ADVANCES IN THE NEUROSURGICAL AND COMBINED TREATMENT OF PATIENTS WITH  ACROMEGALY

Aim. The study was carried out to identify and analyze the factors of a positive outcome of surgical and radiation treatment of acromegaly. Methods. The work was performed on clinical material and summarizes treatment results of 256 patients (90 males and 166 females). 86% of patients underwent surgical treatment, 14% of patients received radiation therapy during 2002–2018. Significance of factors of a positive outcome of treatment was carried out using the RStudio program. Results. The results of the study revealed that: 1. Significant factors (p <0.05) of a positive outcome of surgical treatment of acromegaly are somatostatin analogs (SSA) therapy before surgery, a small tumor size (microadenomas), and the absence of extrasellar tumor spread. 2. The most significant factor in achieving remission of acromegaly after non-radical adenomectomy is postoperative therapy with SSA (p <0.05). 3. Aggressive pituitary tumors invading surrounding structures, high baseline IGF-1 levels, unfavorable histological findings, macroadenomas, growth hormone levels above 10 μg/L before therapy, and extrasellar tumor spread were associated with less favorable outcomes of acromegaly radiation therapy (RT) (p <0.05). The most significant factor in achieving remission of acromegaly is SSA therapy after RT (p <0.05). Conclusion. Surgical treatment is the optimal primary treatment for acromegaly. Drug therapy with SSA is effective and the preferred treatment after non-radical surgery.

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Techniques to Analyze the Effects of Radiation Therapy on Enamel and Dentin - A Review

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1708679 ◽

2016 ◽

Vol 06 (04) ◽

pp. 71-78

Author(s):

Mithra N. Hegde ◽

Nidharsh D. Hegde ◽

Suchetha Kumari N. ◽

Ganesh Sanjeev ◽

Priya G. ◽

...

Keyword(s):

Radiation Therapy ◽

Radiation Treatment ◽

Positive Outcome ◽

Effective Rate ◽

Review Article ◽

Morphological Properties ◽

Common Source ◽

Radiation Caries ◽

Effects Of Radiation

AbstractRadiation therapy is a most common source in the treatment of Head and neck cancers. The therapy has a positive outcome in curing patients out of danger at an effective rate. But there are few major and minor side effects of the treatment which will possibly hinder the quality of life. One such major concern followed with the therapy is Radiation related caries. Radiation is known to damage the tissues of the teeth making it more susceptible for caries. Hence this review article details on techniques that is being used to test the mechanical and morphological properties of the teeth. The changes observed in these tissues after radiation treatment will enable us to understand the causes for caries. therefore further research in this field is necessary to develop strategies that will probably prevent radiation caries in future days.

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Diagnosis and treatment of uterine carcinosarcoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e18111 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e18111-e18111

Author(s):

Anna Beliaeva ◽

Elena Bakhidze

Keyword(s):

Surgical Treatment ◽

Radiation Treatment ◽

Combined Treatment ◽

Pelvic Lymphadenectomy ◽

Stage I ◽

Morphological Data ◽

Stage Iii ◽

Uterine Carcinosarcoma ◽

Treatment Results ◽

Mesenchymal Tumors

e18111 Background: Uterine carcinosarcoma (UCS) is rare and highly aggressive malignant tumor belonging to mixed epithelial and mesenchymal tumors and classified as high-grade endometrial carcinoma. UCS is more prone to metastasis, especially in the lymph nodes, and 35% of the diagnostics show advanced process and worse treatment results. High UCS aggressiveness, unsatisfactory treatment results and the lack of standard approaches to its treatment require more researches. Methods: Clinical and morphological data of 72 patients from N.N. Petrov National Medical Research Center of Oncology treated from 2004 to 2014 were analysed. 28 patients were included with the UCS I – III stages based on clinical and morphological data. The average age of the patients was 61.5 years (43 to 82). Results: 15 patients had stage I (53.6%), 3 - stage II (10.7%), 10 – stage III (35.7%) with ovarian metastases 14.3% and omental - 18.2%. 5 patients received only surgical treatment; 21 received combined treatment, including surgery and radiation therapy (RT). Postoperative remote RT in combination with brachytherapy was applied in 18 patients, only brachytherapy - 5. Chemotherapy (CT) was used in 6 patients. Metastatic lesion of the iliac lymph was morphologically proven in 6 of 18 patients (31.6%). No correlation between frequency of regional metastasis and depth of tumor invasion to the myometrium was found. Overall survival was 52%, relapse-free - 32%, for stage I – II it reached 72.2%. Five-year survival for stage III was 44.4%. Recurrence rate after total hysterectomy with pelvic lymphadenectomy was 2 times lower compared to that without lymphadenectomy (30 and 62.5%, respectively). The relapse rate in patients with UCS I – II stages after surgical treatment without adjuvant RT reached 33.3%, with brachytherapy - 40%, with remote RT in combination with brachytherapy - 20%. Systemic treatment was applied to 6 patients, 2 of them did not undergo RT (relapses in these 2 patients were noted during the first year of observation). Conclusions: The overall 5-year survival and relapse-free survival of patients with UCS I – III stages is quite low: about 50% and 30%, respectively. Optimal surgical staging (which involves performing pelvic lymphadenectomy) and the use of adjuvant RT, can reduce the frequency of relapses. The use of systemic CT as an adjunct to surgical and radiation treatment is justified for patients with UCS from the standpoint of the same frequency of both local relapses and distant metastases.

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Modern approaches to the choice of treatment tactics in patients with cervical cancer

Tumors of female reproductive system ◽

10.17650/1994-4098-2021-17-3-128-133 ◽

2021 ◽

Vol 17 (3) ◽

pp. 128-133

Author(s):

A. L. Chernyshova ◽

L. A. Kolomiets ◽

Yu. M. Trushchuk ◽

O. V. Shpileva ◽

E. V. Denisov ◽

...

Keyword(s):

Cervical Cancer ◽

Radiation Therapy ◽

Surgical Treatment ◽

Combined Treatment ◽

Locally Advanced ◽

Point Of View ◽

Advanced Cervical Cancer ◽

Choice Of Treatment

Currently, approaches to the choice of treatment tactics for cervical cancer have changed significantly. According to the recommendations of ESGO (2018), RUSSCO (2020), the use of a combination of surgical treatment and radiation therapy significantly increases the incidence of complications. Therefore, when planning the treatment of patients with IB1–IIA1, a combination of surgical treatment and radiation therapy should be avoided. The article presents an analysis of modern approaches to the treatment of initial, locally advanced and advanced cervical cancer. Modern approaches to organ-preserving treatment are considered, including the view from the point of view of expanding the indications for trachelectomy as part of combined treatment. The question of the expediency of using hyperthermia and indications for this type of treatment in combination with radiation therapy is considered. The author presents his own view of the problem as a whole and possible ways to solve this problem.

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Follow-up of pituitary tumor volume in patients with acromegaly treated with pegvisomant in clinical trials

Acta Endocrinologica ◽

10.1530/eje-08-0205 ◽

2008 ◽

Vol 159 (5) ◽

pp. 517-523 ◽

Cited By ~ 43

Author(s):

Camilo Jimenez ◽

Pia Burman ◽

Roger Abs ◽

David R Clemmons ◽

William M Drake ◽

...

Keyword(s):

Clinical Trials ◽

Radiation Therapy ◽

Tumor Growth ◽

Pituitary Tumor ◽

Tumor Volume ◽

Somatostatin Analogs ◽

Pituitary Tumors ◽

Magnetic Resonance Images

ObjectiveWe examined pituitary tumor volumes in patients treated with pegvisomant for 18 months or longer, and in whom the tumors were monitored for at least 3 years. We present details on 9 of 304 patients in clinical trials with pegvisomant who experienced tumor growth within the first year of treatment.MethodMagnetic resonance images prior to start of pegvisomant and at last follow-up were examined in 43 patients (14% of participating patients). Twenty-nine had received prior radiation therapy (18% of irradiated patients) and all but five received somatostatin analogs between periods of pegvisomant treatment.ResultsAt follow-up, the median tumor volume was 0.6 cc (range 0.0–19.7 cc), in comparison with 1.6 cc (0.0–19.7 cc) at baseline (P<0.001). Twenty-five patients, of which 23 received radiation therapy, had tumor volume reduction. Seventeen patients had no significant change. One patient, who had not received radiation therapy, had an increase in tumor volume from 1.61 to 1.93 cc. Of the nine patients with tumor growth, six had progressive growth before initiating pegvisomant. Two patients with stable tumors while on octreotide experienced enlargement after octreotide discontinuation but remained stable on long-term pegvisomant therapy.ConclusionThe present data indicate that pegvisomant does not promote tumor growth and suggest that the nine observed cases of tumor progression, which occurred within 8 months after commencing pegvisomant, are likely rebound expansions after discontinuation of somatostatin analogs and/or the natural history of aggressively growing pituitary tumors. Continued long-term surveillance of tumor volume, particularly in non-irradiated patients, is recommended.

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A New Era of Organ-Preserving Treatment in Pediatric Intraocular Retinoblastoma in Russia: A Multicenter Cohort Study

Oncopediatrics ◽

10.15690/onco.v5i1.1866 ◽

2018 ◽

Vol 5 (1) ◽

pp. 51-69 ◽

Cited By ~ 2

Author(s):

Тatiana L. Ushakova ◽

Igor A. Тrofimov ◽

Оlga V. Gorovtsova ◽

Аndrey A. Yarovoy ◽

Svetlana V. Saakyan ◽

...

Keyword(s):

Gamma Knife ◽

Systemic Chemotherapy ◽

Focal Therapy ◽

Primary Treatment ◽

Local Chemotherapy ◽

Multicenter Cohort Study ◽

Cancer Disease ◽

Tumor Spread ◽

Group D

Background.Retinoblastoma (RB) is a life threatening cancer disease. A breakthrough in the treatment of children with RB is associated with the improvement of conservative treatment that was administered in at least one of the two tumor-affected eyes in most bilateral cases, that was chemotherapy both systemic and local (selective intra-arterial and intravitreal) in most cases combined with laser therapy, cryotherapy, or brachytherapy. The development of such techniques as local chemotherapy is focused on preservation of visual functions, reducing the number of enucleations and radiotherapy (RT) course. The success of the healing of RB is closely associated with a multidisciplinary approach to diagnosis and treatment, as well as specialized longterm follow-up clinical examination.Objective.eye and vision preservation against large intraocular tumors with different growth types and localization without the course of remote radiation therapy was the main purpose.Methods.In the period from September 2012 to January 2016, the study enrolled 45 patients with RB when at least one eye had intraocular tumor spread corresponding to the group C or D. According to the ABC international classification, patients have a relatively good prognosis for organ-preserving treatment. 4 of 18 children with bilateral RB had undergone primary enucleation of worse eye the worst eye, group E; 49 (77.8%) of the 63 affected eyes had features for groups C and D. In this study, no patient received local chemotherapy initially, only after prior systemic chemotherapy. Selective intra-arterial chemotherapy (SIAC) was applied to 41 patients (45 eyes; mean course number was 2), and 32 patients (34 eyes) had undergone intravitreal chemo therapy (IViC) (mean course number was 2). Focal therapy and local chemotherapy were the main methods of treatment for progression (new lesions on the retina) in 8 (16.3%) of 49 eyes with tumors of group C (n=1) and D (n=7); the relapse in 14 of 49 (new lesions on the retina) in eyes with tumors of group C (n=5) and D (n=6) and (new lesions on the retina and the vitreous) in eyes with tumors of group D (n=3) (28.5%), and stabilization of disease n=23 (46.9%). We should note that 2 patients underwent repeated course of in case of systemic chemotherapy, 1 patient — a Gamma Knife procedure due to registered disease stabilization, progression or relapse.Results.10 (20.4%) of 49 eyes saved due to the combined chemotherapy. In 45 patients diseasefree survival rate was 56.1±8.9 % (with mean follow-up period 26.9±2.5 months). 1 of 45 patients died from leukemia. 44 of 45 patients are alive without metastasis. The mean follow-up was 20 months (3 to 43 months). Eye salvage rate in group C — 14 (93.3%) of 15, in group D — 31 (91.2%) of 34.Conclusion.These methods: second line of systemic chemotherapy, RT, and a Gamma Knife procedure should be considered as a failure of primary treatment. Our study demonstrated a high efficacy of local chemotherapy with promissing techniques of conservation therapy, which safety increases due to experience.

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Faculty Opinions recommendation of Partial surgical removal of growth hormone-secreting pituitary tumors enhances the response to somatostatin analogs in acromegaly.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.723735015.793511706 ◽

2015 ◽

Author(s):

Niki Karavitaki ◽

Georgia Ntali

Keyword(s):

Growth Hormone ◽

Somatostatin Analogs ◽

Pituitary Tumors ◽

Surgical Removal

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LOCAL HYPERTHERMIA IN TREATMENT FOR MALIGNANT BRAIN TUMORS

Problems in oncology ◽

10.37469/0507-3758-2018-64-1-54-61 ◽

2018 ◽

Vol 64 (1) ◽

pp. 54-61

Author(s):

A. Ryabova ◽

O. Gribova ◽

V. Novikov ◽

E. Choinzonov ◽

Zh. Starceva ◽

...

Keyword(s):

Experimental Data ◽

Radiation Therapy ◽

Brain Tumors ◽

Tumor Cells ◽

Combined Treatment ◽

Complex Treatment ◽

Local Hyperthermia ◽

Malignant Brain Tumors ◽

Sensitizing Effect ◽

Methods Of Treatment

Unsatisfactory results of complex treatment for malignant brain tumors stimulate search of new effective methods of treatment. Radiation therapy is an integral part of the combined treatment but often does not influence lethally on resistant tumor cells. Thereby in recent decades there has been an active search for different modifiers, which can increase the sensitivity of tumors to chemotherapy and radiotherapy. One of the universal sensitizers is the local hyperthermia. Experimental data showed that the effect of high temperatures had both a direct damaging effect on tumor cells and a sensitizing effect. The literature review given in the article provides an overview of the existing methods of the local hyperthermia for brain tumors treatment.

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Management of Recurrent or Progressing Skull Base Chondrosarcomas: Predictors of Long-Term Outcomes

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1701523 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jonathan D. Breshears ◽

Franco DeMonte ◽

Ahmed Habib ◽

Paul W. Gidley ◽

Shaan M. Raza

Keyword(s):

Natural History ◽

Skull Base ◽

Radiation Treatment ◽

Systemic Disease ◽

Primary Treatment ◽

Salvage Treatment ◽

Low Grade ◽

Related Factors ◽

Factors Associated ◽

Initial Recurrence

Abstract Background Skull base chondrosarcomas (CSA) are difficult tumors to cure and there is little data regarding salvage therapy. Objective This study aims to identify presentation and treatment-related factors which impact the progression free survival (PFS) and disease specific survival (DSS) for recurrent CSA, and to identify salvage treatment factors associated with successful restoration to the natural history following primary treatment. Methods This single-institution retrospective review included patients with recurrent/progressive CSA over a 25-year period. Survival analysis for factors impacting PFS and DSS was performed. Salvage treatment factors associated with achieving PFS ≥newly diagnosed median PFS were identified using univariate statistics. Analysis was performed on first recurrences and all recurrences combined. Results A total of 47 recurrence/progression events were analyzed from 17 patients (median two events/patient, range = 1–8). The overall PFS and DSS for the initial recurrence was 32 (range = 3–267) and 79 (range = 3–285) months, respectively. Conventional grade III or mesenchymal histology significantly predicted shorter PFS and DSS (p < 0.0001). After stratification by histology, previous radiation predicted shorter PFS for low-grade tumors (p = 0.009). Gross total resection (GTR) after a first time recurrence was significantly associated with successful salvage treatment (p < 0.05); however, this was rare. Conclusion In this series, high grade histology and prior radiation treatment negatively impacted salvage treatment outcomes, while GTR was associated with restoration to natural history following primary treatment. Careful consideration of histology, systemic disease status, previous treatments, and the anatomic extent of the skull base disease can optimize the outcomes of salvage intervention.

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RADT-29. EFFECT OF RADIATION THERAPY ON OVERALL SURVIVAL FOLLOWING SUBTOTAL RESECTION OF ADULT PILOCYTIC ASTROCYTOMA

Neuro-Oncology ◽

10.1093/neuonc/noaa215.782 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii187-ii188

Author(s):

Adham Khalafallah ◽

Adrian Jimenez ◽

Henry Brem ◽

Debraj Mukherjee

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Pilocytic Astrocytoma ◽

Radiation Treatment ◽

Cox Proportional Hazards Model ◽

Adult Patients ◽

Subtotal Resection ◽

Adjuvant Radiation ◽

Low Grade ◽

Risk Of Death

Abstract BACKGROUND Pilocytic astrocytoma (PCA) is a low-grade glioma common in children but also rarely diagnosed in adults. The role of adjuvant radiation therapy (RT) in treating these tumors remains unclear. OBJECTIVE We investigated the effect of RT on overall survival, specifically among adult patients who had undergone subtotal PCA resection. METHODS Information on adult patients (age 18 years old) who had undergone subtotal PCA resection between 2004 and 2016 was collected from the National Cancer Database (NCDB). A multivariate Cox proportional hazards model was utilized to determine factors independently associated with overall survival. RESULTS A total of 451 patients were identified. The mean age of our patient cohort was 36.8 years old, and the majority of patients (83.4%) did not receive radiation treatment following subtotal PCA resection. Overall median survival was 93.8 months. Survival was longer (p < 0.001) in the patients who did not receive post-surgical RT (median: 98.3 months) compared to patients who did (median: 54.8 months). Patients who had older age at diagnosis (hazard ratio [HR]=1.05, 95% confidence interval [CI]=1.03-1.07, p < 0.01), were Black or African American (HR=2.76, CI=1.12-6.46, p=0.019), received radiation during their initial treatment (HR=4.53, CI=2.08-9.89, p < 0.01), or had a Charlson/Deyo score of > 1 (HR=3.68, CI=1.55, p=0.003) had a significantly higher risk of death following subtotal PCA resection. CONCLUSION Postoperative RT is independently associated with a significantly higher risk of death among adults who underwent subtotal PCA resection. Our findings provide a rationale for further investigation into the efficacy and safety of RT within this patient population.

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