Surgery and radiotherapy: complementary tools in the management of benign intracranial tumors

2008 ◽  
Vol 24 (5) ◽  
pp. E2 ◽  
Author(s):  
Walter D. Johnson ◽  
Lilia N. Loredo ◽  
Jerry D. Slater
Keyword(s):  
Radiation Therapy ◽  
Survival Rates ◽  
Tumor Resection ◽  
Radical Resection ◽  
Benign Tumors ◽  
Tumor Control ◽  
Tumor Type ◽  
Secondary Treatment ◽  
Intracranial Tumors ◽  
Postoperative Radiation Therapy

✓ Historically, radiation therapy has been used extensively in the treatment of malignant and aggressive intracranial tumors, and the importance of its role has been repeatedly verified by prolonged patient survival rates and increased tumor control. As more modern capabilities are employed in surgery and radiotherapy, attention is being directed to the utility of radiation as either primary or secondary treatment of benign tumors. Specifically, primary treatment encompasses irradiation of small benign tumors without biopsy confirmation of tumor type; secondary treatment involves postoperative radiation therapy, with the possibility that less-aggressive tumor resection may be performed in areas that have a higher probability of resultant neurological deficit. Current literature suggests that this is not only a possible treatment strategy, but that it may be superior to more radical resection in some cases, for example, in vestibular schwannomas and meningiomas. This article provides an overview of factors to consider in the use of radiation therapy and reviews the relationships between radiation and surgery, notably the unique complementary role each plays in the treatment of benign intracranial tumors.

scholarly journals Lateral skull base malignancies

2002 ◽  
Vol 12 (5) ◽  
pp. 1-4 ◽  
Author(s):  
Benjamin M. McGrew ◽  
C. Gary Jackson ◽  
Raquel A. Redtfeldt
Keyword(s):  
Skull Base ◽  
Postoperative Radiotherapy ◽  
Survival Rates ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Lateral Skull Base ◽  
The Mean ◽  
Poor Outcomes

Object Historically poor outcomes have been characteristic in patients with lateral skull base malignancies. As advances in skull base surgical techniques have been made, complete resection has increasingly been achieved. This has resulted in improved survival rates and local tumor control. Methods The authors performed a retrospective review of 95 patients treated for lateral skull base malignancies. The mean age of the patients was 49.4 years. There were 44 females and 51 males. The mean follow-up period was 50 months. Resection was performed in all patients, and postoperative radiotherapy was undertaken in 54% of the cases. Local disease control was maintained in 73% of the patients. Tumor involvement of the facial nerve and intracranial tumor extension did not jeopardize the rate of local control. Conclusions Despite the fact that technical advances in skull base surgery have resulted in a higher incidence of complete tumor resection and improved survival rates, a respect for the poor prognosis historically associated with lateral skull base malignancies should be maintained and treatment should be appropriately aggressive.

Laser Resection for Early Oral Cavity Cancer

1987 ◽  
Vol 96 (5) ◽  
pp. 556-560 ◽  
Author(s):  
Matthew J. Nagorsky ◽  
Donald G. Sessions
Keyword(s):  
Radiation Therapy ◽  
Oral Cavity ◽  
Complication Rate ◽  
Oral Cavity Cancer ◽  
Local Control Rate ◽  
Tumor Control ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Laser Excision ◽  
High Level

Laser excision of early selected cancers of the oral cavity and pharynx is a well accepted and reported treatment. Postoperative radiation therapy is employed in patients with unfavorable pathologic findings and in patients expected to have a high recurrence and metastatic rate. In most patients the combination of laser excision and postoperative radiation therapy is well tolerated and results in satisfactory healing, excellent tumor control, and high-level posttreatment function. This report discusses the treatment and results in 28 patients treated for early cancer of the oral cavity and pharynx. The local control rate of 77% compares favorably with the reported results following either conventional or laser excision of these lesions. The overall complication rate was 39%, with a 25% rate for patients not receiving postoperative radiation therapy, and a 58% complication rate for patients treated with postoperative radiation.

Postoperative radiation therapy for high-risk colon carcinoma.

1993 ◽  
Vol 11 (6) ◽  
pp. 1112-1117 ◽  
Author(s):  
C G Willett ◽  
C Y Fung ◽  
D S Kaufman ◽  
J Efird ◽  
P C Shellito
Keyword(s):  
Radiation Therapy ◽  
Colon Carcinoma ◽  
Survival Rates ◽  
Fistula Formation ◽  
Subtotal Resection ◽  
Recurrence Free Survival ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Free Survival ◽  
Systemic Therapies

PURPOSE This study examines the experience of patients treated with postoperative radiation therapy after resection of high-risk colon carcinoma in an effort to assess the potential role of this modality in combination with current systemic therapies. PATIENTS AND METHODS From 1976 to 1989, 203 patients received postoperative radiation therapy with and without concurrent fluorouracil (5-FU) chemotherapy following resection of modified Astler-Coller B2, B3, C2, and C3 colon tumors. Of the 203 patients, 30 (15%) were identified as having residual local tumor after subtotal resection, whereas 173 (85%) had no known residual disease. The 173 patients treated with adjuvant radiation therapy were compared with a historical control group of 395 patients undergoing surgery only. RESULTS Three groups of patients who appeared to benefit from postoperative radiation were identified. Improved local control and recurrence-free survival rates were seen for patients with stage B3 and C3 colon carcinoma treated with postoperative radiation therapy compared with a similarly staged group of patients undergoing surgery only. Irradiated patients whose tumors had an associated abscess or fistula formation had improved local control and recurrence-free survival rates compared with a similar group of patients undergoing surgery only. There appears to be a subset of patients with residual local disease after subtotal resection that may be salvaged by high-dose postoperative radiation therapy. CONCLUSION Selected groups of patients with colon carcinoma may benefit from postoperative radiation in addition to current systemic therapies. Integration of 5-FU and levamisole with postoperative radiation therapy should be considered for patients with (1) stage B3 and C3 lesions, (2) tumors associated with abscess or fistula formation, and (3) residual local disease after subtotal resection.

Carcinoma of the ampulla of Vater: Patterns of failure after resection and benefit of adjuvant radiotherapy.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 254-254
Author(s):  
M. Palta ◽  
C. G. Willett ◽  
P. Patel ◽  
D. S. Tyler ◽  
H. E. Uronis ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Control ◽  
Survival Rates ◽  
Radical Resection ◽  
Ampulla Of Vater ◽  
Ampullary Carcinoma ◽  
Local Failure ◽  
Term Survival ◽  
Free Survival ◽  
Significant Difference

254 Background: Ampullary carcinoma is a rare malignancy. Despite radical resection, survival rates remain low with high rates of local failure. To define the role of radiation therapy and chemotherapy with surgery, we performed a single institution analysis of treatment- related outcomes. Methods: A retrospective analysis was performed of all patients undergoing potentially curative therapy for adenocarcinoma of the ampulla of Vater at Duke University Hospitals between 1975 and 2009. Local control (LC), overall survival (OS), disease-free survival (DFS), and metastases-free survival (MFS) were estimated using the Kaplan-Meier Method. Results: One hundred thirty-seven patients with ampullary carcinoma underwent potentially curative pancreaticoduodenectomy. Sixty-one patients undergoing resection received adjuvant (n= 43) or neoadjuvant (n=18) radiation therapy with concurrent chemotherapy (CRT). Patients receiving radiotherapy were more likely to have poorly differentiated tumors. Median radiation dose was 50 Gy. Median follow up was 8.8 years. Of patients receiving neoadjuvant therapy, 67% were downstaged on final pathology with 28% achieving pathologic complete response. Three-year local control was significantly improved in patients receiving CRT (88% vs. 55% p= 0.001) with trend toward a 3-year OS benefit in patients receiving CRT (62% vs. 46% p=0.074). Despite this, there was no significant difference in 3-year DFS (66% CRT vs 48% surgery alone p=0.09) or MFS (69% CRT vs 63% surgery alone p=0.337). Conclusions: Long term survival rates are low. Local failure rates are high following radical resection alone and improved with CRT. Despite more adverse pathologic features in patients receiving CRT, survival outcomes were at least equivalent with a trend toward statistical significance. Given the patterns of relapse with surgery alone and local control benefit in patients receiving CRT, the use of chemoradiotherapy in selected patients should be considered. No significant financial relationships to disclose.

Adjuvant Therapy for Soft Tissue Sarcoma

2005 ◽  
Vol 3 (2) ◽  
pp. 207-213 ◽  
Author(s):  
Scott M. Schuetze ◽  
Michael E. Ray
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
High Risk ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Survival Rates ◽  
Wide Resection ◽  
High Grade ◽  
Postoperative Radiation Therapy ◽  
Increased Risk

Wide surgical excision is the backbone of therapy for localized soft tissue sarcoma and often produces excellent results. Patients with a marginal resection of disease and high-grade or large tumors are at an increased risk of recurrence. Radiation therapy (external beam or brachytherapy) has been shown to reduce the risk of local recurrence of disease and should be offered to patients with large (>5 cm) or high-grade sarcomas, especially if a wide resection cannot be performed. Use of preoperative versus postoperative radiation therapy should be planned, in consultation with a radiation oncologist and a surgical oncologist, before resection of the sarcoma if possible. Chemotherapy using an anthracycline- and ifosfamide-based regimen may improve disease-free and overall survival rates. Chemotherapy appears to be most beneficial for patients with very large (≥10 cm), high-grade sarcomas of the extremity who are at a high risk of experiencing distant recurrence of disease. The effect of adjuvant chemotherapy on overall survival remains controversial. Research is greatly needed to identify the patients who are most likely to benefit from conventional chemotherapy, improve the treatment of retroperitoneal sarcomas, and identify novel agents that may impact the natural history of high-risk soft tissue sarcoma.

Value of Radiation Therapy in Addition to Surgery for Cancer of the Head and Neck

1986 ◽  
Vol 94 (5) ◽  
pp. 601-604 ◽  
Author(s):  
Ahmad Sadeghi ◽  
John McLaren ◽  
William L. Grist ◽  
Luu Tran ◽  
Hans Kuisk
Keyword(s):  
Radiation Therapy ◽  
Oral Cavity ◽  
Head And Neck ◽  
Primary Site ◽  
Surgical Margins ◽  
Controlled Study ◽  
Tumor Control ◽  
Postoperative Radiation Therapy ◽  
Treatment Groups ◽  
Nodal Control

This historically controlled study evaluates radiation therapy in 119 patients—With squamous cell carcinomas of the head and neck—who underwent surgery alone (SA) or surgery plus radiation (S + R). The primary tumor control and nodal control, in patients with negative surgical margins who had surgery alone (SA), were 63% in the oral cavity, 60% in the oropharynx, and 67% in the hypopharynx. The same rates for S + R group and negative surgical margins were 100%, 73%, and 100%. Combining the patients with negative and positive surgical margins, control of the tumor and nodal control were the same in the oral cavity for both treatment groups (41% for SA and 44% for S + R) and increased with the addition of radiation in the oropharynx (30% for SA to 65% for S + R) and hypopharynx (33% for SA to 86% for S + R), in spite of higher percentages of T3 and T4 tumor and positive lymph nodes in the S + R group. The lower control rate in patients who had surgery alone could be due (in part) to inadequate surgery at the primary site (42% local excision) and lack of neck dissection (35% for SA vs. 77% for S + R). Postoperative radiation therapy to the primary site and neck is shown to effectively reduce local recurrence in patients with oral cavity and oropharynx cancer, regardless of surgical margins.

Stereotactic radiosurgery for trigeminal schwannoma: tumor control and functional preservation

2009 ◽  
Vol 110 (3) ◽  
pp. 553-558 ◽  
Author(s):  
Hideyuki Kano ◽  
Ajay Niranjan ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Stereotactic Radiosurgery ◽  
Tumor Volume ◽  
Tumor Resection ◽  
Neurological Symptoms ◽  
Tumor Control ◽  
Tumor Type ◽  
Patient Age ◽  
Female Sex ◽  
Trigeminal Schwannoma ◽  
Functional Preservation

Object To evaluate outcome predictors after stereotactic radiosurgery (SRS) in patients with trigeminal schwannomas, the authors compared tumor control, functional preservation, and complications with tumor grade, tumor volume, patient age, and tumor imaging characteristics. Methods The records of 33 consecutive patients with trigeminal schwannoma treated via Gamma Knife surgery were retrospectively reviewed. The median patient age was 49.5 years (range 15.1–82.5 years). Eleven patients had undergone prior tumor resection. Two patients had neurofibromatosis Type 2. Lesions were classified as root type (6 tumors), ganglion type (17 tumors), and dumbbell type (10 tumors) based on their location. The median radiosurgery target volume was 4.2 cm3 (range 0.5–18.0 cm3), and the median dose to the tumor margin was 15.0 Gy (range 12–20 Gy). Results At an average of 6 years (range 7.2–147.9 months), the rate of progression-free survival (PFS) at 1, 5, and 10 years after SRS was 97.0, 82.0, and 82.0%, respectively. Factors associated with improved PFS included female sex, smaller tumor volume, and a root or ganglion tumor type. Neurological symptoms or signs improved in 11 (33.3%) of 33 patients and were unchanged in 19 (57.6%). Three patients (9.1%) had symptomatic disease progression. Patients who had not undergone a prior tumor resection were significantly more likely to show improvement in neurological symptoms or signs. Conclusions Stereotactic radiosurgery is an effective and minimally invasive management option in patients with residual or newly diagnosed trigeminal schwannomas. Predictors of a better treatment response included female sex, smaller tumor volume, root or ganglion tumor type, and the application of SRS as the primary treatment.

scholarly journals Image-guided resection of aggressive sacral tumors

2017 ◽  
Vol 42 (1) ◽  
pp. E15 ◽  
Author(s):  
Doniel Drazin ◽  
Neil Bhamb ◽  
Lutfi T. Al-Khouja ◽  
Ari D. Kappel ◽  
Terrence T. Kim ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Case Series ◽  
Benign Tumors ◽  
Image Guided Surgery ◽  
Tumor Type ◽  
Retrospective Case ◽  
Giant Cell Tumors ◽  
Guided Surgery ◽  
Image Guided ◽  
Sacral Tumors

OBJECTIVE The aim of this study was to identify and discuss operative nuances utilizing image guidance in the surgical management of aggressive sacral tumors. METHODS The authors report on their single-institution, multi-surgeon, retrospective case series involving patients with pathology-proven aggressive sacral tumors treated between 2009 and 2016. They also reviewed the literature to identify articles related to aggressive sacral tumors, their diagnosis, and their surgical treatment and discuss the results together with their own experience. Information, including background, imaging, treatment, and surgical pearls, is organized by tumor type. RESULTS Review of the institutional records identified 6 patients with sacral tumors who underwent surgery between 2009 and 2016. All 6 patients were treated with image-guided surgery using cone-beam CT technology (O-arm). The surgical technique used is described in detail, and 2 illustrative cases are presented. From the literature, the authors compiled information about chordomas, chondrosarcomas, giant cell tumors, and osteosarcomas and organized it by tumor type, providing a detailed discussion of background, imaging, and treatment as well as surgical pearls for each tumor type. CONCLUSIONS Aggressive sacral tumors can be an extremely difficult challenge for both the patient and the treating physician. The selected surgical intervention varies depending on the type of tumor, size, and location. Surgery can have profound risks including neural compression, lumbopelvic instability, and suboptimal oncological resection. Focusing on the operative nuances for each type can help prevent many of these complications. Anecdotal evidence is provided that utilization of image-guided surgery to aid in tumor resection at our institution has helped reduce blood loss and the local recurrence rate while preserving function in both malignant and aggressive benign tumors affecting the sacrum.

Meningioma Radiosurgery: Tumor Control, Outcomes, and Complications among 190 Consecutive Patients

Neurosurgery ◽  
2001 ◽  
Vol 49 (5) ◽  
pp. 1029-1038 ◽  
Author(s):  
Scott L. Stafford ◽  
Bruce E. Pollock ◽  
Robert L. Foote ◽  
Michael J. Link ◽  
Deborah A. Gorman ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
External Beam Radiotherapy ◽  
Survival Rates ◽  
Internal Carotid Artery Stenosis ◽  
Benign Tumors ◽  
Tumor Control ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Tumor Margin ◽  
Cause Specific Survival

ABSTRACT OBJECTIVE To determine local control (LC) and complication rates for patients with intracranial meningiomas who underwent radiosurgery. METHODS One hundred ninety consecutive patients with 206 meningiomas underwent radiosurgery between 1990 and 1998. One hundred forty-seven tumors (77%) involved the cranial base. The median age at the time of radiosurgery was 58 years (range, 20–90 yr). There were 126 female patients (66%). One hundred twelve patients (59%) had undergone one or more previous operations (median, 1; range, 1–5). Twenty-two patients (12%) had either atypical (n = 13) or malignant (n = 9) tumors. The median prescription isodose volume was 8.2 cm3 (range, 0.5–50.5 cm3), and the median tumor margin dose was 16 Gy (range, 12–36 Gy). The median imaging and clinical follow-up periods were 40 and 47 months, respectively. RESULTS Overall survival rates for the entire cohort at 5 and 7 years were 82 and 82%, respectively; cause-specific survival rates at 5 and 7 years were 94 and 92%, respectively. The cause-specific survival rates at 5 years for patients with benign, atypical, and malignant tumors were 100, 76, and 0%, respectively (P < 0.0001). The 5-year LC rate was 89%, with 114 tumors (56%) decreasing in size. LC rates were correlated with tumor histological features (P < 0.0001); patients with benign tumors exhibited a 5-year LC rate of 93%, compared with 68 and 0% for patients with atypical or malignant meningiomas, respectively. No correlation was observed between radiation dose and LC rate. Twenty-four patients (13%) experienced treatment-related complications, including cranial nerve deficits (8%), symptomatic parenchymal changes (3%), internal carotid artery stenosis (1%), and symptomatic cyst formation (1%). Only six patients (3%) exhibited decreases in functional status that were directly related to radiosurgery. Tumor volume, tumor margin dose, or previous radiotherapy was not associated with the development of radiation-related complications. CONCLUSION Radiosurgery is an effective management strategy for many patients with meningiomas. Patients with atypical or malignant tumors exhibit high recurrence rates despite the use of radiosurgery, and these patients continue to exhibit worse cause-specific survival rates despite aggressive treatment, including surgery, external-beam radiotherapy, and radiosurgery. Further study is needed to determine the tumor control and complication rates 10 years or more after meningioma radiosurgery.

Larynx Preservation with Combined Chemotherapy and Radiation Therapy in Advanced Hypopharynx Cancer

1994 ◽  
Vol 111 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Dennis H. Kraus ◽  
David G. Pfister ◽  
Louis B. Harrison ◽  
Jatin P. Shah ◽  
Ronald H. Spiro ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Partial Response ◽  
Total Laryngectomy ◽  
Randomized Study ◽  
Survival Rates ◽  
Poor Response ◽  
Functional Results ◽  
Postoperative Radiation Therapy ◽  
Larynx Preservation ◽  
Response To Chemotherapy

Twenty-five untreated patients with advanced, resectable squamous cell carcinoma of the hypopharynx, for whom standard treatment would have required total laryngectomy, were treated with one to three cycles of cisplatin-based chemotherapy with larynx preservation as the goal. Patients with a major (complete or partial) response to chemotherapy at the primary site were treated with definitive radiation therapy, with total laryngectomy reserved for salvage; patients with less than a partial response to chemotherapy had total laryngectomy and postoperative radiation therapy recommended. Four patients had a poor response to chemotherapy and thus were not candidates for laryngectomy. Total largynectomy was required for initial induction chemotherapy failure in five patients and for local recurrence in five others. Three additional patients had unresectable recurrence. Successful larynx preservation was achieved in 32% (8 of 25). With a median follow-up period of 41 months, the actuarial overall and failure-free 2-year survival rates were 44% and 32%, respectively. These preliminary data suggest larynx preservation is feasible in patients with advanced lesions of the hypopharynx. Improved local and regional control must be incorporated into the larynx preservation approach for hypopharyngeal lesions. A prospective, randomized study is necessary for a more valid comparison with conventional therapy, including comparative assessments of survival, morbidity, cost and functional results.

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