scholarly journals The management of clival chordomas: an Italian multicentric study

2020 ◽  
pp. 1-10
Author(s):  
Luigi Maria Cavallo ◽  
Diego Mazzatenta ◽  
Elena d’Avella ◽  
Domenico Catapano ◽  
Marco Maria Fontanella ◽  
...  
Keyword(s):  
Proton Beam ◽  
Doppler Ultrasound ◽  
Previous Treatment ◽  
Proton Beam Therapy ◽  
Extent Of Resection ◽  
National Study ◽  
Surgical Morbidity ◽  
Endoscopic Endonasal ◽  
Beam Radiation ◽  
Multicentric Study

OBJECTIVEIn the last 2 decades, the endoscopic endonasal approach in the treatment of clival chordomas has evolved to be a viable strategy to achieve maximal safe resection of this tumor. Here, the authors present a multicentric national study, intending to analyze the evolution of this approach over a 20-year time frame and its contribution in the treatment of clival chordomas.METHODSClival chordoma cases surgically treated between 1999 and 2018 at 10 Italian neurosurgical departments were included in this retrospective study. Clinical, radiological, and surgical findings, adjuvant therapy, and outcomes were evaluated and compared according to classification in the treatment eras from 1999 to 2008 and from 2009 to 2018.RESULTSOne hundred eighty-two surgical procedures were reviewed, with an increase in case load since 2009. The endoscopic endonasal transclival approach (EETA) was performed in 151 of 182 cases (83.0%) and other approaches were performed in 31 cases (17%). There was an increment in the use of EETA, neuronavigation, and Doppler ultrasound after 2008. The overall postoperative complication rate was 14.3% (26 of 182 cases) consisting of 9 CSF leaks (4.9%), 7 intracranial hemorrhages (3.8%), 5 cases of meningitis (2.7%), and 5 cerebral ischemic injuries (2.7%). Gross-total resection (GTR) was achieved in 93 of 182 cases (51.1%). Extent of resection (EOR) improved in the second era of the study. Signs and/or symptoms at presentation worsened in 27 cases (14.8%), and the Katz Index worsened in 10 cases (5.5%). Previous treatment, dural involvement, EETA, and intraoperative Doppler ultrasound correlated with GTR. Patients received adjuvant proton beam radiation in 115 of 182 cases (63.2%), which was administered more in the latter era. Five-year progression-free survival (PFS) and overall survival (OS) were 62.3% and 73.5%, respectively. GTR, EETA, proton beam therapy, and the chondroid subtype correlated with a better survival rate. The mean follow-up was 62 months.CONCLUSIONSThrough multicentric data collection, this study encompasses the largest series in the literature of clival chordomas surgically treated through an EETA. An increase in the use of this approach was found among Italian neurosurgical departments together with an improved extent of resection over time. The satisfactory rate of GTR was marked by low surgical morbidity and the preservation of patient quality of life. Surgical outcome was reinforced, in terms of PFS and OS, by the use of proton beam therapy, which was increasingly performed along the period of study.

scholarly journals Feasibility of Proton Beam Therapy as a Rescue Therapy in Heavily Pre-Treated Retinoblastoma Eyes

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1862
Author(s):  
Eva Biewald ◽  
Tobias Kiefer ◽  
Dirk Geismar ◽  
Sabrina Schlüter ◽  
Anke Manthey ◽  
...  
Keyword(s):  
Proton Beam ◽  
Rescue Therapy ◽  
Therapeutic Option ◽  
Proton Beam Therapy ◽  
External Beam Radiation ◽  
Time Interval ◽  
Beam Radiation ◽  
Primary Tumors ◽  
Increased Risk

Despite the increased risk of subsequent primary tumors (SPTs) external beam radiation (EBRT) may be the only therapeutic option to preserve a retinoblastoma eye. Due to their physical properties, proton beam therapy (PBT) offers the possibility to use the effectiveness of EBRT in tumor treatment and to decisively reduce the treatment-related morbidity. We report our experiences of PBT as rescue therapy in a retrospectively studied cohort of 15 advanced retinoblastoma eyes as final option for eye-preserving therapy. The average age at the initiation of PBT was 35 (14–97) months, mean follow-up was 22 (2–46) months. Prior to PBT, all eyes were treated with systemic chemotherapy and a mean number of 7.1 additional treatments. Indication for PBT was non-feasibility of intra-arterial chemotherapy (IAC) in 10 eyes, tumor recurrence after IAC in another 3 eyes and diffuse infiltrating retinoblastoma in 2 eyes. Six eyes (40%) were enucleated after a mean time interval of 4.8 (1–8) months. Cataract formation was the most common complication affecting 44.4% of the preserved eyes, yet 77.8% achieved a visual acuity of >20/200. Two of the 15 children treated developed metastatic disease during follow-up, resulting in a 13.3% metastasis rate. PBT is a useful treatment modality as a rescue therapy in retinoblastoma eyes with an eye-preserving rate of 60%. As patients are at lifetime risk of SPTs consistent monitoring is mandatory.

Acute toxicity profile of patients with low-grade gliomas and meningiomas receiving proton therapy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e12508-e12508
Author(s):  
Genevieve Maquilan ◽  
Surbhi Grover ◽  
Michelle Alonso-Basanta ◽  
Robert A. Lustig
Keyword(s):  
Proton Beam ◽  
Proton Therapy ◽  
Radiation Treatment ◽  
Treatment Protocol ◽  
Proton Beam Therapy ◽  
University Of Pennsylvania ◽  
Low Grade ◽  
Beam Radiation ◽  
Low Grade Gliomas ◽  
Starting Point

e12508 Background: Quality of life is not often studied but is an important outcome to measure when evaluating types of radiation treatment. This study attempts to provide data on the treatment effects of proton beam therapy on patients with low grade gliomas and meningiomas, using the National Cancer Institute Common Terminology Criteria (CTCAE) version 4.0 to analyze the severity and frequency of symptoms experienced acutely during and after radiotherapy. Methods: 23 patients diagnosed with low grade gliomas or meningiomas were enrolled in a prospective proton beam radiation treatment protocol (NCT01024907) and were treated and followed between April 2010 and August 2011 in the University of Pennsylvania Radiation Oncology Department. Patients received 54 Gy [relative biologic effectiveness (RBE)] in 1.8 Gy (RBE) per fraction and were assessed at the time of consult, weekly during treatment, and followed up at 1, 3, 6, and 9 months after treatment. Symptoms were graded based on the CTCAE version 4.0. Results: At week 1 of treatment, 4/23 patients experienced Grade 1 anorexia. At week 3, 5/23 patients had Grade 1 nausea, 10/23 patients had Grade 1 headaches, and 1/23 patients had a Grade 3 headache. At the end of treatment at week 6, 13/23 patients had Grade 1 fatigue, 6/23 patients had Grade 2 fatigue, 3/23 patients had Grade 1 nausea, 4/23 patients had Grade 1 headaches, 7/23 patients had Grade 1 insomnia, and 1/23 patients had Grade 2 insomnia. At the 1-month follow-up, 3/23 patients had Grade 1 fatigue, 1/23 patients had Grade 2 fatigue, 2/23 patients had Grade 1 anorexia, 1/23 patients had a Grade 1 headache, and 2/23 patients had Grade 1 insomnia. No patients were reported to have experienced vomiting at any of the 4 time points. Conclusions: Proton therapy has a favorable side effect profile--most patients experienced mild fatigue, headaches, and insomnia that largely resolved by one month after treatment. This study provides a useful starting point for larger-scale studies which could directly compare the acute side effects of proton and conventional radiotherapy.

Is Proton Beam Therapy Cost Effective in the Treatment of Adenocarcinoma of the Prostate?

2007 ◽  
Vol 25 (24) ◽  
pp. 3603-3608 ◽  
Author(s):  
Andre Konski ◽  
William Speier ◽  
Alexandra Hanlon ◽  
J. Robert Beck ◽  
Alan Pollack
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Proton Beam ◽  
Comprehensive Evaluation ◽  
Cost Effective ◽  
Proton Beam Therapy ◽  
Sensitivity Analyses ◽  
Beam Radiation ◽  
Life Years ◽  
The Cost

Purpose New treatments are introduced routinely into clinical practice without rigorous economic analysis. The specific aim of this study was to examine the cost effectiveness of proton beam radiation compared with current state-of-the art therapy in the treatment of patients with prostate cancer. Materials and Methods A Markov model was informed with cost, freedom from biochemical failure (FFBF), and utility data obtained from the literature and from patient interviews to compare the cost effectiveness of 91.8 cobalt gray equivalent (CGE) delivered with proton beam versus 81 CGE delivered with intensity-modulated radiation therapy (IMRT). The length of how many years the model was run, patient's age, probability of FFBF after treatment with proton beam therapy and IMRT, utility of patients treated with salvage hormone therapy, and treatment cost were tested in sensitivity analyses. Results Analysis at 15 years resulted in an expected mean cost of proton beam therapy and IMRT of $63,511 and $36,808, and $64,989 and $39,355 for a 70-year-old and 60-year-old man respectively, with quality-adjusted survival of 8.54 and 8.12 and 9.91 and 9.45 quality-adjusted life-years (QALY), respectively. The incremental cost effectiveness ratio was calculated to be $63,578/QALY for a 70-year-old man and $55,726/QALY for a 60-year-old man. Conclusion Even when based on the unproven assumption that protons will permit a 10-Gy escalation of prostate dose compared with IMRT photons, proton beam therapy is not cost effective for most patients with prostate cancer using the commonly accepted standard of $50,000/QALY. Consideration should be given to limiting the number of proton facilities to allow comprehensive evaluation of this modality.

scholarly journals Radiation Induced Cavernomas in the Treatment of Pediatric Medulloblastoma: Comparative Study Between Proton and Photon Radiation Therapy

2021 ◽  
Vol 11 ◽  
Author(s):  
S. Joy Trybula ◽  
Mark W. Youngblood ◽  
Hanna R. Kemeny ◽  
Jeffrey R. Clark ◽  
Constantine L. Karras ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Proton Beam ◽  
Surgical Resection ◽  
Proton Beam Therapy ◽  
Photon Radiation ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Significant Difference ◽  
Radiation Induced

Radiation induced cavernomas among children with medulloblastoma are common following external beam radiation (XRT) treatment with either photon or proton beams. However, with the increased utilization of proton beam therapy over the last decade we sought to determine if there was any difference in the development or natural history of these cavernous malformations (CM) or CM-like lesions. We performed a retrospective analysis of 79 patients from 2003 to 2019 who had undergone resection of medulloblastoma and subsequent XRT (30 photon or 49 proton beam therapy). The average age of patients at radiation treatment was 8.7 years old. Average follow up for patients who received photon beam therapy was 105 months compared to 56.8 months for proton beam therapy. A total of 68 patients (86.1%) developed post-radiation CMs, including 26 photon and 42 proton patients (86.7% and 85.7% respectively). The time to cavernoma development was significantly different, with a mean of 40.2 months for photon patients and 18.2 months for proton patients (p = 1.98 x 10-4). Three patients, one who received photon and two who received proton beam radiation, required surgical resection of a cavernoma. Although CM or CM-like lesions are detected significantly earlier in patients after receiving proton beam therapy, there appears to be no significant difference between the two radiation therapy modalities in the development of significant CM requiring surgical resection or intervention other than continued follow up and surveillance.

Complications after Proton Beam Therapy to Skull Base Tumors: Case Series

2019 ◽  
Author(s):  
Gustavo Rangel ◽  
Mostafa Shahein ◽  
Thiago Felicio ◽  
Guilhermo Malave ◽  
Nyall London ◽  
...  
Keyword(s):  
Skull Base ◽  
Proton Beam ◽  
Case Series ◽  
Proton Beam Therapy ◽  
Skull Base Tumors

Proton Beam Therapy for Unresectable Adenoid Cystic Carcinoma of the Skull Base

Skull Base ◽  
2008 ◽  
Vol 18 (S 01) ◽  
Author(s):  
Annie Chan ◽  
Paul Busse ◽  
Urmila Kamat ◽  
Derrick Lin ◽  
Norbert Liebsch
Keyword(s):  
Adenoid Cystic Carcinoma ◽  
Skull Base ◽  
Proton Beam ◽  
Proton Beam Therapy ◽  
Adenoid Cystic

Evaluation and treatment of children with radiation-induced cerebral vasculopathy

2019 ◽  
Vol 24 (6) ◽  
pp. 680-688
Author(s):  
David S. Hersh ◽  
Kenneth Moore ◽  
Vincent Nguyen ◽  
Lucas Elijovich ◽  
Asim F. Choudhri ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Proton Beam ◽  
Tumor Imaging ◽  
Clinic Visit ◽  
Surgical Patient ◽  
Beam Radiation ◽  
Proton Beam Radiotherapy ◽  
Cranial Radiation ◽  
Delayed Complication ◽  
Radiation Induced

OBJECTIVEStenoocclusive cerebral vasculopathy is an infrequent delayed complication of ionizing radiation. It has been well described with photon-based radiation therapy but less so following proton-beam radiotherapy. The authors report their recent institutional experience in evaluating and treating children with radiation-induced cerebral vasculopathy.METHODSEligible patients were age 21 years or younger who had a history of cranial radiation and subsequently developed vascular narrowing detected by MR arteriography that was significant enough to warrant cerebral angiography, with or without ischemic symptoms. The study period was January 2011 to March 2019.RESULTSThirty-one patients met the study inclusion criteria. Their median age was 12 years, and 18 (58%) were male. Proton-beam radiation therapy was used in 20 patients (64.5%) and photon-based radiation therapy was used in 11 patients (35.5%). Patients were most commonly referred for workup as a result of incidental findings on surveillance tumor imaging (n = 23; 74.2%). Proton-beam patients had a shorter median time from radiotherapy to catheter angiography (24.1 months [IQR 16.8–35.4 months]) than patients who underwent photon-based radiation therapy (48.2 months [IQR 26.6–61.1 months]; p = 0.04). Eighteen hemispheres were revascularized in 15 patients. One surgical patient suffered a contralateral hemispheric infarct 2 weeks after revascularization; no child treated medically (aspirin) has had a stroke to date. The median follow-up duration was 29.2 months (IQR 21.8–54.0 months) from the date of the first catheter angiogram to last clinic visit.CONCLUSIONSAll children who receive cranial radiation therapy from any source, particularly if the parasellar region was involved and the child was young at the time of treatment, require close surveillance for the development of vasculopathy. A structured and detailed evaluation is necessary to determine optimal treatment.

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