Gamma knife radiosurgery in patients with advanced breast cancer undergoing bone marrow transplant

2002 ◽  
Vol 97 ◽  
pp. 663-665 ◽  
Author(s):  
Kenneth J. Levin ◽  
Emad F. Youssef ◽  
Andrew E. Sloan ◽  
Rajiv Patel ◽  
Rana K. Zabad ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
High Dose Chemotherapy ◽  
Advanced Breast ◽  
High Dose ◽  
Initial Management ◽  
Content Type ◽  
Fine Print

Object. Recent studies have suggested a high incidence of cognitive deficits in patients undergoing high-dose chemotherapy, which appears to be dose related. Whole-brain radiotherapy (WBRT) has previously been associated with cognitive impairment. The authors attempted to use gamma knife radiosurgery (GKS) to delay or avoid WBRT in patients with advanced breast cancer treated with high-dose chemotherapy and autologous bone marrow transplantation (HDC/ABMT) in whom brain metastases were diagnosed. Methods. A retrospective review of our experience from 1996 to 2001 was performed to identify patients who underwent HDC/ABMT for advanced breast cancer and brain metastasis. They were able to conduct GKS as initial management to avoid or delay WBRT in 12 patients following HDC/ABMT. All patients were women. The median age was 48 years (range 30–58 years). The Karnofsky Performance Scale score was 70 (range 60–90). All lesions were treated with a median prescription dose of 17 Gy (range 15–18 Gy) prescribed to the 50% isodose. Median survival was 11.5 months. Five patients (42%) had no evidence of central nervous system disease progression and no further treatment was given. Four patients were retreated with GKS and three of them eventually received WBRT as well. Two patients were treated with WBRT as the primary salvage therapy. The median time to retreatment with WBRT was 8 months after the initial GKS. Conclusions. Gamma knife radiosurgery can be effectively used for the initial management of brain metastases to avoid or delay WBRT in patients treated previously with HDC, with acceptable survival and preserved cognitive function.

Impact of Consolidation Radiotherapy in Patients With Advanced Breast Cancer Treated With High-Dose Chemotherapy and Autologous Bone Marrow Rescue

1999 ◽  
Vol 17 (3) ◽  
pp. 887-887 ◽  
Author(s):  
Dennis L. Carter ◽  
Lawrence B. Marks ◽  
Joseph M. Bean ◽  
Gloria Broadwater ◽  
Atif Hussein ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Overall Survival ◽  
Advanced Breast Cancer ◽  
Autologous Bone Marrow ◽  
High Dose Chemotherapy ◽  
Advanced Breast ◽  
High Dose ◽  
Autologous Bone ◽  
The Impact

PURPOSE: To examine the impact of consolidation radiotherapy (RT) after high-dose chemotherapy with autologous bone marrow rescue (HDC) in patients with advanced breast cancer. PATIENTS AND METHODS: Between 1988 and 1994, 425 patients with metastatic or recurrent breast cancer received doxorubicin, fluorouracil, and methotrexate (AFM) induction chemotherapy in a single-institution prospective trial. One hundred patients who achieved a complete response were randomized to receive HDC (cyclophosphamide, cisplatin, carmustine), with autologous bone marrow rescue immediately after AFM, or to observation, with HDC to be administered at next relapse. Seventy-four of the 100 became eligible for RT; 53 received consolidation RT (HDC RT+ and 21 did not (HDC RT−). The assignment of RT was not randomized. The RT+ and RT− groups were similar with regard to number of involved sites, the fraction of patients with only local-regional disease, age, and interval since initial diagnosis. Local control at previously involved sites and distant sites was assessed with extensive radiologic and clinical evaluations at the time of first failure or most recent follow-up. The impact of RT on failure patterns, event-free survival, and overall survival was evaluated. RESULTS: Sites of first failure were located exclusively at previously involved sites in 28% of RT+ patients versus 62% of RT− patients (P < .01). Event-free survival at 4 years was 31% and 21% in the RT+ and RT− groups, respectively (P = .02). Overall survival at 4 years was 30% and 16% in the RT+ and RT− groups, respectively (P = .20). CONCLUSION: Patients with advanced breast cancer who were treated with HDC without RT failed predominantly at the initial sites of disease. The addition of RT appeared to reduce the failure rate at initial disease sites and may improve event-free and overall survival. Our observations await verification in a trial in which assignment to RT is randomized.

High-dose chemotherapy in advanced breast cancer

2002 ◽  
Vol 41 (2) ◽  
pp. 141-149 ◽  
Author(s):  
Patrice Viens ◽  
Dominique Maraninchi
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
High Dose Chemotherapy ◽  
Advanced Breast ◽  
High Dose

scholarly journals Novobiocin in combination with high-dose chemotherapy for the treatment of advanced breast cancer: A phase 2 study

2000 ◽  
Vol 6 (3) ◽  
pp. 335-343 ◽  
Author(s):  
Hillary A. Hahm ◽  
Deborah K. Armstrong ◽  
Ting-Ling Chen ◽  
Louise Grochow ◽  
Jose Passos-Coelho ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
High Dose Chemotherapy ◽  
Advanced Breast ◽  
High Dose ◽  
Phase 2 ◽  
Phase 2 Study

Survival and pattern of failure in brain metastasis treated with stereotactic gamma knife radiosurgery

2002 ◽  
Vol 97 ◽  
pp. 499-506 ◽  
Author(s):  
Zbigniew Petrovich ◽  
Cheng Yu ◽  
Steven L. Giannotta ◽  
Steven O'day ◽  
Michael L. J. Apuzzo
Keyword(s):  
Breast Cancer ◽  
Brain Metastasis ◽  
Gamma Knife ◽  
Tumor Volume ◽  
Systemic Disease ◽  
Gamma Knife Radiosurgery ◽  
Unknown Primary ◽  
Pattern Of Failure ◽  
Content Type ◽  
Fine Print

Object. Gamma knife radiosurgery (GKS) has become a well-established treatment modality in the management of selected patients with brain metastasis. The authors review the management patients with these tumors treated at a single center. Methods. Between 1994 and 2002, 458 consecutive patients with metastatic brain disease underwent GKS. There were 1305 lesions treated in 680 separate sessions. The histological diagnosis was melanoma in 231 (50%), lung cancer in 94 (20.5%), breast cancer in 38 (8.3%), renal cell carcinoma (RCC) in 29 (6.3%), colon carcinoma in 13 (2.8%), unknown primary site in 14 (3.1%), and other in 39 patients (8.5%). The median tumor volume was 0.9 cm3 and the median volume treated was 2.3 cm3. The median radiation dose was 18 Gy prescribed to a median isodose of 60%; the median dose was 20 Gy in melanoma, sarcoma, and RCC. Whole-brain radiotherapy (WBRT) either prior to or following GKS was performed in 114 patients (25%). Follow up ranged from 3 to 84 months with a median of 9 months. The median survival for all patients was 9 months and depended on tumor histology. Survival ranged from 6 months for patients with colon carcinoma, unknown primary tumors, and other tumors to 17 months for those with breast cancer. Median survival in patients with melanoma was 8 months. In multivariate analysis Karnofsky Performance Scale score (< 70 vs > 70), status of systemic disease (yes vs no), histological diagnosis, and total intracranial tumor volume were the only significant factors influencing survival. The number of brain metastases (one–five), WBRT (yes vs no), and age were not significant. Pattern of failure was different in patients with melanoma compared with those with other diagnoses. Cause of death in patients with melanoma was in 50% of the cases due to systemic disease and in 42% due to central nervous system causes, whereas it was 70% for the former and 23% for the latter in patients with other diagnoses. The treatment was well tolerated with significant late toxicity requiring craniotomy for removal of a necrotic focus in only 20 patients (4.7%). Conclusions. Gamma knife radiosurgery provided an excellent palliation with low incidence of toxicity. A Phase III prospective randomized trial is required to define the role of WBRT in combination with GKS.

scholarly journals Immune reconstitution following high-dose chemotherapy with stem cell rescue in patients with advanced breast cancer

2000 ◽  
Vol 26 (2) ◽  
pp. 169-176 ◽  
Author(s):  
D Avigan ◽  
Z Wu ◽  
R Joyce ◽  
A Elias ◽  
P Richardson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Stem Cell ◽  
Advanced Breast Cancer ◽  
Immune Reconstitution ◽  
High Dose Chemotherapy ◽  
Advanced Breast ◽  
High Dose ◽  
Stem Cell Rescue

Gamma knife radiosurgery for thalamotomy in parkinsonian tremor: a five-year experience

1998 ◽  
Vol 88 (6) ◽  
pp. 1044-1049 ◽  
Author(s):  
Christopher M. Duma ◽  
Deane B. Jacques ◽  
Oleg V. Kopyov ◽  
Rufus J. Mark ◽  
Brian Copcutt ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Dose Response ◽  
Dose Group ◽  
Low Dose ◽  
Gamma Knife Radiosurgery ◽  
High Dose ◽  
Anatomical Landmarks ◽  
Content Type ◽  
Parkinsonian Tremor ◽  
Fine Print

Object. Certain patients, for example, elderly high-risk surgical patients, may be unfit for radiofrequency thalamotomy to treat parkinsonian tremor. Some patients, when given the opportunity, may choose to avoid an invasive surgical procedure. The authors retrospectively reviewed their experience using gamma knife radiosurgery for thalamotomies in this patient subpopulation: 1) to determine the efficacy of the procedure; 2) to see if there is a dose—response relationship; 3) to review radiological findings of radiosurgical lesioning; and 4) to assess the risks of complications. Methods. Radiosurgical nucleus ventralis intermedius thalamotomy using the gamma knife unit was performed to make 38 lesions in 24 men and 10 women (median age 73 years, range 58–87 years) over a 5-year period. A median radiation dose of 130 Gy (range 100–165 Gy) was delivered to 38 nuclei (four patients underwent bilateral thalamotomy) using a single 4-mm collimator following classic anatomical landmarks. Twenty-nine lesions were made in the left nucleus ventralis intermedius thalamus for right-sided tremor. Patients were followed for a median of 28 months (range 6–58 months). Independent neurological evaluation of tremor based on the change in the Unified Parkinson's Disease Rating Scale tremor score was correlated with subjective patient evaluation. Comparison was made between a subgroup of patients in whom “low-dose” lesions were made (range 110–135 Gy, mean 120 Gy) and those in whom “high-dose” lesions were made (range 140–165 Gy, mean 160 Gy) for purposes of dose—response information. Four thalamotomies (10.5%) failed, four (10.5%) produced mild improvement, 11 (29%) produced good improvement, and 10 (26%) produced excellent relief of tremor. In nine thalamotomies (24%) the tremor was eliminated completely. The median time to onset of improvement was 2 months (range 1 week–8 months). Concordance between an independent neurologist's evaluation and that of the patient was statistically significant (p < 0.001). Two patients who underwent unilateral thalamotomy experienced bilateral improvement in their tremor. There were no neurological complications. There was better tremor reduction in the high-dose group than in the low-dose group (p < 0.04). Conclusions. Although less effective than other stereotactic techniques, gamma knife radiosurgery for thalamotomy offers tremor control with minimal risk to patients unsuited for open surgery.

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