Gamma Knife surgery for primary central nervous system lymphoma: usefulness as palliative local tumor control

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 133-138 ◽  
Author(s):  
Hiroyuki Kenai ◽  
Masanori Yamashita ◽  
Takaharu Nakamura ◽  
Tomoshige Asano ◽  
Yasutomo Momii ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Central Nervous System ◽  
Nervous System ◽  
Gamma Knife ◽  
Central Nervous System Lymphoma ◽  
Local Tumor Control ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Local Tumor

ObjectAlthough there is no established treatment for primary central nervous system lymphoma (PCNSL), therapeutic protocols involving high-dose methotrexate therapy followed, in some cases, by whole-brain radiotherapy (WBRT) have generally been adopted, and they have yielded relatively favorable results. Gamma Knife surgery (GKS) is a stopgap measure to treat patients with PCNSL. The authors summarize the results of their cases and evaluate the efficacy and usefulness of GKS.MethodsBetween June 1999, and June 2005, 22 patients suffering from PCNSL were treated with GKS at the authors' institution and were followed up for more than 6 months. Some combination of chemotherapy and/or WBRT and/or microsurgery had been performed in 18 of the 22 patients before GKS. The remaining four patients had not undergone any previous treatment. In these patients, the mean tumor volume was 4.14 cm3, and the tumors were treated with a mean margin dose of 16.5 Gy to the 52.8% isodose line. Magnetic resonance imaging demonstrated the disappearance of the GKS-treated lesions; however, new lesions were observed in other regions of the brain in 10 patients and repeated GKS was performed in some cases. No local recurrences were observed an average of 19.4 months after GKS, and good level of quality of life (QOL) was maintained during this period.Conclusions Gamma Knife surgery should be performed only for local tumor control as a stopgap measure in the treatment of PCNSL. It is noninvasive and safe, and its effects occur rapidly. Its use improves prognosis and enhances the patient's quality of life. Gamma Knife surgery should be considered one of the treatment strategies for patients with PCNSLs.

scholarly journals Thoracolumbar vertebral reconstruction after surgery for metastatic spinal tumors: long-term outcomes

2005 ◽  
Vol 19 (3) ◽  
pp. 1-8 ◽  
Author(s):  
Alan T. Villavicencio ◽  
Rod J. Oskouian ◽  
Cliff Roberson ◽  
John Stokes ◽  
Jongsoo Park ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Survival Rates ◽  
Neurological Status ◽  
Pain Scale ◽  
Local Tumor Control ◽  
Neurological Dysfunction ◽  
Spinal Tumors ◽  
Tumor Control ◽  
Local Tumor

Object Metastatic spinal tumors continue to represent a major problem for patients and treating physicians. The purpose of this study was to assess quantitatively the functional outcome, quality of life, and survival rates of patients after major reconstructive spine surgery. Methods A prospective database was established and 58 patients were identified who had undergone thoracolum-bar vertebral reconstruction for metastatic spinal tumors between March 1993 and October 1999. Surgical indications included disabling pain (92%) and/or progressive neurological dysfunction (60%). Forty-nine patients (85%) had clinical improvement in pain as determined based on the Oswestry pain scale (p < 0.05); 60% demonstrated improvement in their neurological status. The mean neurological improvement in Frankel grade was 1.2 (p < 0.05). The 12-month survival rate was 65%, and all patients who were ambulatory after surgery remained so until the time of death. Instrumentation failure requiring repeated operation occurred in two patients (3.5%), and in 12 patients (21%) local tumor recurrence necessitated repeated surgery. There were no cases of neurological deficit or death related to surgery. Conclusions Major anterior thoracolumbar vertebral reconstruction is an effective treatment for local tumor control. More importantly, the authors have demonstrated that surgical treatment can significantly improve the quality of life by improvement of pain control and maintenance of ambulation during the patient's remaining life span.

scholarly journals Gamma Knife surgery for treating brain metastases arising from hepatocellular carcinomas

2014 ◽  
Vol 121 (Suppl_2) ◽  
pp. 102-109 ◽  
Author(s):  
Eun Suk Park ◽  
Do Hoon Kwon ◽  
Jun Bum Park ◽  
Do Hee Lee ◽  
Young Hyun Cho ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Univariate Analysis ◽  
Radiation Therapy Oncology Group ◽  
Local Tumor Control ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Significant Variable ◽  
Local Tumor ◽  
The Mean

ObjectBrain metastases from hepatocellular carcinoma (HCC) are rare, and the evidence of the effectiveness of Gamma Knife surgery (GKS) in this disease is lacking. The authors report their institutional experience with GKS in patients with brain metastases from HCCs.MethodsThe authors retrospectively reviewed the medical records of 73 consecutive patients who had a combined total of 141 brain metastases arising from HCCs and were treated with GKS. Sixty-four (87.7%) patients were male, and the mean age of the patients was 52.5 years (range 30–79 years). The mean tumor volume was 7.35 cm3 (range 0.19–33.7 cm3). The median margin dose prescribed was 23 Gy (range 15–32 Gy). Univariate and multivariate survival analyses were performed to identify possible prognostic factors of outcomes.ResultsThe estimated rate of local tumor control was 79.6% at 3 months after GKS. The median overall survival time after GKS was 16 weeks. The actuarial survival rates were 76.7%, 58.9%, and 26.0% at 4, 12, and 24 weeks after GKS, respectively. In the univariate analysis, an age of ≤ 65 years, Child-Pugh Class A (pertaining to liver function), high Karnofsky Performance Scale score (≥ 70), and low Radiation Therapy Oncology Group recursive partitioning analysis class (I or II) were positively associated with the survival times of patients. No statistically significant variable was identified in the multivariate analysis.ConclusionsAlthough survival was extremely poor in patients with brain metastases from HCCs, GKS showed acceptable local tumor control at 3 months after the treatment. The authors suggest that GKS represents a noninvasive approach that may provide a valuable option for treating patients with brain metastases from HCCs.

Combination of microsurgery and Gamma Knife surgery for the treatment of intracranial chondrosarcomas

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 18-25 ◽  
Author(s):  
Petter Förander ◽  
Tiit Rähn ◽  
Lars Kihlström ◽  
Elfar Ulfarsson ◽  
Tiit Mathiesen
Keyword(s):  
Gamma Knife ◽  
Cranial Nerve ◽  
Residual Tumor ◽  
Local Tumor Control ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
Tumor Control ◽  
Low Grade ◽  
Cranial Nerve Palsies ◽  
Tumor Volume Reduction

ObjectIntracranial chondrosarcomas have a high risk of recurrence after surgery. This retrospective study of patients with intracranial chondrosarcoma was conducted to determine the long-term results of microsurgery followed by Gamma Knife surgery (GKS) for residual tumor or recurrence.MethodsThe authors treated nine patients whose median age was 36 years. Seven patients had low-grade chondrosarcomas (LGCSs), whereas mesenchymal chondrosarcomas (MCSs) were diagnosed in two. Radiosurgery was performed in eight patients, whereas one patient declined further surgical intervention and tumor-volume reduction necessary for the GKS.The patients were followed up for 15 to 173 months (median 108 months) after diagnosis and 3 to 166 months (median 88 months) after GKS. Seven patients had residual tumor tissue after microsurgery, and two operations appeared radical. In the two latter cases, tumors recurred after 25 and 45 months. Thus, definite tumor control was not achieved after surgery alone in any patient, whereas the addition of radiosurgery allowed tumor control in all six patients with LGCSs. Two of these patients experienced an initial tumor regrowth after GKS; in both cases the recurrences were outside the prescribed radiation field. The patients underwent repeated GKS, and subsequent tumor control was observed. An MCS was diagnosed in the remaining two patients. Complications after microsurgery included diplopia, facial numbness, and paresis. After GKS, one patient had radiation necrosis, which required microsurgery, and two patients had new cranial nerve palsies.Conclusions Tumor control after microsurgery alone was not achieved in any patient, whereas adjuvant radiosurgery provided local tumor control in six of eight GKS-treated patients. Tumor control was not achieved in the two patients with MCS. Similar to other treatments for intracranial chondrosarcoma, morbidity after micro- and radiosurgical combination therapy was high and included severe cranial nerve palsies.

scholarly journals QOL-36. USE OF CANNABINOIDS IN THE PEDIATRIC CENTRAL NERVOUS SYSTEM TUMOR POPULATION

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii438-iii438
Author(s):  
Kathleen Dorris ◽  
Jessica Channell ◽  
Ashley Mettetal ◽  
Molly Hemenway ◽  
Natalie Briones ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Central Nervous System ◽  
Nervous System ◽  
Cell Activity ◽  
Cns Tumors ◽  
Low Grade ◽  
Tumor Type ◽  
Central Nervous System Tumor ◽  
The Impact

Abstract BACKGROUND Cannabinoids, including cannabidiol (CBD) and tetrahydrocannabinol (THC), are a class of compounds found in marijuana. Numerous studies in adults have examined cannabinoid use in management of cancer-related symptoms such as nausea, anorexia, and pain. Less is known about the use in the pediatric oncology population. METHODS A prospective observational study has been ongoing since 2016 at Children’s Hospital Colorado to evaluate cannabinoids’ impact using PedsQL™ modules on quality of life of pediatric patients with central nervous system (CNS) tumors who are 2–18 years old. Laboratory assessments of T-cell activity and pharmacokinetics of CBD, THC and associated metabolites are in process. Diaries with exploratory information on cannabinoid use patterns are being collected. RESULTS Thirty-three patients (14:19; male:female) have been enrolled with a median age of 6.4 years (range, 2.9–17.7 years). The most common tumor type in enrolled patients is embryonal tumors (13/33; 39%). Nine (27%) patients have low-grade glial/glioneuronal tumors, and eight (24%) had high-grade/diffuse midline gliomas. The remaining patients had ependymoma or craniopharyngioma. The median time on cannabinoids is 9 months. Most (n=20) patients have used oral products with CBD and THC. One patient continues on cannabinoid therapy in follow up. Preliminary immune function analyses identified impaired neutrophil superoxide anion production and chemotaxis in patients taking cannabinoids at early time points on therapy. CONCLUSIONS Families of children with various CNS tumors are pursuing cannabinoid therapy for both antitumor and supportive care purposes. Analysis of the impact of cannabinoids on patients’ quality of life is ongoing.

Behandeling van spasticiteit met enkele overwegingen naar sport toe

2021 ◽  
Author(s):  
K. DECLERCK ◽  
F. HEISTERCAMP ◽  
K. SLABBYNCK ◽  
A. BOSMANS
Keyword(s):  
Quality Of Life ◽  
Central Nervous System ◽  
Nervous System ◽  
Multidisciplinary Approach ◽  
Healthy Lifestyle ◽  
Crucial Aspect ◽  
Limited Function ◽  
Sporting Activities ◽  
Interventional Therapies

Treatment of spasticity with some considerations regarding sport Spasticity is a possible side effect in patients with a central nervous system pathology and it affects more than 12 million people worldwide. Spasticity can have an important impact on the quality of life and sporting activities. Spasticity only needs to be treated if there is spasticity associated pain and/or (expected) limited function. Primarily triggering factors of spasticity must be treated. A multidisciplinary approach containing a combination of medication and physical therapy is recommended in the treatment of spasticity. If this approach remains insufficient, interventional therapies can be taken into consideration, although they should always be combined with rehabilitation to reduce (the) spastic tone/spasticity. Sports and exercising should not be merely seen in the context of therapy and/or rehabilitation but also as a crucial aspect of a healthy lifestyle, in particular for people ‘at risk’ for inactivity. Therefore, it is important to fill the gap between rehabilitation and sustainable sports practice for the rehabilitator.

scholarly journals RADI-06. Gamma knife surgery for brain stem metastases

2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii19-iii19
Author(s):  
Choo Heng Tan ◽  
Bengt Karlsson ◽  
Shilin Wang ◽  
John J Y Zhang ◽  
Yvonne Ang ◽  
...  
Keyword(s):  
Survival Time ◽  
Gamma Knife ◽  
Performance Status ◽  
Local Tumor Control ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Cerebral Peduncle ◽  
Complication Rates ◽  
Tumor Control Rate ◽  
Number Of Patients

Abstract Introduction Gamma Knife Surgery (GKS) is widely used for treatment of brainstem metastases (BSMs) with or without whole bran radiation therapy (WBRT). We hypothesized that BSMs treated with GKS using lower doses and omitting WBRT result in acceptable tumor control rates and low complication rates. Methods A retrospective single center study was performed to investigate the outcome following GKS of BSMs. All 33 patients with follow-up information treated with GKS for 39 metastases located in the cerebral peduncle, midbrain, pons or medulla oblongata were included in the study. The median treatment dose, defined as the lowest dose to 95% of the tumor volume, was 18 Gy. The tumor control rate as well as the survival time were related to a number of patients, tumor and treatment parameters. Results The local tumor control rate was 100% at one year and 89% at five years, and the overall median survival was 17 months. A good performance status and a treatable extracranial disease were favorably related to survival time. Two complications were observed, one lethal hemorrhage at the day of the treatment and one transient complication three months following GKS, resulting in a 6% complication rate at five years. Four of the 10 patient with symptomatic BSM improved clinically after GKS, while six remained unchanged. Conclusions High local control and a low complication rates can be achieved using GKS for BSMs using lower doses as compared to brain metastases in other locations.

scholarly journals Quality of Life in Carotid Atherosclerosis: The Role of Co-morbid Mood Disorders

2016 ◽  
Vol 12 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Maria Lecca ◽  
Luca Saba ◽  
Roberto Sanfilippo ◽  
Elisa Pintus ◽  
Michela Cadoni ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Central Nervous System ◽  
Nervous System ◽  
Mood Disorders ◽  
Carotid Atherosclerosis ◽  
Short Form ◽  
The Central Nervous System ◽  
Dsm Iv

Introduction/Objective: To study in severe carotid atherosclerosis (CA): the frequency of mood disorders (MD); the impairment of quality of life (QoL); the role of co-morbid MD in such impairment. Methods: Case-control study. Cases: consecutive in-patients with CA (stenosis ≥ 50%). Controls: subjects with no diagnosis of CA randomized from a database of a community survey. Psychiatric diagnosis according to DSM-IV made by clinicians and semi-structured interview, QoL measured by the Short Form Health Survey (SF-12). Results: This is the first study on comorbidity on CA disease and MD in which psychiatric diagnoses are conducted by clinicians according to DSM-IV diagnostic criteria. Major Depressive Disorder (MDD) (17.4% vs 2.72%, P <0.0001) but not Bipolar Disorders (BD) (4.3% vs 0.5%, P = 0.99) was higher in cases (N=46) than in controls (N= 184). SF-12 scores in cases were lower than in controls (30.56±8.12 vs 36.81±6:40; p <0.001) with QoL comparable to serious chronic diseases of the central nervous system. The burden of a concomitant MDD or BD amplifies QoL impairment. Conclusion: Comorbid MD aggravates the impairment of QoL in CA. Unlike autoimmune diseases or degenerative diseases of the Central Nervous System, CA shows a strong risk of MDD than BD.

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