Petroclival meningiomas: long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution

2020 ◽  
Vol 132 (6) ◽  
pp. 1675-1682 ◽  
Author(s):  
Jin Wook Kim ◽  
Hee-Won Jung ◽  
Yong Hwy Kim ◽  
Chul-Kee Park ◽  
Hyun-Tai Chung ◽  
...  
Keyword(s):  
Adjuvant Treatment ◽  
Management Strategies ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Years Of Experience ◽  
Local Tumor ◽  
Long Term Outcomes ◽  
Single Institution ◽  
Petroclival Meningiomas

OBJECTIVEA thorough investigation of the long-term outcomes and chronological changes of multimodal treatments for petroclival meningiomas is required to establish optimal management strategies. The authors retrospectively reviewed the long-term clinical outcomes of patients with petroclival meningioma according to various treatments, including various surgical approaches, and they suggest treatment strategies based on 30 years of experience at a single institution.METHODSNinety-two patients with petroclival meningiomas were treated surgically at the authors’ institution from 1986 to 2015. Patient demographics, overall survival, local tumor control rates, and functional outcomes according to multimodal treatments, as well as chronological change in management strategies, were evaluated. The mean clinical and radiological follow-up periods were 121 months (range 1–368 months) and 105 months (range 1–348 months), respectively.RESULTSA posterior transpetrosal approach was most frequently selected and was followed in 44 patients (48%); a simple retrosigmoid approach, undertaken in 30 patients, was the second most common. The initial extent of resection and following adjuvant treatment modality were classified into 3 subgroups: gross-total resection (GTR) only in 13 patients; non-GTR treatment followed by adjuvant radiosurgery or radiation therapy (non-GTR+RS/RT) in 56 patients; and non-GTR without adjuvant treatment (non-GTR only) in 23 patients. The overall progression-free survival rate was 85.8% at 5 years and 81.2% at 10 years. Progression or recurrence rates according to each subgroup were 7.7%, 12.5%, and 30.4%, respectively.CONCLUSIONSThe authors’ preferred multimodal treatment strategy, that of planned incomplete resection and subsequent adjuvant radiosurgery, is a feasible option for the management of patients with large petroclival meningiomas, considering both local tumor control and postoperative quality of life.

scholarly journals Volumetric changes and clinical outcome for petroclival meningiomas after primary treatment with Gamma Knife radiosurgery

2018 ◽  
Vol 129 (6) ◽  
pp. 1623-1629 ◽  
Author(s):  
Zjiwar H. A. Sadik ◽  
Suan Te Lie ◽  
Sieger Leenstra ◽  
Patrick E. J. Hanssens
Keyword(s):  
Gamma Knife ◽  
Clinical Symptoms ◽  
Cranial Nerves ◽  
Gamma Knife Radiosurgery ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Local Tumor ◽  
Tumor Control Rate ◽  
Petroclival Meningiomas

OBJECTIVEPetroclival meningiomas (PCMs) can cause devastating clinical symptoms due to mass effect on cranial nerves (CNs); thus, patients harboring these tumors need treatment. Many neurosurgeons advocate for microsurgery because removal of the tumor can provide relief or result in symptom disappearance. Gamma Knife radiosurgery (GKRS) is often an alternative for surgery because it can cause tumor shrinkage with improvement of symptoms. This study evaluates qualitative volumetric changes of PCM after primary GKRS and its impact on clinical symptoms.METHODSThe authors performed a retrospective study of patients with PCM who underwent primary GKRS between 2003 and 2015 at the Gamma Knife Center of the Elisabeth-Tweesteden Hospital in Tilburg, the Netherlands. This study yields 53 patients. In this study the authors concentrate on qualitative volumetric tumor changes, local tumor control rate, and the effect of the treatment on trigeminal neuralgia (TN).RESULTSLocal tumor control was 98% at 5 years and 93% at 7 years (Kaplan-Meier estimates). More than 90% of the tumors showed regression in volume during the first 5 years. The mean volumetric tumor decrease was 21.2%, 27.1%, and 31% at 1, 3, and 6 years of follow-up, respectively. Improvement in TN was achieved in 61%, 67%, and 70% of the cases at 1, 2, and 3 years of follow-up, respectively. This was associated with a mean volumetric tumor decrease of 25% at the 1-year follow-up to 32% at the 3-year follow-up.CONCLUSIONSGKRS for PCMs yields a high tumor control rate with a low incidence of neurological deficits. Many patients with TN due to PCM experienced improvement in TN after radiosurgery. GKRS achieves significant volumetric tumor decrease in the first years of follow-up and thereafter.

Management of newly diagnosed single brain metastasis using resection and permanent iodine-125 seeds without initial whole-brain radiotherapy: a two-institution experience

2007 ◽  
Vol 22 (3) ◽  
pp. 1-6 ◽  
Author(s):  
Elias Dagnew ◽  
Jeffrey Kanski ◽  
Michael W. McDermott ◽  
Penny K. Sneed ◽  
Christopher McPherson ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Whole Brain Radiotherapy ◽  
Distant Metastases ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Newly Diagnosed ◽  
Local Tumor ◽  
Brain Radiotherapy ◽  
Single Brain Metastasis

Object Whole-brain radiotherapy (WBRT) after resection of a single brain metastasis can cause long-term radiation toxicity. The authors evaluated the efficacy of resection and placement of 125I seeds (without concomitant WBRT) for newly diagnosed single brain metastases. Methods In a retrospective review from two institutions (1997–2003), 15 women and 11 men (mean age 55 years) with single brain metastasis underwent gross-total resection and placement of permanent low-activity 125I seeds. Primary systemic cancer sites varied. Patients were monitored clinically and radiographically. With neuroimaging evidence of local recurrence or new distant metastasis, further treatment was administered at the physician's discretion. By the median follow-up evaluation (12 months), the local tumor control rate was 96%. Distant metastases occurred in three patients within 3 months, suggesting synchronous metastasis, and in six patients more than 3 months after treatment, indicating metachronous metastasis. Treatment in these cases included radio-surgery in seven patients, WBRT in two, and resection together with 125I seed placement in one. Two patients who suffered radiation necrosis required operative intervention (lesion diameter > 3 cm, total activity > 40 mCi). All 26 patients who had been treated using resection and placement of 125I seeds had a stable or an improved Karnofsky Performance Scale score. At the last review, nine of 16 living patients showed no evidence of treatment failure. The median actuarial survival rate was 17.8 months (Kaplan–Meier method). Conclusions Permanent 125I brachytherapy applied at the initial operation without WBRT provided excellent local tumor control. Local control and patient survival rates were at least as good as those reported for resection combined with WBRT. Although the authors noted a higher incidence of distant metastases compared with that reported in other studies of initial WBRT, these metastases were generally well controlled with a combination of surgery, stereotactic radiosurgery, and, less often, WBRT. Twenty-four patients (92%) never required WBRT, thus avoiding potential long-term radiation-induced neurotoxicity.

Vaginal embryonal rhabdomyosarcoma

2021 ◽  
Vol 20 (3) ◽  
pp. 174-177
Author(s):  
N.I. Minashkina ◽  
◽  
V.A. Strykov ◽  
T.G. Dyadik ◽  
I.V. Karachentsova ◽  
...  
Keyword(s):  
Tumor Response ◽  
Management Strategies ◽  
Young Patients ◽  
Reproductive Function ◽  
High Dose Rate ◽  
Local Tumor Control ◽  
Embryonal Rhabdomyosarcoma ◽  
Tumor Control ◽  
High Dose ◽  
Local Tumor

Vaginal embryonal rhabdomyosarcoma is a relatively rare tumor, which is more commonly diagnosed in children under three years of age and is rarely associated with organ-sparing treatment. Neoadjuvant chemotherapy followed by radiotherapy or surgery can be currently used as local tumor control. A clinical case of vaginal embryonal rhabdomyosarcoma in a 5-year-old girl is presented. Considering the tumor response to polychemotherapy, high dose rate intracavitary radiation therapy (brachytherapy) was chosen as the method of local control. Brachytherapy reduces the need for surgery and radiation of large regions in children and enables young patients to realize their reproductive function in the future. Key words: brachytherapy, management strategies, embryonal rhabdomyosarcoma

scholarly journals Quantitative optical spectroscopy can identify long-term local tumor control in irradiated murine head and neck xenografts

2009 ◽  
Vol 14 (5) ◽  
pp. 054051 ◽  
Author(s):  
Karthik Vishwanath ◽  
Daniel Klein ◽  
Kevin Chang ◽  
Thies Schroeder ◽  
Mark W. Dewhirst ◽  
...  
Keyword(s):  
Head And Neck ◽  
Optical Spectroscopy ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Local Tumor

scholarly journals Late Toxicities, Failure Patterns, Local Tumor Control, and Survival of Esophageal Squamous Cell Carcinoma Patients After Chemoradiotherapy With a Simultaneous Integrated Boost: A 5-Year Phase II Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Chuangzhen Chen ◽  
Jianzhou Chen ◽  
Ting Luo ◽  
Siyan Wang ◽  
Hong Guo ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rates ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Local Tumor ◽  
Integrated Boost ◽  
Grade 3 ◽  
Overall Survival Rates

PurposeWe aimed to evaluate the long-term outcomes of concurrent chemoradiotherapy (CCRT) with a simultaneous integrated boost (SIB) of radiotherapy for esophageal squamous cell carcinoma (ESCC).Methods and MaterialsEighty-seven patients with primary ESCC enrolled in this phase II trial. The majority (92.0%) had locoregionally advanced disease. They underwent definitive chemoradiotherapy. The radiotherapy doses were 66 Gy for the gross tumor and 54 Gy for the subclinical disease. Doses were simultaneously administered in 30 fractions over 6 weeks. The patients also underwent concurrent and adjuvant chemotherapy, which comprised cisplatin and fluorouracil. The study end points were acute and late toxicities, first site of failure, locoregional tumor control, and overall survival rates.ResultsThe median follow-up time was 65.7 (range, 2.2-97.5) months for all patients and 81.5 (range, 19.4-97.5) months for those alive. There were 17 cases (19.5%) of severe late toxicities, including four cases (4.6%) of grade 5 and seven (8.0%) of grade 3 esophageal ulceration, four (4.6%) of grade 3 esophageal stricture, and two (2.3%) of grade 3 radiation-induced pneumonia. Twenty-three (26.4%) patients had locoregional disease progression. Most (86.7%) locally progressive lesions were within the dose-escalation region in the initial radiation plan, while majority of the recurrent lymph nodes were found out-of-field (83.3%) and in the supraclavicular region (75.0%). The 1-, 2-, 3-, and 5-year locoregional tumor control and overall survival rates were 79.2%, 72.4%, 72.4%, 70.8%, and 82.8%, 66.6%, 61.9%, 58.4%, respectively. Incomplete tumor response, which was assessed immediately after CCRT was an independent risk predictor of disease progression and death in ESCC patients.ConclusionsCCRT with SIB was well tolerated in ESCC patients during treatment and long-term follow-up. Moreover, patients who underwent CCRT with SIB exhibited improved local tumor control and had better survival outcomes compared to historical data of those who had standard-dose radiotherapy.

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