scholarly journals Three-stage Gamma Knife treatment for metastatic brain tumors larger than 10 cm3: a 2-institute study including re-analyses of earlier results using competing risk analysis

2018 ◽  
Vol 129 (Suppl1) ◽  
pp. 77-85 ◽  
Author(s):  
Masaaki Yamamoto ◽  
Yoshinori Higuchi ◽  
Toru Serizawa ◽  
Takuya Kawabe ◽  
Osamu Nagano ◽  
...  
Keyword(s):  
Risk Analysis ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Survival Rates ◽  
Competing Risk ◽  
Published Data ◽  
Competing Risk Analysis ◽  
Survival Times ◽  
Actuarial Survival ◽  
Peripheral Dose

OBJECTIVEThe results of 3-stage Gamma Knife treatment (3-st-GK-Tx) for relatively large brain metastases have previously been reported for a series of patients in Chiba, Japan (referred to in this study as the C-series). In the current study, the authors reappraised, using a competing risk analysis, the efficacy and safety of 3-st-GK-Tx by comparing their experience with that of the C-series.METHODSThis was a retrospective cohort study. Among 1767 patients undergoing GK radiosurgery for brain metastases at Mito Gamma House during the 2005–2015 period, 78 (34 female, 44 male; mean age 65 years, range 35–86 years) whose largest tumor was > 10 cm3, treated with 3-st-GK-Tx, were studied (referred to in this study as the M-series). The target volumes were covered with a 50% isodose gradient and irradiated with a peripheral dose of 10 Gy at each procedure. The interval between procedures was 2 weeks. Because competing risk analysis had not been employed in the published C-series, the authors reanalyzed the previously published data using this method.RESULTSThe overall median survival time after 3-st-GK-Tx was 8.3 months (95% CI 5.6–12.0 months) in the M-series and 8.6 months (95% CI 5.5–10.6 months) in the C-series (p = 0.41). Actuarial survival rates at the 6th and 12th post–3-st-GK-Tx months were, respectively, 55.1% and 35.2% in the M-series and 62.5% and 26.4% in the C-series (HR 1.175, 95% CI 0.790–1.728, p = 0.42). Cumulative incidences at the 12th post–3-st-GK-Tx, determined by competing risk analyses, of neurological deterioration (14.2% in C-series vs 12.8% in M-series), neurological death (7.2% vs 7.7%), local recurrence (4.8% vs 6.2%), repeat SRS (25.9% vs 18.0%), and SRS-related complications (2.3% vs 5.1%) did not differ significantly between the 2 series.CONCLUSIONSThere were no significant differences in post–3-st-GK-Tx results between the 2 series in terms of overall survival times, neurological death, maintained neurological status, local control, repeat SRS, and SRS-related complications. The previously published results (C-series) are considered to be validated by the M-series results.

scholarly journals MET-05 PRELIMINARY REPORT OF RADIOTHERAPY FOR BRAIN METASTASES FROM GASTRO-INTESTINAL CANCERS USING MASK SYSTEM OF LEKSELL GAMMA KNIFE ICON

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii35-ii36
Author(s):  
Takuya Kawabe ◽  
Manabu Sato
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Local Control ◽  
Malignant Tumors ◽  
Survival Rates ◽  
Benign Tumors ◽  
Survival Times ◽  
Single Session ◽  
Tumor Number ◽  
Eloquent Area

Abstract OBJECT Leksell Gamma Knife Icon enables us to apply new methods of immobilization using mask fixation and the option of fractionated treatment. This provides exceptional accuracy and precision of radiosurgery, making it a possibility for many more disease types and many more patients to be treated. METHODS We retrospectively analyzed 50 patients (71 times) with brain metastases from gastro-intestinal cancers who underwent Gamma Knife Icon using mask fixation between September 25th, 2017 and June 30th, 2019 at Rakusai Shimizu Hospital. Patients with small, few, newly diagnosed, and non-eloquent area tumors were treated in a single session. If the tumor volume was larger than 5.0 ml, recurrence, or the location was in an eloquent area, we applied a fractionated schedule. If the tumor number was large, we selected a multisession schedule. The most common origin was colon (19 patients), followed by rectum (11), stomach (7), esophagus (5) and others (8). RESULTS 13 cases were treated in a single session, 53 with fractionation, and five with multiple sessions. We selected fractionated schedules as follows; 7.0 Gy x 5Fr (5–10 ml), 4.2Gy x 10Fr (10-20ml), 3.7Gy x 10Fr (20-30ml), 3.2Gy x 10Fr (30ml-) for malignant tumors, and 2.7Gy x 10Fr for benign tumors. Median tumor number was two (1–40) and median tumor size was 8.1 (0.03–67.5) ml. Median survival times after Icon treatment was 13.5 months and local control rate after 6-month Icon treatment was 80%. CONCLUSIONS Although these results are limited to short periods, survival rates, local control rates and qualitative survival rated in patients unsuitable for stereotactic radiosurgery, such as those with large, recurrent, and eloquent site lesions, were within the acceptable ranges.

scholarly journals Effects of Albumin on Survival after a Hepatic Encephalopathy Episode: Randomized Double-Blind Trial and Meta-Analysis

2021 ◽  
Vol 10 (21) ◽  
pp. 4885
Author(s):  
Meritxell Ventura-Cots ◽  
Macarena Simón-Talero ◽  
Maria Poca ◽  
Xavier Ariza ◽  
Helena Masnou ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Risk Analysis ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Survival Rates ◽  
Competing Risk ◽  
Competing Risk Analysis ◽  
Double Blind ◽  
Clinical Events ◽  
Grade Ii

No therapies have been proven to increase survival after a hepatic encephalopathy (HE) episode. We hypothesize that two doses of albumin could improve 90-day survival rates after a HE episode. Methods: (1) A randomized double-blind, placebo-controlled trial (BETA) was conducted in 12 hospitals. The effect of albumin (1.5 g/kg at baseline and 1 g/kg on day 3) on 90-day survival rates after a HE episode grade II or higher was evaluated. (2) A meta-analysis of individual patient’s data for survival including two clinical trials (BETA and ALFAE) was performed. Results: In total, 82 patients were included. Albumin failed to increase the 90-day transplant-free survival (91.9% vs. 80.5%, p = 0.3). A competing risk analysis was performed, observing a 90-day cumulative incidence of death of 9% in the albumin group vs. 20% in the placebo (p = 0.1). The meta-analysis showed a benefit in the albumin group, with a lower rate of clinical events (death or liver transplant) than patients in the placebo (HR, 0.44; 95% CI, 0.21–0.82), when analyzed by a competing risk analysis (90-days mortality rate of 11% in the albumin group vs. 30% in the placebo, p = 0.02). Conclusions: Repeated doses of albumin might be beneficial for patient’s survival as an add-on therapy after an HE episode, but an adequately powered trial is needed

scholarly journals MET-10 Preliminary report of radiotherapy for brain metastases from breast and kidney using mask system of Leksell Gamma Knife Icon

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii20-ii20
Author(s):  
Takuya Kawabe ◽  
Manabu Sato
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Local Control ◽  
Survival Rates ◽  
Survival Times ◽  
Single Session ◽  
Accuracy And Precision ◽  
Tumor Number ◽  
Eloquent Area ◽  
Hospital Patients

Abstract Object: Leksell Gamma Knife Icon enables us to apply new methods of immobilization using mask fixation and the option of fractionated treatment. This provides exceptional accuracy and precision of radiosurgery, making it a possibility for many more disease types and many more patients to be treated. Methods: We retrospectively analyzed 97 patients (140 times) with brain metastases from breast (B group) and 26 patients (33 times) with brain metastases from kidney (K group) and who underwent Gamma Knife Icon using mask fixation between September 25th, 2017 and June 30th, 2020 at Rakusai Shimizu Hospital. Patients with small, few, newly diagnosed, and non-eloquent area tumors were treated in a single session. If the tumor volume was larger than 5.0 ml, recurrence, or the location was in an eloquent area, we applied a fractionated schedule. If the tumor number was large, we selected a multisession schedule. Median tumor number was three (1–64) in B group and two (1–31) in K group. Median tumor size was 2.7 (0. 01-58.8) ml in B group and 2.8 (0.02–123.5) ml in K group. We selected fractionated schedules as follows; 7.0 Gy x 5Fr (5–10 ml), 4.2Gy x 10Fr (10-20ml), 3.7Gy x 10Fr (20-30ml), 3.2Gy x 10Fr (30ml-). Results: 32 (B) and 14 (K) cases were treated in a single session, 80 (B) and 17 (K) with fractionation, and 28 (B) and 2 (K) with multiple sessions. Median survival times after Icon treatment was 28.2 (B) and 15.5 (K) months. Local control rates were 89 % (B) and 85% after 12-month Icon treatment. Qualitative survival rates were 91% (B) and 86% (K) after 12-month Icon treatment. There were no statistically differences between two groups. Conclusions: Although these results are limited to short periods, survival rates, local control rates and qualitative survival rates were within the acceptable ranges.

scholarly journals Waitlist Mortality and Posttransplant Outcomes in African Americans with Autoimmune Liver Diseases

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
John Paul Nsubuga ◽  
Daniela Goyes ◽  
Hirsh D. Trivedi ◽  
Esli Medina-Morales ◽  
Vilas Patwardhan ◽  
...  
Keyword(s):  
African Americans ◽  
Risk Analysis ◽  
Liver Transplant ◽  
Graft Survival ◽  
Liver Diseases ◽  
Cox Regression ◽  
Survival Rates ◽  
Competing Risk ◽  
Competing Risk Analysis ◽  
Autoimmune Liver Diseases

Background. Liver transplantation is indicated in end-stage liver disease due to autoimmune diseases. The liver allocation system can be affected by disparities such as decreased liver transplant referrals for racial minorities, especially African Americans that negatively impact the pre- and posttransplant outcomes. Aim. To determine differences in waitlist survival and posttransplant graft survival rates between African American and Caucasian patients with autoimmune liver diseases. Study. The United Network for Organ Sharing database was used to identify all patients with autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis who underwent liver transplant from 1988 to 2019. We compared waitlist survival and posttransplant graft survival between Caucasians and African Americans using Kaplan–Meier curves and Cox regression models. We also evaluated the cumulative incidence of death or delisting for deterioration and posttransplant incidence of death and retransplantation using competing risk analysis. Results. African Americans were more likely to be removed from the waitlist for death or clinical deterioration (subdistribution hazard ratio (SHR) 1.26, 95% CI 1–1.58, P = 0.046 ) using competing risk analysis. On multivariate Cox regression analysis, there was no difference in posttransplant graft survival among the two groups (hazard ratio (HR) 1.10, 95% CI 0.98–1.23, P = 0.081 ). Conclusions. Despite the current efforts to reduce racial disparities, we found that African Americans are more likely to die on the waitlist for liver transplant and are less likely to be transplanted, with no differences in graft survival rates. The persistence of healthcare disparities continues to negatively impact African Americans.

scholarly journals Bayesian competing risk analysis: An application to nasopharyngeal carcinoma patients data

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Rakesh Kumar Saroj ◽  
K. Narasimha Murthy ◽  
Mukesh Kumar ◽  
Atanu Bhattacharjee ◽  
Kamalesh Kumar Patel
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Risk Analysis ◽  
Competing Risk ◽  
Competing Risk Analysis

scholarly journals A Scoring System For Predicting Hepatocellular Carcinoma Risk In Alcoholic Cirrhosis: A Competing Risk Analysis

2021 ◽  
Author(s):  
Kyunghan Lee ◽  
Gwang Hyeon Choi ◽  
Eun Sun Jang ◽  
Sook-Hyang Jeong ◽  
Jin–Wook Kim
Keyword(s):  
Hepatocellular Carcinoma ◽  
Risk Analysis ◽  
Viral Hepatitis ◽  
Validation Cohort ◽  
Alcoholic Cirrhosis ◽  
Competing Risk ◽  
Competing Risk Analysis ◽  
Hazards Model ◽  
B Virus

Abstract Background & Aims: The role of hepatocellular carcinoma (HCC) surveillance is being questioned in alcoholic cirrhosis because of the relative low HCC risk. Comorbid viral hepatitis may synergistically increase the HCC risk in alcoholic cirrhosis. This study aimed to assess the risk and predictors of HCC in patients with alcoholic cirrhosis by using competing risk analysis in an area with intermediate prevalence for hepatitis B virus.Methods: A total of 965 patients with alcoholic cirrhosis were recruited at a university-affiliated hospital in Korea and randomly assigned to either the derivation (n=643) and validation (n=322) cohort. Subdistribution hazards model of Fine and Gray was used with deaths and liver transplantation treated as competing risks. Death records were confirmed from Korean government databases. A nomogram was developed to calculate the Alcohol-associated Liver Cancer Estimation (ALICE) score.Results: Markers for viral hepatitis were positive in 21.0 % and 25.8 % of patients in derivation and validation cohort, respectively. The cumulative incidence of HCC was 13.5 and 14.9 % at 10 years for derivation and validation cohort, respectively. Age, positivity for viral hepatitis markers, alpha-fetoprotein level, and platelet count were identified as independent predictors of HCC and incorporated in the ALICE score, which discriminated low, intermediate, and high risk for HCC in alcoholic cirrhosis at the cut-off of 120 and 180. Conclusions: HCC risk can be stratified by using clinical parameters including viral markers in alcoholic cirrhosis in an area where the prevalence of viral hepatitis is substantial.

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