with LF had local-regional only disease at the time of recurrence. Conclusions: Patients with pT4 or N1 disease have a 2-year risk of LF that exceeds 30%. These patients may be the most likely to benefit from local adjuvant therapies.

The role for adjuvant radiotherapy in the treatment of hemangiopericytoma: a Surveillance, Epidemiology, and End Results analysis

2014 ◽  
Vol 120 (2) ◽  
pp. 300-308 ◽  
Author(s):  
Adam M. Sonabend ◽  
Brad E. Zacharia ◽  
Hannah Goldstein ◽  
Samuel S. Bruce ◽  
Dawn Hershman ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Radiation Therapy ◽  
Survival Data ◽  
Survival Benefit ◽  
Radiation Treatment ◽  
Univariate Analysis ◽  
Adjuvant Radiation ◽  
Significant Difference ◽  
End Results

Object Central nervous system (CNS) hemangiopericytomas are relatively uncommon and unique among CNS tumors as they can originate from or develop metastases outside of the CNS. Significant difference of opinion exists in the management of these lesions, as current treatment paradigms are based on limited clinical experience and single-institution series. Given these limitations and the absence of prospective clinical trials within the literature, nationwide registries have the potential to provide unique insight into the efficacy of various therapies. Methods The authors queried the Surveillance Epidemiology and End Results (SEER) database to investigate the clinical behavior and prognostic factors for hemangiopericytomas originating within the CNS during the years 2000–2009. The SEER survival data were adjusted for demographic factors including age, sex, and race. Univariate and multivariate analyses were performed to identify characteristics associated with overall survival. Results The authors identified 227 patients with a diagnosis of CNS hemangiopericytoma. The median length of follow-up was 34 months (interquartile range 11–63 months). Median survival was not reached, but the 5-year survival rate was 83%. Univariate analysis showed that age and radiation therapy were significantly associated with survival. Moreover, young age and supratentorial location were significantly associated with survival on multivariate analysis. Most importantly, multivariate analysis using the Cox proportional hazards model showed a statistically significant survival benefit for patients treated with gross-total resection (GTR) in combination with adjuvant radiation treatment (HR 0.31 [95% CI 0.01–0.95], p = 0.04), an effect not appreciated with GTR alone. Conclusions The authors describe the epidemiology of CNS hemangiopericytomas in a large, national cancer database, evaluating the effectiveness of various treatment paradigms used in clinical practice. In this study, an overall survival benefit was found when GTR was accomplished and combined with radiation therapy. This finding has not been appreciated in previous series of patients with CNS hemangiopericytoma and warrants future investigations into the role of upfront adjuvant radiation therapy.

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