scholarly journals Multimodality Treatment of Craniopharyngioma: Aspiration of Cystic Contents and Placement of Ommaya Reservoir Stereotactically Followed by Gamma Knife Radiosurgery – Single Center Study of 81 Cases

2020 ◽  
Vol 24 (2) ◽  
Author(s):  
AURANGZEB KALHORO ◽  
SANAM B. RAJPER ◽  
ABID SALEEM ◽  
A. SATTAR M. HASHIM
Keyword(s):  
Radiation Treatment ◽  
Gamma Knife Radiosurgery ◽  
Major Complication ◽  
Multimodality Treatment ◽  
Tumor Grade ◽  
Histopathological Diagnosis ◽  
Surgical Morbidity ◽  
Eloquent Area ◽  
Biopsy Report ◽  
Grade 3

Objective:  The objective of this present study was to assess the accuracy, result, and safety measures of stereotactic biopsy. The study was conducted at the Neurospinal & Cancer Care Institute Karachi. Material and Methods:  After the approval from the ethical hospital committee, the study was conducted on 34 patients, in which 9 (26.4%) were females, and 25 (73.5%) were males. 34 consecutive patients with biopsy inclusion deep seated lesion, mid line pathology, eloquent area and operated surgery, previous radiation treatment were excluded, and after that, the biopsy report based surgery or radiotherapy treatment was decided. Result:  The biopsy underwent histopathological diagnosis proving Astrocytoma in 7 (20.5%) patients out of which four were in the Eloquent area, tuberculosis diagnosed in 5 (14.7%) patient, Oligodendroglioma diagnosed in 3 (8.8%) patients, metastasis in 5 (14.7%), Abscess in 4 (11.7%) patient which was aspirated to maximum and sent for culture, Malignant tumor (grade 3 & 4) 5 (14.7%), Lymphoma in 2 (5.8%) patient both were given radiation therapy Tumor necrosis 1 (2.9%) case,  and No tissue obtained in 2 (5.8%) which was repeated later. No major complication or side effects were observed in the patient. Conclusion:  Stereotactic Framed biopsy is safe and accurate and can be used in deep seated lesions with high success rate, minimal complication and decrease surgical morbidity for patients, and it is comparable to updated methods

scholarly journals Framed Stereotactic Brain Biopsy Outcome – Single Center Study

2020 ◽  
Vol 24 (2) ◽  
Author(s):  
AURANGZEB KALHORO ◽  
A. SATTAR M. HASHIM
Keyword(s):  
Radiation Treatment ◽  
Major Complication ◽  
Brain Biopsy ◽  
Tumor Grade ◽  
Histopathological Diagnosis ◽  
Surgical Morbidity ◽  
Stereotactic Brain Biopsy ◽  
Eloquent Area ◽  
Biopsy Report ◽  
Grade 3

stereotactic biopsy. The study was conducted at the Neurospinal & Cancer Care Institute Karachi. Material and Methods:  After the approval from the ethical hospital committee, the study was conducted on 34 patients, in which 9 (26.4%) were females, and 25 (73.5%) were males. 34 consecutive patients with biopsy inclusion deep seated lesion, mid line pathology, eloquent area and operated surgery, previous radiation treatment were excluded, and after that, the biopsy report based surgery or radiotherapy treatment was decided. Result:  The biopsy underwent histopathological diagnosis proving Astrocytoma in 7 (20.5%) patients out of which four were in the Eloquent area, tuberculosis diagnosed in 5 (14.7%) patient, Oligodendroglioma diagnosed in 3 (8.8%) patients, metastasis in 5 (14.7%), Abscess in 4 (11.7%) patient which was aspirated to maximum and sent for culture, Malignant tumor (grade 3 & 4) 5 (14.7%), Lymphoma in 2 (5.8%) patient both were given radiation therapy Tumor necrosis 1 (2.9%) case,  and No tissue obtained in 2 (5.8%) which was repeated later. No major complication or side effects were observed in the patient. Conclusion:  Stereotactic Framed biopsy is safe and accurate and can be used in deep seated lesions with high success rate, minimal complication and decrease surgical morbidity for patients, and it is comparable to updated methods.  

Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 113-119 ◽  
Author(s):  
D. Hung-Chi Pan ◽  
Wan-Yuo Guo ◽  
Wen-Yuh Chung ◽  
Cheng-Ying Shiau ◽  
Yue-Cune Chang ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Radiation Treatment ◽  
Gamma Knife Radiosurgery ◽  
Consecutive Series ◽  
Content Type ◽  
Obliteration Rate ◽  
Complete Obliteration ◽  
Fine Print

Object. A consecutive series of 240 patients with arteriovenous malformations (AVMs) treated by gamma knife radiosurgery (GKS) between March 1993 and March 1999 was evaluated to assess the efficacy and safety of radiosurgery for cerebral AVMs larger than 10 cm3 in volume. Methods. Seventy-six patients (32%) had AVM nidus volumes of more than 10 cm3. During radiosurgery, targeting and delineation of AVM nidi were based on integrated stereotactic magnetic resonance (MR) imaging and x-ray angiography. The radiation treatment was performed using multiple small isocenters to improve conformity of the treatment volume. The mean dose inside the nidus was kept between 20 Gy and 24 Gy. The margin dose ranged between 15 to 18 Gy placed at the 55 to 60% isodose centers. Follow up ranged from 12 to 73 months. There was complete obliteration in 24 patients with an AVM volume of more than 10 cm3 and in 91 patients with an AVM volume of less than 10 cm3. The latency for complete obliteration in larger-volume AVMs was significantly longer. In Kaplan—Meier analysis, the complete obliteration rate in 40 months was 77% in AVMs with volumes between 10 to 15 cm3, as compared with 25% for AVMs with a volume of more than 15 cm3. In the latter, the obliteration rate had increased to 58% at 50 months. The follow-up MR images revealed that large-volume AVMs had higher incidences of postradiosurgical edema, petechiae, and hemorrhage. The bleeding rate before cure was 9.2% (seven of 76) for AVMs with a volume exceeding 10 cm3, and 1.8% (three of 164) for AVMs with a volume less than 10 cm3. Although focal edema was more frequently found in large AVMs, most of the cases were reversible. Permanent neurological complications were found in 3.9% (three of 76) of the patients with an AVM volume of more than 10 cm3, 3.8% (three of 80) of those with AVM volume of 3 to 10 cm3, and 2.4% (two of 84) of those with an AVM volume less than 3 cm3. These differences in complications rate were not significant. Conclusions. Recent improvement of radiosurgery in conjunction with stereotactic MR targeting and multiplanar dose planning has permitted the treatment of larger AVMs. It is suggested that gamma knife radiosurgery is effective for treating AVMs as large as 30 cm3 in volume with an acceptable risk.

Prognostic transcriptome classes of duodenopancreatic neuroendocrine tumors

2021 ◽  
Author(s):  
Marc Diedisheim ◽  
Solène Dermine ◽  
Anne Jouinot ◽  
Amandine Septier ◽  
Sébastien Gaujoux ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Pancreatic Beta Cell ◽  
Tumor Biology ◽  
Disease Free Survival ◽  
Tumor Grade ◽  
Pancreatic Alpha Cell ◽  
Liver Gene ◽  
Well Differentiated ◽  
Grade 3 ◽  
Definition Of

Duodenopancreatic neuroendocrine tumors (DPNETs) aggressiveness is heterogeneous. Tumor grade and extension are commonly used for prognostic determination. Yet, grade classes are empirically defined, with regular up-dates changing the definition of classes. Genomic screening may provide more objective classes, and reflect tumor biology. The aim of this study was to provide a transcriptome classification of DPNETs. We included 66 DPNETs, covering the entire clinical spectrum of the disease in terms of secretion, grade, and stage. Three distinct molecular groups were identified, associated with distinct outcome (log-rank p<0.01): (i) better-outcome DPNETs with pancreatic beta-cell signature. This group was mainly composed of well-differentiated, grade 1 insulinomas; (ii) poor-outcome DPNETs with pancreatic alpha-cell and hepatic signature. This group included all neuroendocrine carcinomas and grade 3 DPNETs, but also some grade 1 and grade 2 DPNETs; and (iii) intermediate-outcome DPNETs with pancreatic exocrine and progenitor signature. This group included grade 1 and grade 2 DPNETs, with some insulinomas. Fibrinogen gene FGA expression was one of the top most expressed liver gene. FGA expression was associated with disease-free survival (HR=1.13, p=0.005), and could be validated on two independent cohorts. This original pathophysiologic insight provides new prognostic classification perspectives.

scholarly journals Factors increasing the risk of flap complications following pectoralis major myocutaneous flap reconstruction for head and neck cancers

2020 ◽  
Vol 6 (6) ◽  
pp. 1138
Author(s):  
Subbiah Shanmugam ◽  
Syed Afroze Hussain ◽  
Rajiv Michael
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Radiation Treatment ◽  
Demographic Data ◽  
Major Complication ◽  
Pectoralis Major ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Flap Reconstruction ◽  
Operative Care

<p class="abstract"><strong>Background:</strong> Oral cavity cancer is one of the most common cancers and a leading cause of cancer death in India. Pectoralis major myocutaneous flaps (PMMC) are still widely used for reconstruction of defects in the head and neck, though microvascular free flaps are the ‘gold standard’. This study was aimed to identify the risk factors involved in increasing the post-operative PMMC flap complications.</p><p class="abstract"><strong>Methods:</strong> Patients who underwent surgical resection of primary head and neck cancer with PMMC flap reconstruction were included and their demographic data, pre-operative laboratory values, surgery details and post-operative flap morbidity were collected retrospectively from the master case sheets from January 2013 to December 2019. Factors such as age, gender, stage of disease, pre-operative anemia, hypoprotenemia and radiation therapy, presence of diabetes and size of the flaps were analysed to find their relation in causing flap complications.  </p><p class="abstract"><strong>Results:</strong> Totally 285 patients were included for analysis and 9.82% (n=28) had major flap complications. On analysis we found that pre-operative hypoproteinemia (serum albumin &lt;3.5) (p=0.001) and prior radiation therapy (p=0.02) significantly increased the risk of flap complications. Similarly, patients with larger bipaddled flaps had higher flap complication rates (p=0.0002) and previous radiation treatment further increased the major complication rates in bipaddle flaps.</p><p class="abstract"><strong>Conclusions:</strong> PMMC flaps are still a viable option for head and neck reconstruction especially in patients with multiple comorbidities and where free microvascular flaps are not done routinely. Careful patient selection, pre-operative optimisation and good post-operative care will help to reduce flap complications.</p><p> </p>

scholarly journals Reduced-Dose Radiation Therapy for HPV-Associated Oropharyngeal Carcinoma (NRG Oncology HN002)

2021 ◽  
pp. JCO.20.03128
Author(s):  
Sue S. Yom ◽  
Pedro Torres-Saavedra ◽  
Jimmy J. Caudell ◽  
John N. Waldron ◽  
Maura L. Gillison ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Radiation Treatment ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Phase Iii ◽  
Oropharyngeal Carcinoma ◽  
Reduced Dose ◽  
Phase Iii Study ◽  
Grade 3 ◽  
Dose Radiation

PURPOSE Reducing radiation treatment dose could improve the quality of life (QOL) of patients with good-risk human papillomavirus–associated oropharyngeal squamous cell carcinoma (OPSCC). Whether reduced-dose radiation produces disease control and QOL equivalent to standard chemoradiation is not proven. PATIENTS AND METHODS In this randomized, phase II trial, patients with p16-positive, T1-T2 N1-N2b M0, or T3 N0-N2b M0 OPSCC (7th edition staging) with ≤ 10 pack-years of smoking received 60 Gy of intensity-modulated radiation therapy (IMRT) over 6 weeks with concurrent weekly cisplatin (C) or 60 Gy IMRT over 5 weeks. To be considered for a phase III study, an arm had to achieve a 2-year progression-free survival (PFS) rate superior to a historical control rate of 85% and a 1-year mean composite score ≥ 60 on the MD Anderson Dysphagia Inventory (MDADI). RESULTS Three hundred six patients were randomly assigned and eligible. Two-year PFS for IMRT + C was 90.5% rejecting the null hypothesis of 2-year PFS ≤ 85% ( P = .04). For IMRT, 2-year PFS was 87.6% ( P = .23). One-year MDADI mean scores were 85.30 and 81.76 for IMRT + C and IMRT, respectively. Two-year overall survival rates were 96.7% for IMRT + C and 97.3% for IMRT. Acute adverse events (AEs) were defined as those occurring within 180 days from the end of treatment. There were more grade 3-4 acute AEs for IMRT + C (79.6% v 52.4%; P < .001). Rates of grade 3-4 late AEs were 21.3% and 18.1% ( P = .56). CONCLUSION The IMRT + C arm met both prespecified end points justifying advancement to a phase III study. Higher rates of grade ≥ 3 acute AEs were reported in the IMRT + C arm.

scholarly journals P03.08 Large cerebral arteriovenous malformations management with Volume-staged gamma knife radiosurgery

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii26-iii26
Author(s):  
R M Emad Eldin ◽  
W A Reda ◽  
A M El-Shehaby ◽  
K Abdel Karim ◽  
A Nabeel ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Cerebral Arteriovenous Malformations ◽  
Factors Affecting ◽  
Prescription Dose ◽  
The Mean ◽  
Cerebral Avms ◽  
Grade 3

Abstract BACKGROUND Large cerebral arteriovenous malformations (AVM) pose a management dilemma because of the limited success of any single treatment modality by itself. Surgery alone is associated with significant morbidity and mortality. Similarly, embolization alone has limited efficacy. Volume-staged gamma knife radiosurgery (VSGR) has been developed for the treatment of large AVMs, to increase the efficacy and improve safety of treatment of these lesions. The aim of the study was to assess the efficacy and safety of VSGR technique for the treatment of large cerebral AVMs. METHODS The study included patients treated by VSGR between May 2009 and July 2015. All cases had large AVMs (>10 cc). These were 29 patients. RESULTS Twenty-four patients completed radiographic follow up with 15 obliteration cases (62.5%). There was a total of 56 sessions performed. The mean AVM volume was 16 cc (10.1–29.3 cc). The mean prescription dose was 18 Gy (14–22 Gy). The mean follow up duration was 43 months (21–73 months). One patient died during follow up from unrelated cause. Two cases suffered haemorrhage during follow up. Symptomatic edema developed in 5 (17%) patients. The factors affecting obliteration were smaller total volume, higher dose/stage, non-deep location, compact AVM, AVM score less than 3, >18 Gy dose and <15 cc total volume. The factors affecting symptomatic edema were smaller total volume and shorter time between first and last sessions (p 0.012). T2 image changes were affected by SM grade 3 or more (p 0.013) and AVM score 3 or more (p 0.014). CONCLUSION VSGR provides an effective and safe treatment option for large cerebral AVMs. Smaller AVM volume is associated with higher obliteration rate.

scholarly journals Survival predictors of metastatic angiosarcomas: a surveillance, epidemiology, and end results program population-based retrospective study

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shihong Ren ◽  
Yucheng Wang ◽  
Zhan Wang ◽  
Jinxiang Shao ◽  
Zhaoming Ye
Keyword(s):  
Tumor Size ◽  
Cox Regression ◽  
Radiation Treatment ◽  
Tumor Grade ◽  
Population Based ◽  
Cancer Specific Survival ◽  
Cox Regression Analysis ◽  
Metastatic Sites ◽  
Survival Predictors ◽  
End Results

Abstract Background Angiosarcomas (AS) have poor prognosis and often metastasize to distant sites. The potential predictors of metastatic angiosarcomas (MAS) have not been extensively investigated. The main objective of this study was to identify survival predictors of MAS. Methods Surveillance, Epidemiology, and End Results (SEER) datasets were used to identify patients with MAS from 2010 to 2016. Risk predictors were determined with the aid of Kaplan-Meier and Cox regression model analyses. Results A total of 284 MAS patients met the study entry criteria. Among these, 121 patients (42.6%) were diagnosed with metastasis in bone, 26 in brain (9.2%), 86 in liver (30.3%) and 171 in lung (60.2%). Overall, 96 patients (33.8%) had two or more metastatic sites. The 1- and 3-year overall survival (OS) rates were 20.8 and 3.8% while 1- and 3-year cancer-specific survival (CSS) rates were 22.0 and 5.2%, respectively. Cox regression analysis revealed chemotherapy, radiation treatment (RT) and tumor size ≤10 cm as independent favorable predictors of OS. In terms of CSS, tumor grade IV, tumor size > 10 cm and absence of chemotherapy were independent adverse predictors. Surgery did not prolong survival outcomes (both OS and CSS) in the current cohort. Conclusion MAS is associated with extremely poor survival. Chemotherapy, RT, and tumor size are independent predictors of OS. Chemotherapy and tumor size are independent prognostic factors of CSS. Chemotherapy is therefore recommended as the preferred treatment option for MAS patients.

scholarly journals Patient Outcomes after Reirradiation of Small Skull Base Tumors using Stereotactic Body Radiotherapy, Intensity Modulated Radiotherapy, or Proton Therapy

2019 ◽  
Vol 81 (06) ◽  
pp. 638-644
Author(s):  
Sweet Ping Ng ◽  
He Wang ◽  
Courtney Pollard ◽  
Theresa Nguyen ◽  
Houda Bahig ◽  
...  
Keyword(s):  
Skull Base ◽  
Stereotactic Body Radiotherapy ◽  
Radiation Treatment ◽  
Intensity Modulated Radiotherapy ◽  
Treatment Modalities ◽  
Tumor Control ◽  
Skull Base Tumors ◽  
Intensity Modulated ◽  
Grade 3

Abstract Purpose The aim of this study was to evaluate outcomes of patients who received reirradiation for small skull base tumors utilizing either intensity modulated radiotherapy (IMRT), stereotactic body radiotherapy (SBRT), and proton radiotherapy (PRT). Methods Patients who received IMRT, SBRT or PRT reirradiation for recurrent or new small skull base tumors (< 60 cc) between April 2000 and July 2016 were identified. Those with < 3 months follow-up were excluded. Clinical outcomes and treatment toxicity were assessed. The Kaplan–Meier method was used to estimate the local control (LC), regional control (RC), distant control (DC), progression free survival (PFS), and overall survival (OS). Results Of the 75 patients eligible, 30 (40%) received SBRT, 30 (40%) received IMRT, and 15 (20%) received PRT. The median retreatment volume was 28 cc. The median reirradiation dose was 66 Gy in 33 fractions for IMRT/PRT, and 45 Gy in 5 fractions for SBRT. The median time to reirradiation was 41 months. With a median follow-up of 24 months, the LC, RC, DC, PFS, and OS rates were 84%, 79%, 82%, 60%, and 87% at 1 year, and 75%, 72%, 80%, 49%, and 74% at 2 years. There was no difference in OS between radiation modalities. The 1- and 2-year late Grade 3 toxicity rates were 3% and 11% respectively.. Conclusions Reirradiation of small skull base tumors utilizing IMRT, PRT, or SBRT provided good local tumor control and low rates of Grade 3 late toxicity. A prospective clinical trial is needed to guide selection of radiation treatment modalities.

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