scholarly journals Intraoperative radiotherapy with low energy x-rays after neurosurgical resection of brain metastases – Augsburg University Medical Center experience

2021 ◽  
Author(s):  
Klaus-Henning Kahl ◽  
Nikolaos Balagiannis ◽  
Michael Höck ◽  
Sabine Schill ◽  
Zoha Roushan ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Treatment Time ◽  
Medical Center ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
X Rays ◽  
Overall Treatment Time ◽  
X Ray ◽  
Resection Cavity ◽  
Brain Radiotherapy

Abstract Purpose External beam radiotherapy (EBRT) is the predominant method for localized brain radiotherapy (LBRT) after resection of brain metastases (BM). Intraoperative radiotherapy (IORT) with 50kV x-rays is an alternative way to irradiate the resection cavity focally after BM surgery with the option to shorten the overall treatment time and limit normal tissue irradiation.Methods We retrospectively analyzed the outcomes of all patients who underwent neurosurgical resection of BM and 50kV x-ray IORT between 2013 and 2020 at Augsburg University Medical Center.Results We identified 40 patients with 44 resected BM treated with 50kV x-ray IORT. Median diameter of the resected metastases was 2.8 cm (range 1.5–5.9 cm). Median applied dose was 20 Gy. All patients received standardized follow-up (FU) including 3-monthly MRI of the brain. Mean FU was 14.4 months, with a median MRI FU for patients alive of 12.2 months. Median overall survival (OS) of all treated patients was 26.4 months (estimated 1-year OS 61.6%). The observed local control (LC) rate of the resection cavity was 88.6% (estimated 1-year LC 84.3%). Distant brain control (DC) was 47.5% (estimated 1-year DC 33.5%). Only 25% of all patients needed WBI in the further course of disease. The observed radionecrosis rate was 2.5%.Conclusion IORT with 50kV x-rays is a safe and appealing way to apply LBRT after neurosurgical resection of BM with low toxicity and excellent LC. Close MRI FU is paramount to detect distant brain failure (DBF) early.

scholarly journals Intraoperative radiotherapy with low-energy x-rays after neurosurgical resection of brain metastases—an Augsburg University Medical Center experience

2021 ◽  
Author(s):  
Klaus-Henning Kahl ◽  
Nikolaos Balagiannis ◽  
Michael Höck ◽  
Sabine Schill ◽  
Zoha Roushan ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Treatment Time ◽  
Medical Center ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
X Rays ◽  
Overall Treatment Time ◽  
X Ray ◽  
Resection Cavity ◽  
Brain Radiotherapy

Abstract Purpose External-beam radiotherapy (EBRT) is the predominant method for localized brain radiotherapy (LBRT) after resection of brain metastases (BM). Intraoperative radiotherapy (IORT) with 50-kV x‑rays is an alternative way to focally irradiate the resection cavity after BM surgery, with the option of shortening the overall treatment time and limiting normal tissue irradiation. Methods We retrospectively analyzed the outcomes of all patients who underwent neurosurgical resection of BM and 50-kV x‑ray IORT between 2013 and 2020 at Augsburg University Medical Center. Results We identified 40 patients with 44 resected BM treated with 50-kV x‑ray IORT. Median diameter of the resected metastases was 2.8 cm (range 1.5–5.9 cm). Median applied dose was 20 Gy. All patients received standardized follow-up (FU) including 3‑monthly MRI of the brain. Mean FU was 14.4 months, with a median MRI FU for alive patients of 12.2 months. Median overall survival (OS) of all treated patients was 26.4 months (estimated 1‑year OS 61.6%). The observed local control (LC) rate of the resection cavity was 88.6% (estimated 1‑year LC 84.3%). Distant brain control (DC) was 47.5% (estimated 1‑year DC 33.5%). Only 25% of all patients needed WBI in the further course of disease. The observed radionecrosis rate was 2.5%. Conclusion IORT with 50-kV x‑rays is a safe and appealing way to apply LBRT after neurosurgical resection of BM, with low toxicity and excellent LC. Close MRI FU is paramount to detect distant brain failure (DBF) early.

Does overall treatment time impact on survival after whole-brain radiotherapy for brain metastases?

2011 ◽  
Vol 13 (12) ◽  
pp. 885-888
Author(s):  
Carsten Nieder ◽  
Nicolaus H. Andratschke ◽  
Oddvar Spanne ◽  
Hans Geinitz ◽  
Anca L. Grosu
Keyword(s):  
Brain Metastases ◽  
Treatment Time ◽  
Whole Brain Radiotherapy ◽  
Overall Treatment Time ◽  
Whole Brain ◽  
Brain Radiotherapy ◽  
Impact On Survival

scholarly journals Effect of intraoperative radiotherapy on wound healing in breast cancer patient post breast conserving surgery, KSUMC, Riyadh, Saudi Arabia: Case series and review of literature.

2019 ◽  
Vol 6 (06) ◽  
pp. 4505-4510
Author(s):  
Dr. Maha Alamodi Alghamdi ◽  
Abdulaziz Saleh Altwjri ◽  
Abdullah Alsuhaibani ◽  
Abdulaziz Alsaif
Keyword(s):  
Breast Cancer ◽  
Hormone Receptor ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
Breast Conserving Surgery ◽  
Hormone Receptor Status ◽  
Wound Complications ◽  
External Beam ◽  
X Rays ◽  
Receptor Status

Intraoperative radiotherapy during breast-conserving surgery is being studied as an alternative to 6 weeks of external beam radiotherapy (EBRT) for low-risk women; it can be delivered using electrons (intraoperative electron radiotherapy, IOERT) or 50-kV X-rays. Intraoperative radiation therapy (IORT) may pose a risk for wound complications.  Between March 2018 and June 2018, 5 breast cancer patients, all eligible for breast conserving surgery (BCS), were treated at the King Saud Medical city with IORT using the IOERT. Complete data sets for age, stage (T, N, and M), and histology and hormone receptor status were available in 5 cases. Parameters to identify eligible patients are as follows: ESTRO: >50 years, invasive ductal carcinoma/other favourable histology (IDC), T1-2 (≤3 cm), N0, any hormone receptor status, M0; ASTRO: ≥60 years, IDC, T1, N0, positive estrogen hormone receptor status, M0; TARGIT E “elderly”, risk adapted radiotherapy with IORT followed by external beam radiotherapy in case of risk factors in final histopathology. Consecutive patients operated on with the same surgical technique and given IORT were included. Wound complications were evaluated.

scholarly journals Outcomes of Radical and Boost Dose of Intraoperative Radiotherapy with Electron and Low KV X-Ray Based on Islamic Republic Intraoperative Radiotherapy (IRIORT) Consensus and the External Beam Radiotherapy in Pure Ductal Carcinoma in Situ (DCIS) in Breast Cancer Patients

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Solmaz Hashemi ◽  
Seyedmohammadreza Javadi ◽  
Mohammad Esmaeil Akbari ◽  
Hamid Reza Mirzaei ◽  
Seied Rabi Mahdavi
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
External Beam ◽  
X Ray ◽  
Boost Dose

Background: Radiotherapy plays an essential role in breast cancer treatment following breast conserving surgery even in good-risk patients with ductal carcinoma in situ (DCIS) histology. It can be delivered by many techniques, among which is intraoperative radiotherapy (IORT). In recent years, intraoperative radiation therapy has had the same outcome compared with EBRT. Objectives: We studied whether whole breast radiotherapy (WBRT) could safely be replaced by IORT and its ability to control local recurrence like EBRT in pure DCIS. Methods: We assigned 138 patients into the external beam radiotherapy (EBRT), radical, and boost groups. The patients were treated during the last 6 years in the Cancer Research Center of Shahid Beheshti University of Medical Sciences. A total of 57 patients received EBRT, 45 patients received the radical dose of radiotherapy by IORT (36 patients received intraoperative electron radiotherapy [IOeRT] and 9 patients received intraoperative X-ray radiotherapy [IOxRT]) according to the IRIORT consensus protocol, and 36 patients received the boost dose of radiotherapy by IORT (15 patients received IOeRT and 21 patients received IOxRT). The IORT and EBRT groups were compared. The primary endpoint was local recurrence and death and the secondary endpoint was the role of variables in local recurrence. Results: With the mean follow-up of 37 months for the IORT group and 40.1 months for the EBRT group, local recurrence occurred in 8.8% (5 patients), 13.9% (5 patients), and 2.2% (1 patient) of the patients in the EBRT, boost, and radical groups, respectively. Concerning the local recurrence, no significant difference was observed between the radical and EBRT groups (P = 0.058) and between the boost and EBRT groups (P = 0.12). Hazard ratios (HRs) of grade, hormone receptor (HR), tumor size, and age in disease-free survival were evaluated and none of these variables had a significant role in local recurrence. Conclusions: IORT is a good alternative for WBRT in DCIS patients because of its non-inferiority results in comparison with EBRT. Being careful about age, tumor size, biological markers, and margin status is of high importance when using IORT for DCIS.

scholarly journals Pneumonia Detection using Chest X-Ray Images

2021 ◽  
Vol 9 (VI) ◽  
pp. 1611-1618
Author(s):  
Shruti Meshram
Keyword(s):  
Medical Center ◽  
Network Models ◽  
Ensemble Model ◽  
X Rays ◽  
Neural Network Models ◽  
X Ray ◽  
Learning Framework ◽  
Unseen Data ◽  
Chest X Ray ◽  
Bacteria And Fungi

Pneumonia is among the top diseases which cause most of the deaths all over the world. Virus, bacteria and fungi can all cause pneumonia. However, it is difficult to judge the pneumonia just by looking at chest X-rays. The aim of this study is to simplify the pneumonia detection process for experts as well as for novices. We suggest a novel deep learning framework for the detection of pneumonia using the concept of transfer learning. In this approach, features from images are extracted using different neural network models pre-trained on Image Net, which then are fed into a classifier for prediction. We prepared five different models and analyzed their performance. Thereafter, we proposed an ensemble model that combines outputs from all pre-trained models, which outperformed individual models, reaching the state-of-the-art performance in pneumonia recognition. Our ensemble model reached an accuracy of 96.4% with a recall of 99.62% on unseen data from the Guangzhou Women and Children’s Medical Center dataset.

Breast intraoperative radiotherapy: a review of available modalities, dedicated machines and treatment procedure

2018 ◽  
Vol 18 (1) ◽  
pp. 98-106 ◽  
Author(s):  
Hamid Reza Baghani ◽  
Hajar Moradmand ◽  
Seyed Mahmoud Reza Aghamiri
Keyword(s):  
Clinical Outcomes ◽  
Treatment Time ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
Reference List ◽  
Treatment Procedure ◽  
Dose Uniformity ◽  
Dedicated Machines ◽  
Treatment Procedures ◽  
Electron Radiotherapy

AbstractBackgroundBreast intraoperative radiotherapy (IORT) is a partial irradiation technique that delivers a single fraction of radiation dose to the tumour bed during surgery. The use of this technique is increasing (especially in the Middle East), and therefore, it is essential to have a comprehensive approach to this treatment modality. The aim of this study is to conduct a literature review on available IORT modalities during breast irradiation as well as dedicated IORT machines and associated treatment procedures. The main IORT trials and corresponding clinical outcomes are also studied.Materials and MethodsA computerised search was performed through MEDLINE, PubMed, PubMed Central, ISI web of knowledge and reference list of related articles.ResultsIORT is now feasible through using two main modalities, including low-kilovolt IORT and intraoperative electron radiotherapy (IOERT). The dedicated machines employed and treatment procedure for mentioned modalities are quite different. The outcomes of implemented clinical trials showed that IORT is not inferior to external beam radiotherapy (EBRT) in specifically selected and well-informed patients and can be considered as an alternative to EBRT.ConclusionAlthough the clinical outcomes of introduced IORT methods are comparable, but based on the review results, it could be said that IOERT is the most effective technical method, in view of the treatment time and dose uniformity concepts. The popularity of IORT is mainly due to the distinguished obtained results during breast cancer treatment. Despite the presence of some technical challenges, it is expected that the IORT technique will become more widespread in the immediate future.

Evaluation of Stereotactic Radiotherapy of the Resection Cavity After Surgery of Brain Metastases Compared to Postoperative Whole-Brain Radiotherapy (ESTRON)—A Single-Center Prospective Randomized Trial

Neurosurgery ◽  
2018 ◽  
Vol 83 (3) ◽  
pp. 566-573 ◽  
Author(s):  
Rami A El Shafie ◽  
Angela Paul ◽  
Denise Bernhardt ◽  
Henrik Hauswald ◽  
Thomas Welzel ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiotherapy ◽  
Randomized Study ◽  
Whole Brain Radiotherapy ◽  
Progression Free Survival ◽  
Locoregional Control ◽  
Single Center ◽  
Whole Brain ◽  
Resection Cavity ◽  
Brain Radiotherapy

Abstract BACKGROUND Neurosurgical resection is recommended for symptomatic brain metastases, in oligometastatic patients or for histology acquisition. Without adjuvant radiotherapy, roughly two-thirds of the patients relapse at the resection site within 24 mo, while the risk of new metastases in the untreated brain is around 50%. Adjuvant whole-brain radiotherapy (WBRT) can reduce the risk of both scenarios of recurrence significantly, although the associated neurocognitive toxicity is substantial, while stereotactic radiotherapy (SRT) improves local control at comparably low toxicity. OBJECTIVE To compare locoregional control and treatment-associated toxicity for postoperative SRT and WBRT after the resection of 1 brain metastasis in a single-center prospective randomized study. METHODS Fifty patients will be randomized to receive either hypofractionated SRT of the resection cavity and single- or multisession SRT of all unresected brain metastases (up to 10 lesions) or WBRT. Patients will be followed-up regularly and the primary endpoint of neurological progression-free survival will be assessed by magnetic resonance imaging (MRI). Quality of life and neurocognition will be assessed in 3-mo intervals using standardized tests and EORTC questionnaires. EXPECTED OUTCOMES We expect to show that postoperative SRT of the resection cavity and further unresected brain metastases is a valid means of improving locoregional control over observation at less neurocognitive toxicity than caused by WBRT. DISCUSSION The present study is the first to compare locoregional control as well as neurocognitive toxicity for postoperative SRT and WBRT in patients with up to 10 metastases, while utilizing a highly sensitive and standardized MRI protocol for treatment planning and follow-up.

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