Impact of PET-imaging during treatment planning on outcome in meningioma patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13542-e13542
Author(s):  
Stephanie E Combs ◽  
Hanna Fischer ◽  
Theresa Voglhuber ◽  
Christian Diehl ◽  
Chistoph Straube ◽  
...  
Keyword(s):  
Treatment Planning ◽  
Pet Imaging ◽  
Residual Tumor ◽  
Target Volume ◽  
Open Science ◽  
Low Grade ◽  
High Grade ◽  
Prognostic Assessment ◽  
Science Framework ◽  
The Impact

e13542 Background: Modern radiotherapy (RT) techniques such as IMRT combined with IGRT increased safety and precision over the years. However, during treatment planning, the definition of the planning target volume (PTV) remains challenging, and differentiation between healthy tissue, i.e., meninges, post-operative changes, and residual tumor can be difficult using MR and CT imaging alone. In this study, we evaluated the impact of additional PET-imaging on local control (LCR) and overall survival (OS). Methods: We analyzed 351 patients with primary RT of meningiomas treated between 1996 and 2018 and divided the cohort into low-grade (n = 283) and high-grade (n = 68) cases. All patients were treated with fractionated stereotactic radiotherapy (FSRT) with a median dose of 54.0 Gy and a median single dose of 1.8 Gy. A radiation oncologist delineated PTV based on diagnostic CT and MRI and, if available, additional PET-imaging. We used only PET-images acquired within 50 days before RT. In our clinic, PET-planned meningioma treatment started in 2000 with Methionine (2001-2010), between 2004 and 2011 F-18 FET tracer was used, and since 2011 only 68Ga-Dotanoc/Dotatoc PETs are acquired. This study is registered under the open science framework: DOI 10.17605/OSF.IO/RYX9D. Results: Median follow-up was 6.9 years (95%-KI: 6.3-7.4). For low-grade meningiomas, mean OS was 15.5 years (95%-KI: 14.7-16.2) and mean PFS was 15.7 years (95%-KI: 14.9-16.6); for high-grade cases, median OS was 13.8 years (95%-KI: 10.4-17.1), and median PFS was 8.9 years (95%-KI: 6.4-11.4). PET imaging had a significant impact on OS (p = 0.030) and PFS (p = 0.023) for low-grade meningiomas; however, in the multivariate analysis (with the prognostic factors age, gender, PTV, Karnofsky index, and time from resection to RT), it remained only significant for LCR. For high-grade cases, PET-imaging had no influence. Conclusions: PET-imaging improves the detection of tumor cells, especially during treatment planning. It showed a significant influence on OS and LCR. Further analyses will investigate the influence of PET regarding, e.g., residual tumor tissue, tumor size, and establish cut-off values for which tumors additional PET-imaging might be beneficial. With the further prognostic a weighted scoring system will be developed for prognostic assessment. [Table: see text]

The integration of metabolic imaging in stereotactic procedures including radiosurgery: a review

2002 ◽  
Vol 97 ◽  
pp. 542-550 ◽  
Author(s):  
Marc Levivier ◽  
David Wikler ◽  
Nicolas Massager ◽  
Philippe David ◽  
Daniel Devriendt ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Brain Tumors ◽  
Treatment Planning ◽  
Target Volume ◽  
Emission Tomography ◽  
Low Grade ◽  
Content Type ◽  
Positron Emission ◽  
Pet Scanning ◽  
Fine Print

Object. The authors review their experience with the clinical development and routine use of positron emission tomography (PET) during stereotactic procedures, including the use of PET-guided gamma knife radiosurgery (GKS). Methods. Techniques have been developed for the routine use of stereotactic PET, and accumulated experience using PET-guided stereotactic procedures over the past 10 years includes more than 150 stereotactic biopsies, 43 neuronavigation procedures, and 34 cases treated with GKS. Positron emission tomography—guided GKS was performed in 24 patients with primary brain tumors (four pilocytic astrocytomas, five low-grade astrocytomas or oligodendrogliomas, seven anaplastic astrocytomas or ependymomas, five glioblastomas, and three neurocytomas), five patients with metastases (single or multiple lesions), and five patients with pituitary adenomas. Conclusions. Data obtained with PET scanning can be integrated with GKS treatment planning, enabling access to metabolic information with high spatial accuracy. Positron emission tomography data can be successfully combined with magnetic resonance imaging data to provide specific information for defining the target volume for the radiosurgical treatment in patients with recurrent brain tumors, such as glioma, metastasis, and pituitary adenoma. This approach is particularly useful for optimizing target selection for infiltrating or ill-defined brain lesions. The use of PET scanning contributed data in 31 cases (93%) and information that was specifically utilized to adapt the target volume in 25 cases (74%). It would seem that the integration of PET data into GKS treatment planning may represent an important step toward further developments in radiosurgery: this approach provides additional information that may open new perspectives for the optimization of the treatment of brain tumors.

scholarly journals Impact of Pathological Stratification on the Clinical Outcomes of Advanced Well-Differentiated/Dedifferentiated Liposarcoma Treated with Trabectedin

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1453
Author(s):  
Chiara Fabbroni ◽  
Giovanni Fucà ◽  
Francesca Ligorio ◽  
Elena Fumagalli ◽  
Marta Barisella ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Proportional Hazards ◽  
Case Series ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Low Grade ◽  
High Grade ◽  
Retrospective Case ◽  
Well Differentiated ◽  
The Impact

Background. We previously showed that grading can prognosticate the outcome of retroperitoneal liposarcoma (LPS). In the present study, we aimed to explore the impact of pathological stratification using grading on the clinical outcomes of patients with advanced well-differentiated LPS (WDLPS) and dedifferentiated LPS (DDLPS) treated with trabectedin. Patients: We included patients with advanced WDLPS and DDLPS treated with trabectedin at the Fondazione IRCCS Istituto Nazionale dei Tumori between April 2003 and November 2019. Tumors were categorized in WDLPS, low-grade DDLPS, and high-grade DDLPS according to the 2020 WHO classification. Patients were divided in two cohorts: Low-grade (WDLPS/low-grade DDLPS) and high-grade (high-grade DDLPS). Results: A total of 49 patients were included: 17 (35%) in the low-grade cohort and 32 (65%) in the high-grade cohort. Response rate was 47% in the low-grade cohort versus 9.4% in the high-grade cohort (logistic regression p = 0.006). Median progression-free survival (PFS) was 13.7 months in the low-grade cohort and 3.2 months in the high-grade cohort. Grading was confirmed as an independent predictor of PFS in the Cox proportional-hazards regression multivariable model (adjusted hazard ratio low-grade vs. high-grade: 0.45, 95% confidence interval: 0.22–0.94; adjusted p = 0.035). Conclusions: In this retrospective case series, sensitivity to trabectedin was higher in WDLPS/low-grade DDLPS than in high-grade DDLPS. If confirmed in larger series, grading could represent an effective tool to personalize the treatment with trabectedin in patients with advanced LPS.

Endoscopic Surveillance Practice for Barrett's Oesophagus in Scotland and Early Experience in Implementing Local Guidelines

2003 ◽  
Vol 48 (2) ◽  
pp. 43-45 ◽  
Author(s):  
E F Shen ◽  
S Gladstone ◽  
G Milne ◽  
S Paterson-Brown ◽  
I D Penman
Keyword(s):  
Early Experience ◽  
High Grade Dysplasia ◽  
Low Grade ◽  
High Grade ◽  
Wide Variability ◽  
Low Grade Dysplasia ◽  
Surveillance Practice ◽  
Four Quadrant ◽  
The Impact

Management of columnar lined oesophagus (CLO; Barrett s oesophagus) is controversial. We prospectively audited surveillance practices in Scotland and prospectively assessed the impact of introducing local guidelines for Barrett s surveillance in Edinburgh. Most respondents were gastroenterologists. The majority take random, not four quadrant, biopsies from the CLO. In Edinburgh during 2000, 80 patients underwent surveillance. The guideline protocol was not followed in 30 (37.5%) patients. Follow up of patients without dysplasia generally conformed to the guidelines. Follow up of patients with low grade dysplasia was highly variable while management of those with high grade dysplasia followed the guidelines. Overall we found a wide variability in the management and surveillance of CLO. Early experience suggests that implementation of guidelines is helpful but there is still variation in practice.

Applying the Paris System for Reporting Urine Cytology Increases the Rate of Atypical Urothelial Cells in Benign Cases: A Need for Patient Management Recommendations

2016 ◽  
Vol 61 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Rosario Granados ◽  
Joanny A. Duarte ◽  
Teresa Corrales ◽  
Encarnación Camarmo ◽  
Paloma Bajo
Keyword(s):  
False Positive Rate ◽  
Urine Cytology ◽  
Urinary Cytology ◽  
Low Grade ◽  
High Grade ◽  
Abnormal Cytology ◽  
Positive Rate ◽  
High Grade Carcinoma ◽  
Management Recommendations ◽  
The Impact

The Paris System (TPS) for reporting urinary cytology attempts to unify the terminology in this field. Objectives: To analyze the impact of adopting TPS by measuring nomenclature agreement and cytohistological correlation. Materials and Methods: Voided urine liquid-based cytology samples corresponding to 149 biopsy-proven cases (76 high-grade carcinomas, 40 low-grade carcinomas, and 33 benign lesions), were reclassified by the same pathologist using TPS. Diagnostic agreement and sensitivity for both nomenclature systems was measured. Results: When using TPS, the rate of atypical samples increased 8 times (from 3 to 24.2%) in benign cases, 10 times (from 2.5 to 25%) in low-grade carcinomas, and 2.4 times (from 6.6 to 15.8%) in high-grade carcinomas. The false-positive rate (abnormal cytology in negative or low-grade carcinoma cases) increased from 11 to 34.2%. Sensitivity was higher (63 vs. 49%) with TPS at the expense of a lower specificity (73 vs. 91%). The agreement between both nomenclatures was moderate for negative and high-grade carcinoma cases (k = 0.42 and 0.56, respectively) and weak for low-grade tumors (k = 0.35). Conclusions: Adopting TPS for reporting urine cytology results in a considerable increase in atypical diagnoses, improving sensitivity but lowering specificity. Appropriate management recommendations for patients with an atypical cytological diagnosis are required.

Primary Oral Cavity Lymphomas. Features of 29 Patients Assisted at Oncology Hospital Marie Curie, Buenos Aires Argentina.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4617-4617
Author(s):  
Marta O. Dragosky ◽  
Nelly Frascino ◽  
Susana Alcaraz ◽  
Isabel Annetta ◽  
Laura Devoto ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Hiv Infection ◽  
International Prognostic Index ◽  
Cell Lineage ◽  
Prognostic Index ◽  
Low Grade ◽  
High Grade ◽  
Male Predominance ◽  
Prognostic Assessment ◽  
Oral Malignancies

Abstract Primary oral cavity lymphomas (POCV) are uncommon and must be distinguish from widespread involvement of systemic lymphomas. Countries with high incidence of oral malignancies report cancer predominance. HIV+ population have higher prevalence than immunocompetent patientes. Alcohol and tobacco have been mentioned like risk factors. The International Prognostic Index has been taken in consideration. Patients attended Hospital on referal from medical or odontology centers and others on their own. A total of 29 patientes were studied. Aged 21 to 70, media 47,3 years. Male predominance: 69%. Histopathology: NHL high grade B: 19 cases, NHL low grade B: 4, NHL high grade T: 3 and plasmoblastic 3. Sites: superior maxilla: 12, inferior maxilla 11, tongue 3, palate 3. No predominance for right or left locations. HIV+ 9 patients (31%) The prevalence among inmmunocompetent was markedly lower: in 662 diagnosed with NHL 20 cases=3,02%, in 32 NHL HIV+ 9 cases= 28,12%. More frequent complaints were: painless swell of the maxilla, movable teeth, dysphagia, facial edema. The stages were I and II, 28% with locoregional extension: adenopathies or bone infiltration. The IPI was 0 in17, 1 in 10 and 2 in 2 patients. All patients received chemotherapy (CVP, CHOP), with initial good response and early relapse in HIV+. Conclusions: In correspondence with others reports, we found predominance in male and middle age, B cell lineage and connection with HIV infection. POCL may lead to the diagnosis of an up to then unknown HIV infection. The little specificity of the initial symptons tends to delay the diagnosis and the referal to a specialized center. IPI didn’t prove useful as a prognostic assessment.

Morbidity profile following aggressive resection of parietal lobe gliomas

2012 ◽  
Vol 116 (6) ◽  
pp. 1182-1186 ◽  
Author(s):  
Nader Sanai ◽  
Juan Martino ◽  
Mitchel S. Berger
Keyword(s):  
Classification System ◽  
Tumor Volume ◽  
Parietal Lobe ◽  
Tumor Resection ◽  
High Rate ◽  
Low Grade ◽  
High Grade ◽  
Language Pathways ◽  
The Impact ◽  
Glioma Classification

Object The impact of parietal lobe gliomas is typically studied in the context of parietal lobe syndromes. However, critical language pathways traverse the parietal lobe and are susceptible during tumor resection. The authors of this study reviewed their experience with parietal gliomas to characterize the impact of resection and the morbidity associated with language. Methods The study population included adults who had undergone resection of parietal gliomas of all grades. Tumor location was identified according to a proposed classification system for parietal region gliomas. Low- and high-grade tumors were volumetrically analyzed using FLAIR and T1-weighted contrast-enhanced MR imaging. Results One hundred nineteen patients with parietal gliomas were identified—34 with low-grade gliomas and 85 with high-grade gliomas. The median patient age was 45 years, and most patients (53) presented with seizures, whereas only 4 patients had an appreciable parietal lobe syndrome. The median preoperative tumor volume was 31.3 cm3, the median extent of resection was 96%, and the median postoperative tumor volume was 0.9 cm3. Surprisingly, the most common early postoperative neurological deficit was dysphasia (16 patients), not weakness (12 patients), sensory deficits (14 patients), or parietal lobe syndrome (10 patients). A proposed parietal glioma classification system, based on surgical anatomy, was predictive of language deficits. Conclusions This is the largest reported experience with parietal lobe gliomas. The findings suggested that parietal language pathways are compromised at a surprisingly high rate. The proposed parietal glioma classification system is predictive of postoperative morbidity associated with language and can assist with preoperative planning. Taken together, these data emphasize the value of identifying language pathways when operating within the parietal lobe.

scholarly journals The Impact of Blastocyst Grade on Singleton Birthweight in Fresh Transplanted Cycles

2021 ◽  
Author(s):  
Qiongyao Shi ◽  
Senlin Shi ◽  
Wenyan Song ◽  
Feifei Zhao ◽  
Haixia Jin ◽  
...  
Keyword(s):  
Birth Weight ◽  
Live Birth ◽  
Cell Mass ◽  
The Other ◽  
Low Grade ◽  
High Grade ◽  
Significant Difference ◽  
Group A ◽  
Grade 3 ◽  
The Impact

Abstract Background: A retrospectively cohort study was performed to compare the birth weight of different blastocyst grades in fresh transplantation cycle and explore the related factors affecting the birth weight. Methods: The 1301 fresh cycles of single blastocyst transplantation and single live birth profile were analyzed,four groups were divided according to the grade of transplanted blastocyst. There are 170 cycles in group A with AA blastocyst grade, 312 cycles in group B with AB/BA blastocyst grade, 559 cycles in group C with BB/CA/AC blastocyst grade and 260 cycles in group D with BC/CB blastocyst grade. Comparison were made among four groups of birth weight, general conditions, fertilization rate, embryo rate, cleavage rate and D5,D6 blastocyst formation rate and other laboratory indicators. And then comparison were performed among the birth weight of different groups which were divided by the degree of blastocyst expansion, and the classification of inner cell mass(ICM) and the trophectoderm(TE). Results: The study shows that the birth weight of group A is significantly higher than that of the other three groups (P < 0.05). And the high quality embryo rate and blastocyst rate of group A are significantly higher than those of the other three groups (P < 0.05). What’s more, the clinical pregnancy rate, implantation rate and live birth rate of high grade blastocyst are higher, but there are no significant difference in abortion rate. The birth weight of the degree of blastocyst expansion in grade 3 and below is significantly lower than that of those with grade 3 and above (P < 0.05). The birth weight of grade A of ICM is significantly higher than that of grade B (P < 0.05). The birth weight of grade B of TE is significantly heavier than that of grade C (P < 0.05). Conclusions: Our results indicate that high grade blastocyst transplantation can achieve better pregnancy outcome. Different blastocyst grades affect birth weight, and low grade blastocyst transplantation is associated with a single birth weight loss.

Screening for gastrointestinal disease

2018 ◽  
Author(s):  
Satish Keshav ◽  
Alexandra Kent
Keyword(s):  
Colorectal Cancer ◽  
Early Detection ◽  
Advanced Disease ◽  
Gastrointestinal Disease ◽  
Hepatocellular Cancer ◽  
High Grade Dysplasia ◽  
Low Grade ◽  
High Grade ◽  
The Impact

This chapter discusses screening for gastrointestinal disease, including Barrett’s oesophagus (BO), colorectal cancer, and hepatocellular cancer (HCC). In patients with BO, approximately 5% will develop dysplasia, and 10%–50% of the low-grade dysplasias will progress to high-grade dysplasia or adenocarcinoma within 2–5 years. Thus, screening for BO has been developed to reduce the development of adenocarcinoma via the early detection of high-grade dysplasia or cancer in situ. The main aim of colorectal cancer screening is the early detection of polyps and cancers, at a time when treatment is likely to be more effective. Similarly, early detection of HCC is advantageous, as the prognosis in advanced disease is very poor. This chapter describes the current processes of screening for these diseases, and the impact of this screening, as well as screening for gastrointestinal cancer in specific groups.

Postoperative Stereotactic Body Radiotherapy for Spinal Metastases and the Impact of Epidural Disease Grade

Neurosurgery ◽  
2019 ◽  
Vol 85 (6) ◽  
pp. E1111-E1118 ◽  
Author(s):  
Majed Alghamdi ◽  
Arjun Sahgal ◽  
Hany Soliman ◽  
Sten Myrehaug ◽  
Victor X D Yang ◽  
...  
Keyword(s):  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Spinal Metastases ◽  
Retrospective Chart Review ◽  
Vertebral Compression Fractures ◽  
Low Grade ◽  
High Grade ◽  
Hardware Failure ◽  
Spinal Segments ◽  
The Impact

Abstract BACKGROUND Postoperative stereotactic body radiotherapy (pSBRT) is an emerging indication for spinal metastases (SM). OBJECTIVE To report our experience with pSBRT for SM. METHODS A retrospective chart review was performed for prospectively collected data of patients treated between September 2008 to December 2015 with pSBRT and followed with serial spinal MRIs every 2 to 3 mo until death or last follow-up. Univariate and multivariable analyses were performed to identify predictive factors. RESULTS A total of 83 spinal segments in 47 patients treated with a median dose of 24 Gy in 2 fractions were included, with mostly lung and breast primaries. A total of 59.3% had preoperative high-grade epidural disease (ED) and 39.7% were unstable. The 12-mo cumulative incidence of local failure was 17% for all segments, and 33.3%, 21.8%, and 0% in segments with postoperative high-grade, low-grade, and no ED, respectively. Downgrading preoperative ED was predictive of better local control (P = .03). The grade of postoperative ED was also predictive for local control (P < .0001), as was a longer interval between prior radiotherapy and pSBRT in those previously irradiated (P = .004). The 12-mo overall survival rate was 55%. One case of radiculopathy, 3 vertebral compression fractures, and no cases of myelopathy, hardware failure, or skin breakdown were observed. CONCLUSION pSBRT is an effective and safe treatment. The association between downgrading preoperative ED and better local control following pSBRT is confirmed and supports the concept of separation surgery.

Impact of multidisciplinary therapy on high-grade appendiceal adenocarcinoma (AA).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4134-4134
Author(s):  
Karen A. Beaty ◽  
Richard E. Royal ◽  
Keith F. Fournier ◽  
Melissa W. Taggart ◽  
Michael J. Overman ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Tumor Biology ◽  
Low Grade ◽  
High Grade ◽  
Multidisciplinary Therapy ◽  
Peritoneal Disease ◽  
Signet Ring Cells ◽  
Heated Intraperitoneal Chemotherapy ◽  
Signet Ring ◽  
The Impact

4134 Background: AA is a rare malignancy ranging from well-differentiated to poorly differentiated carcinoma, including those with signet ring cells. Optimal therapy for low grade peritoneal disease is cytoreductive surgery (CRS) combined with heated intraperitoneal chemotherapy (HIPEC). However, some patients (pts) are suboptimal for CRS/HIPEC, and are considered for systemic chemotherapy (SC) alone, or SC + CRS. In light of our previously reported overall survival (OS) benefits for the role of SC in metastatic AA, here we explore the impact of surgical intervention on OS in these pts. Our aim was to clarify the OS benefit of multidisciplinary therapy (SC + CRS + HIPEC) in those pts with aggressive tumor biology. Methods: A retrospective chart review of AA pts registered in our tumor registry between Jan. 2005 to Dec. 2009 was undertaken to identify patients with AA who received SC. Electronic medical records (EMR) were reviewed for CRS, HIPEC, histology, SC, and OS. The K-M method and Log-Rank test were used for statistical analysis. Results: Of 143 AA pts, 52 (36%) pts were high grade with 33 (23%) having signet ring cells. After a median follow-up of 35M, high grade tumors were noted to have worse OS overall (24M vs 56M, p<.001). When comparing treatment received, and adjusting for tumor biology, those pts with high grade disease again fared worse, and experienced comparatively worse OS. However, those treated with SC + CRS + HIPEC experienced the longest median survival. Conclusions: Pts with peritoneal disease from high grade AA who completed SC with CRS + HIPEC experienced prolonged OS compared to those treated by SC +/- CRS. Our data suggest that SC + palliative CRS offers minimal benefit for high grade disease. Selection bias influences these results heavily; as those who do well proceed to complete all components of therapy. A treatment plan that includes SC + CRS + HIPEC can result in durable survival, and is a strategy that warrants further study emphasizing the importance of multidisciplinary management. [Table: see text]

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