How soon will the patient with metastasis return for radiosurgery?

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 82-85 ◽  
Author(s):  
Kotaro Nakaya ◽  
Motohiro Hayashi ◽  
Masahiro Izawa ◽  
Taku Ochiai ◽  
Tomokatsu Hori ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Standard Treatment ◽  
Small Cell Lung Carcinoma ◽  
Treatment Options ◽  
Single Session ◽  
Cell Lung Carcinoma ◽  
Almost All ◽  
Medical University ◽  
Median Interval

ObjectStereotactic radiosurgery for brain metastasis has become one of the standard treatment options in recent years. Some patients must undergo repeated stereotactic radiosurgery for new lesions. The authors retrospectively reviewed their data to estimate how soon the patients undergo repeated radiosurgery for new lesions.MethodsBetween October 1999 and March 2006, 1081 patients with brain metastases underwent Gamma Knife surgery (GKS) at Tokyo Women's Medical University. One hundred and forty-nine patients in whom GKS had been performed two or more times were evaluated. There were 68 men and 81 women with a median age of 61 years (range 29–90 years). The authors analyzed data on patient age, number of treated lesions, and period between GKSs. Follow-up imaging was performed in almost all patients every 2 to 3 months after GKS.The number of lesions treated in a single session varied from one to 35. The median interval between GKSs was 26 weeks (range 3–175 weeks) for patients with breast cancer and 23 weeks (range 4–179 weeks) for patients with non–small cell lung carcinoma.Conclusions It would appear that follow-up imaging studies should be obtained every 2 to 3 months after GKS to monitor patients for tumor recurrence.

104 Stereotactic Radiosurgery for Spetzler-Martin Grade IV and V Arteriovenous Malformations: An International Multicenter Study

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 220-221
Author(s):  
Jason P Sheehan ◽  
Mohana Rao Patibandla ◽  
Dale Ding ◽  
Hideyuki Kano ◽  
Zhiyuan Xu ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Independent Predictor ◽  
Multivariate Logistic Regression Analysis ◽  
Favorable Outcome ◽  
Single Session ◽  
Radiation Induced ◽  
International Multicenter Study ◽  
Induced Changes

Abstract INTRODUCTION Due to the complexity of Spetzler-Martin (SM) grade IV-V arteriovenous malformations (AVM), the management of these lesions remains controversial. The aims of this multicenter, retrospective study are to evaluate outcomes after single-session stereotactic radiosurgery (SRS) for SM grade IV-V AVMs and determine predictive factors. METHODS We pooled data from 233 patients (mean age 33 years) with SM grade IV (94.4%) or V AVMs (5.6%) treated with single-session SRS at eight participating centers in the International Gamma Knife Research Foundation. Pre-SRS embolization was performed in 71 AVMs (30.5%). The mean nidus volume, SRS margin dose, and follow-up duration were 9.7 cc, 17.3 Gy, and 84.5 months, respectively. RESULTS >At a mean follow-up interval of 84.5 months, favorable outcome was defined as AVM obliteration, no post-SRS hemorrhage, and no permanently symptomatic radiation-induced changes (RIC) and was achieved in 26.2% of patients. The actuarial obliteration rates at 3, 7, 10, and 12 years were 15%, 34%, 37% and 42%, respectively. The annual post-SRS hemorrhage rate was 3.0%. Symptomatic and permanent RIC occurred in 10.7% and 4% of the patients, respectively. Only larger AVM diameter (P = 0.04) found to be an independent predictor of unfavorable outcome in the multivariate logistic regression analysis. The rate of favorable outcome was significantly lower for unruptured SM grade IV-V AVMs compared to ruptured ones (P = 0.042). Prior embolization was a negative independent predictor of AVM obliteration (P = 0.024) and radiologically evident RIC (P = 0.05) in multivariate analyses. CONCLUSION In this multi-institutional study, single session SRS had limited efficacy in the management of SM grade IV-V AVMs Favorable outcome was only achieved in a minority of unruptured SM grade IV-V AVMs, which supports less frequent utilization of SRS for the management of these lesions. A volume staged SRS approach for large AVMs represents an alternative approach for high grade AVM’s, but it requires further investigation.

scholarly journals Untargeted lipidomics of non-small cell lung carcinoma shows differentially abundant lipid classes in cancer vs non-cancer tissue

2021 ◽  
Author(s):  
Joshua M Mitchell ◽  
Robert M Flight ◽  
Andrew N Lane ◽  
Hunter N.B. Moseley
Keyword(s):  
Mass Spectrometry ◽  
Lung Cancer ◽  
Small Cell Lung Carcinoma ◽  
Treatment Options ◽  
Small Cell ◽  
Metabolic Phenotype ◽  
Small Cell Lung ◽  
Cell Lung Carcinoma ◽  
Genetic Subtypes ◽  
Primary Nsclc

Lung cancer is the leading cause of cancer death worldwide and non-small cell lung carcinoma (NSCLC) represents 85% of newly diagnosed lung cancers. The high mortality rate of lung cancer is due in part to the lack of effective treatment options for advanced disease. A major limitation in the development of effective treatment options is our incomplete understanding of NSCLC metabolism at a molecular level, especially lipids. Improvements in mass spectrometry combined with our untargeted assignment tool SMIRFE enable the systematic and less biased examination of NSCLC lipid metabolism. Lipids were extracted from paired tumorous and non-tumorous lung tissue samples from 86 patients with suspected resectable stage I or IIa primary NSCLC and were analyzed using ultra-high resolution Fourier transform mass spectrometry. Pathological examination of the samples revealed that the majority of the samples were primary NSCLC; however, the disease group does include examples of metastases of other cancers and several granulomas. Information-content-informed (ICI) Kendall tau correlation analysis revealed correlation and co-occurrence patterns consistent with significant changes in lipid profiles between disease and non-disease samples. Lipids assigned using the program SMIRFE (Mitchell et al., 2019) were analyzed for differential abundance, followed by machine learning to classify the SMIRFE formula assignments into lipid categories. At the lipid category level, sterol abundances were consistently higher in diseased versus non-diseased lung tissues at statistically significant levels. The statistically significant increase in sterol abundances in primary NSCLC compared with non-cancerous lung tissue suggests for treatment of primary NSCLC a possible therapeutic role for statins and nitrogenous bisphosphonates, pharmaceuticals that inhibit endogenous sterol biosynthesis. This hypothesis is consistent with previous epidemiological studies that have identified a therapeutic role for statins in the treatment of NSCLC but were unable to identify a molecular mechanism for this effect. Additionally, the majority of the consistently increased sterol abundances belong to the sterol ester subcategory, suggesting increased SCD1 and ACAT1 activity. SCD1 expression is a known negative prognostic indicator for survival in NSCLC. In our study, a large fraction of the NSCLC samples displayed this phenotype; however, SCD1 mutants would be unexpected in all of these samples. This suggests that this metabolic phenotype may be shared across multiple genetic subtypes of NSCLC. Thus, inhibitors of SCD1 and other enzymes involved in the production of this metabolic phenotype could have utility in the treatment of many genetic subtypes of NSCLC.

Results of stereotactic body radiation therapy (SBRT) for T2 lung cancer: Outcomes of longer term follow-up.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 8542-8542 ◽  
Author(s):  
Stephen Shamp ◽  
Tangel C. Chang ◽  
Tithi Biswas ◽  
Philip Aaron Linden ◽  
Yaron Perry ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Cox Regression ◽  
Small Cell Lung Carcinoma ◽  
Combined Modality Therapy ◽  
High Rate ◽  
Tumor Diameter ◽  
Cell Lung Carcinoma ◽  
Cox Regression Analysis

8542 Background: SBRT is a well-established, highly efficacious treatment for T1N0 non-small cell lung carcinoma (NSCLC). Its efficacy in T2N0 cancers is less clear. This is a review of our institutional experience with long-term follow-up. Methods: 45 patients with medically inoperable T2 N0/Nx M0 NSCLC who were treated with definitive SBRT between 2009 and 2013 were analyzed retrospectively. All patients underwent PET/CT staging and fiducial marker placement for image guided therapy with the Cyberknife platform. Radiation dose was 50 Gray in 5 fractions (N = 24), 50 Gray in 4 fractions (N = 11) or 54-60 Gray in 3 fractions (N = 10) delivered over 7 to 14 days. We analyzed overall survival from the date of start of SBRT, and we performed analyses actuarially using Cox regression analysis and Kaplan-Meier survival analysis for comparisons of hazard ratio (HR) among subgroups. Results: 45 patients were studied (median age 74). The 5-year actuarial overall survival was 18.7% (39.3% at 2 years), with most patients dying from lung cancer recurrence/progression outside of the treatment field. Subgroup analyses showed no statistically significant differences with respect to age, gender, histology, nominal radiation prescription dose, tumor diameter or PTV target volume (median PTV 87cc). There was statistically significantly better survival associated with increased maximum biologically effective dose (BED10) of radiation at the center of the tumor (p = 0.03). Conclusions: Unlike the outcomes for T1 NSCLC, our results in T2 NSCLC were disappointing, with a high rate of out-of-field failure and death from lung cancer. We stress the importance of diagnosis and treatment of NSCLC at the T1N0 stage. We suggest that patients with T2N0/Nx NSCLC be considered for SBRT dose intensification and/or combined modality therapy protocols.

8. Post-surgical follow-up for non-small cell lung carcinoma: should we change our practice?

2015 ◽  
Vol 41 (11) ◽  
pp. S263-S264 ◽  
Author(s):  
Fahad Fahad ◽  
Mohammed Haris ◽  
Imran Hussain ◽  
Shilajit Ghosh
Keyword(s):  
Lung Carcinoma ◽  
Small Cell Lung Carcinoma ◽  
Small Cell ◽  
Small Cell Lung ◽  
Cell Lung Carcinoma

scholarly journals Treatment of Sarcoma Lung Metastases with Stereotactic Body Radiotherapy

Sarcoma ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Adam D. Lindsay ◽  
Edward E. Haupt ◽  
Chung M. Chan ◽  
Andre R. Spiguel ◽  
Mark T. Scarborough ◽  
...  
Keyword(s):  
Stereotactic Body Radiotherapy ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Treatment Options ◽  
Computed Tomography Imaging ◽  
Metastatic Lesions ◽  
Metastatic Sarcoma ◽  
Median Interval

Background. The most common site of sarcoma metastasis is the lung. Surgical resection of pulmonary metastases and chemotherapy are treatment options that have been employed, but many patients are poor candidates for these treatments for multiple host or tumor-related reasons. In this group of patients, radiation might provide a less morbid treatment alternative. We sought to evaluate the efficacy of radiotherapy in the treatment of metastatic sarcoma to the lung. Methods. Stereotactic body radiotherapy (SBRT) was used to treat 117 pulmonary metastases in 44 patients. Patients were followed with serial computed tomography imaging of the chest. The primary endpoint was failure of control of a pulmonary lesion as measured by continued growth. Radiation-associated complications were recorded. Results. The majority of patients (84%) received a total dose of 50 Gy per metastatic nodule utilizing an image-guided SBRT technique. The median interval follow-up was 14.2 months (range 1.6–98.6 months). Overall survival was 82% at two years and 50% at five years. Of 117 metastatic nodules treated, six nodules showed failure of treatment (95% control rate). Twenty patients (27%) developed new metastatic lesions and underwent further SBRT. The side effects of SBRT included transient radiation pneumonitis n=6, cough n=2, rib fracture n=1, chronic pain n=1, dermatitis n=1, and dyspnea n=1. Conclusion. Stereotactic body radiotherapy is an effective and safe treatment for the ablation of pulmonary metastasis from sarcoma. Further work is needed to evaluate the optimal role of SBRT relative to surgery or chemotherapy for treatment of metastatic sarcoma.

Volume-Staged Stereotactic Radiosurgery for Intracranial Arteriovenous Malformations: Outcomes Based on an 18-Year Experience

Neurosurgery ◽  
2017 ◽  
Vol 80 (4) ◽  
pp. 543-550 ◽  
Author(s):  
Bruce E. Pollock ◽  
Michael J. Link ◽  
Scott L. Stafford ◽  
Giuseppe Lanzino ◽  
Yolanda I. Garces ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Radiation Effects ◽  
Background Radiation ◽  
Treatment Options ◽  
Cure Rate ◽  
Intracranial Arteriovenous Malformations ◽  
Treatment Volume ◽  
Actuarial Risk

Abstract BACKGROUND: Radiation-based treatment options of large intracranial arteriovenous malformations (AVM) must balance the likelihood of obliteration with the risk of adverse radiation effects (ARE). OBJECTIVE: To analyze the efficacy and risks of volume-staged stereotactic radiosurgery (VS-SRS) for AVM. METHODS: Retrospective study of 34 AVM patients having VS-SRS between 1997 and 2012. A median of 2 stages (range, 2-4) was used to treat a median AVM volume of 22.2 cm3 (range, 7.4-56.7). The median AVM margin dose was 16 Gy (range, 14-18); the median radiosurgery-based AVM score was 2.81 (range, 1.54-6.45). The median follow-up after VS-SRS was 8.2 years (range, 3-13.3). RESULTS: Nidus obliteration was noted in 18 patients (53%) after VS-SRS. The rate of obliteration was 14% at 3 years, 54% at 5 years, and 75% at 7 years. Six patients (18%) had 11 bleeds after VS-SRS. Two patients (6%) remained neurologically stable, 2 (6%) patients had significant deficits, and 2 patients (6%) died. The actuarial risk of a first bleed after VS-SRS was 6% at 1 year, 12% at 3 years, and 19% at 7 years. Six patients (18%) underwent repeat SRS; all achieved nidus obliteration for an overall cure rate of 71%. Two patients (6%) had a permanent ARE after VS-SRS or repeat SRS. CONCLUSION: VS-SRS permitted large volume intracranial AVM to be treated with a low rate of ARE. Further study is needed on dose escalation and decreasing the treatment volume per stage to determine if this will increase the rate of obliteration with this technique.

MULTISESSION CYBERKNIFE STEREOTACTIC RADIOSURGERY OF LARGE, BENIGN CRANIAL BASE TUMORS

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. 898-907 ◽  
Author(s):  
Francesco Tuniz ◽  
Scott G. Soltys ◽  
Clara Y. Choi ◽  
Steven D. Chang ◽  
Iris C. Gibbs ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Stereotactic Radiosurgery ◽  
Radiation Injury ◽  
Tumor Volume ◽  
Neurological Status ◽  
Cranial Base ◽  
Single Session ◽  
Effective Option ◽  
Cyberknife Radiosurgery

Abstract OBJECTIVE Although radiosurgery plays an important role in managing benign cranial base lesions, the potential for increased toxicity with single-session treatment of large tumors is a concern. In this retrospective study, we report the intermediate-term rate of local control, morbidity, and clinical outcomes of patients with large cranial base tumors treated with multisession stereotactic radiosurgery with the CyberKnife (Accuray, Inc., Sunnyvale, CA). METHODS Between 1999 and 2008, 34 consecutive patients with large (>15 cm3), benign cranial base tumors (21 meningiomas, 9 schwannomas, 4 glomus jugulare tumors) underwent primary or postoperative radiosurgical treatment using a multisession approach at Stanford University and were considered in this retrospective study. Forty-four percent of these patients had undergone previous subtotal surgical resection or radiotherapy. CyberKnife radiosurgery was delivered in 2 to 5 sessions (median, 3 sessions) to a median tumor volume of 19.3 cm3 (range, 15.8–69.3 cm3). The median marginal dose was 24 Gy (range, 18–25 Gy) prescribed to a median 78% isodose line. RESULTS After a median clinical follow-up of 31 months (range, 12–77 months), 21% of patients experienced clinical improvement of neurological symptoms, whereas neurological status remained unchanged among the rest. Four patients experienced prolonged use of glucocorticoids owing to transient neurological worsening and radiographic signs of radiation injury. No permanent neurotoxicity was seen. To date, all tumors remain locally controlled. CONCLUSION Over our modest length of follow-up, multisession radiosurgery appears to be a safe and effective option for selected large, benign brain and cranial base lesions.

Relationship Between Cisplatin Administration and the Development of Ototoxicity

2006 ◽  
Vol 24 (6) ◽  
pp. 918-924 ◽  
Author(s):  
Jeany M. Rademaker-Lakhai ◽  
Mirjam Crul ◽  
Lot Zuur ◽  
Paul Baas ◽  
Jos H. Beijnen ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Small Cell Lung Carcinoma ◽  
Area Under The Curve ◽  
Dose Intensity ◽  
Cell Lung Carcinoma ◽  
High Frequencies ◽  
Hearing Thresholds ◽  
Receive Treatment ◽  
To Receive

Purpose To determine the auditory toxicity associated with dose- and schedule- intensive cisplatin/gemcitabine chemotherapy in non–small-cell lung carcinoma patients. Patients and Methods Patients were treated with gemcitabine followed by cisplatin according to an interpatient dose-escalation scheme. Patients were randomly assigned to receive treatment once a week for 6 weeks or once every 2 weeks for 4 weeks. The following cohorts of patients were treated with a reversed schedule once every 2 weeks, in which cisplatin was followed by gemcitabine. The dose-intensity of cisplatin was equal in both schedules. Audiometric evaluations were obtained for each ear at several frequencies. Mean hearing loss after cisplatin treatment was computed for each dose level at each tested frequency in each ear at baseline and subsequent follow-up audiometry. Pure tone averages (PTAs) were also calculated. The pharmacokinetics of cisplatin was determined to study the correlation among the maximum drug concentration, the area under the curve of unbound platinum, and the development of ototoxicity. Results A total of 328 audiograms were analyzed. At the higher frequencies, a more severe hearing impairment was recorded. Most patients showed a decrease in hearing thresholds at dosages above 60 mg/m2 cisplatin at the higher frequencies. PTAs at 1, 2, and 4 kHz show a mean hearing loss of 19 dB after cisplatin administration at dosages above 90 mg/m2. Threshold shifts at 8 and 12.5 kHz after cisplatin administration were experienced at dosages above 60 mg/m2. Conclusion Hearing loss after cisplatin therapy occurs mainly at high frequencies and at cisplatin dosages more than 60 mg/m2. It is more pronounced when cisplatin is given once every 2 weeks.

scholarly journals Nonsurgical treatment of recurrent glioblastoma

2015 ◽  
Vol 22 (4) ◽  
pp. 273 ◽  
Author(s):  
O. Gallego
Keyword(s):  
Standard Treatment ◽  
Treatment Options ◽  
Growth Factor Receptor ◽  
Response Assessment ◽  
Recurrent Glioblastoma ◽  
Second Line ◽  
Glioblastoma Recurrence ◽  
Epidermal Growth ◽  
Almost All ◽  
New Surgery

Standard treatment for glioblastoma multiforme is surgery followed by radiotherapy and chemotherapy, generally with temozolomide. However, disease recurs in almost all patients. Diagnosis of progression is complex given the possibility of pseudoprogression.The Response Assessment in Neuro-Oncology criteria increase the sensitivity for detecting progression. Most patients will not be candidates for new surgery or re-irradiation, and anticancer drugs are the most common approach for second-line treatment, if the patient’s condition allows. Antiangiogenics, inhibitors of the epidermal growth factor receptor, nitrosoureas, and re-treatment with temozolomide have been studied in the second line, but a standard therapy has not yet been established. This review considers currently available medical treatment options for patients with glioblastoma recurrence.

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