A Comparison of Survival after Radiosurgery in Non-Small Cell Lung Cancer Patients with One versus More than Twenty Brain Metastases

Background Whether the number or cumulative volume of brain metastases affects survival in patients with metastatic non-small cell lung cancer (NSCLC) remains controversial. We sought to compare whether patients with solitary brain disease had better outcomes than patients with ≥ 20 brain metastases. Methods Between 2014 to 2020, 26 NSCLC patients (925 tumors) underwent stereotactic radiosurgery (SRS) for ≥ 20 metastases in a single procedure (median margin dose = 16 Gy, median cumulative tumor volume = 4.52 cc); 56 patients underwent SRS for a single metastasis (median margin dose = 18 Gy, median volume = 4.74 cc). The overall survival (OS), local tumor control (LC), adverse radiation effect (ARE) risk, and incidence of new tumor development were compared. Results No difference in OS was found between patients with ≥ 20 brain metastases (median OS = 15 months) and patients with solitary metastasis (median OS = 12 months; p = 0.3). In the solitary tumor cohort, two of 56 (3.5%) tumors progressed whereas in the ≥ 20 cohort only 3 of 925 (0.3%) tumors showed progression (*p = 0.0013). The rate of new tumor development was significantly higher in patients with ≥ 20 tumors (***p = 0.0001). No significant difference of ARE rate was found (7.5% for ≥ 20 tumors vs. 8.7% for single metastasis). Conclusions Patients with ≥ 20 tumors showed significantly better LC with similar OS compared to patients with solitary tumors. Current guidelines that restrict the role of SRS to patients with 1-4 tumors should be revised.

Two new species and new records of Otocepheidae (Acari, Oribatida) from Yunnan, Southwest China

This work includes taxonomic data on four species of oribatid mites of the family Otocepheidae from Yunnan, China. Two new species of the genera Basiceramerus and Eurostocepheus are described, respectively. Basiceramerus ovatussp. nov. differs from B. bangladeshensis Corpuz-Raros & Gruèzo, 2008 by the wavy marginalis passing the base of the adanal setae, prodorsal condyles well separated from median ones, a ventral ridge present, and the anal plate foveolate; it differs from B. igorotus Corpuz-Raros & Gruèzo, 2011 from Vietnam by the wavy marginalis passing the base of the adanal setae, a connected tutorium and lamelliform expansion, a ventral ridge present, a smooth genital plate, and seta an2 located close to the median margin of the anal opening; it differs from B. igorotus from the Philippines by the lamellar setae inserted behind the tip of the lamella, separated prodorsal condyles, lyrifissure im posterior to gla, genital plate smooth, anal plate foveolate, and the wavy marginalis passing the base of the adanal setae. Eurostocepheus (Eurostocepheus) sinutussp. nov. differs from other known species of this genus by having a ventral groove between the genital aperture and the ventral ridge, eight pairs of notogastral setae, and distinctly shorter and thinner notogastral setae p1, p2, p3, h3. Eurostocepheus (Eurostocepheus) aquilinus Aoki, 1965 and E. (E.) mahunkai Mondal & Kundu, 1999 are reported for the first time from China.

Adverse radiation effects in volume-staged radiosurgery for large arteriovenous malformations: a multiinstitutional study

OBJECTIVE The optimal treatment paradigm for large arteriovenous malformations (AVMs) is controversial. One approach is volume-staged stereotactic radiosurgery (VS-SRS). The authors previously reported efficacy of VS-SRS for large AVMs in a multiinstitutional cohort; here they focus on risk of symptomatic adverse radiation effects (AREs). METHODS This is a multicentered retrospective review of patients treated with a planned prospective volume staging approach to stereotactically treat the entire nidus of an AVM, with volume stages separated by intervals of 3–6 months. A total of 9 radiosurgical centers treated 257 patients with VS-SRS between 1991 and 2016. The authors evaluated permanent, transient, and total ARE events that were symptomatic. RESULTS Patients received 2–4 total volume stages. The median age was 33 years at the time of the first SRS volume stage, and the median follow-up was 5.7 years after VS-SRS. The median total AVM nidus volume was 23.25 cm3 (range 7.7–94.4 cm3), with a median margin dose per stage of 17 Gy (range 12–20 Gy). A total of 64 patients (25%) experienced an ARE, of which 19 were permanent. Rather than volume, maximal linear dimension in the Z (craniocaudal) dimension was associated with toxicity; a threshold length of 3.28 cm was associated with an ARE, with a 72.5% sensitivity and a 58.3% specificity. In addition, parietal lobe involvement for superficial lesions and temporal lobe involvement for deep lesions were associated with an ARE. CONCLUSIONS Size remains the dominant predictor of toxicity following SRS, but overall rates of AREs were lower than anticipated based on baseline features, suggesting that dose and size were relatively dissociated through volume staging. Further techniques need to be assessed to optimize outcomes.

Optimizing Stereotactic Radiosurgery in Patients With Recurrent or Residual Craniopharyngiomas

PurposeStereotactic radiosurgery (SRS) is an important management strategy for residual and recurrent Craniopharyngiomas. The current study evaluated the factors which affected tumor control and complications in craniopharyngioma SRS.MethodsThis study includes 53 consecutive patients who underwent single-session SRS for recurrent or residual craniopharyngiomas. The median age was 41 years with 28 male and 25 females. The median tumor volume was 0.63 cm3 and median margin dose was 12 Gy (range, 9-25 Gy).ResultsThe overall 3-, 5-, and 10-year survival rates were 97.8%, 92.7% and 88.5%. The overall 3-, 5-, and 10-year tumor control rates were 81.0%, 72.1%, and 53.4%. In univariate analysis, >3 mm distance from optic structures (p=0.002), only solid or cystic tumor type (p=0.037), and >12 Gy to ≥85% of the tumor (p<0.001) were significantly associated with improved tumor control. In multivariate analysis, only solid or cystic tumor type, (p=0.034), and >85% of the tumor receiving >12 Gy (p=0.004) were significantly associated with better tumor control. When >85% of the tumor received >12 Gy the tumor control rates at 3-, 5-, and 10-year were 100%, 93.3%, and 93.3%. Higher conformity index was not associated with better tumor control.ConclusionsThe tumor control rates after recurrent or residual craniopharyngiomas SRS were improved by ensuring that at least 85% of the tumor received >12 Gy even when the distance between the tumor and the optic system is <3 mm. This concept refutes the conformity theory that a high conformity index is a critical feature of effective SRS.

Description of a new species of the genus Lebbeus White, 1847 (Decapoda, Thoridae) from the Bohai Sea, China

A new species of the caridean family Thoridae, Lebbeus liui sp. nov., is described from the Bohai Sea, China. It belongs to the group characterized by the presence of epipods on the third maxilliped to third pereiopod. The new species is most similar to L. fasciatus and L. speciosus. It differs from the above two species by the number of the dorsal teeth and the spacing of those on the rostrum, and by the posterior median margin of the telson not produced into a triangular tooth.

Gamma Knife radiosurgery for cerebral cavernous malformation

This is a retrospective study examining the efficacy and safety of Gamma Knife radiosurgery (GKS) in treating patients with cerebral cavernous malformations (CCMs). Between 1993 and 2018, 261 patients with 331 symptomatic CCMs were treated by GKS. The median age was 39.9 years and females were predominant (54%). The median volume of CCMs was 3.1 mL. The median margin dose was 11.9 Gy treat to a median isodose level of 59%. Median clinical and imaging follow-up times were 69 and 61 months, respectively. After the initial hemorrhage that led to CCM diagnosis, 136 hemorrhages occurred in the period prior to GKS (annual incidence = 23.6%). After GKS, 15 symptomatic hemorrhages occurred within the first 2 years of follow-up (annual incidence = 3.22%), and 37 symptomatic hemorrhages occurred after the first 2 years of follow-up (annual incidence = 3.16%). Symptomatic radiation-induced complication was encountered in 8 patients (3.1%). Mortality related to GKS occurred in 1 patient (0.4%). In conclusion, GKS decreased the risk of hemorrhage in CCM patients presenting with symptomatic hemorrhage. GKS is a viable alternative treatment option for patients with surgically-inaccessible CCMs or significant medical comorbidities.

MLTI-15. A CASE SERIES OF PRE-OPERATIVE GAMMA-KNIFE RADIOSURGERY FOR RESECTABLE BRAIN METASTASES

Recent advances in the systemic treatment of various cancers have resulted in longer survival and higher incidence of brain metastases. Phase 3 trials in north America and in Japan have demonstrated that stereotactic radiosurgery will be a standard adjuvant modality following surgery for resectable brain metastases. However, we don’t know the optimal sequence of this combination therapy. We hypothesized that pre-operative stereotactic radiosurgery for resectable brain metastases provides favorable rates of local control, overall survival, leptomeningeal dissemination and symptomatic radiation necrosis. We have experienced 4 cases of resected brain metastases within 1–7 days after Gamma-knife surgery (median margin dose:22Gy) and have been following their clinical course. We will show the repressive cases.

P03.03 Dynamics of brain metastasis cavities between resection and adjuvant stereotactic radiotherapy and impact of the delay on local control

BACKGROUND Adjuvant stereotactic radiotherapy (SRT) to the surgical cavity of brain metastases (BM) improves the local control. An early post-operative irradiation is desirable to limit the risk of recurrence while delaying it might reduce the risk of radionecrosis by reducing the size of the target volume (TV) thanks to the cavity constriction. The purpose of our study was to examine cavity dynamics after resection to determine if delaying SRT influences cavity size as well as local progression (LP). MATERIAL AND METHODS We reviewed 70 BM resection cavities treated with adjuvant SRT. A preoperative, immediate postoperative and at the time of SRT, 3D T1-weigthed MRI, were available for all patients. The volumes were retrospectively calculated with the PACS software Telemis® version 4 and the iPlan RT image software. For all cavities, the TV was obtained by expanding the cavity by a median margin of 2mm to account for microscopic spread. The surgical track and edema areas were not included in the TV. The dynamic evolution of cavities and LP according to the delay of SRT were analyzed. RESULTS The median time from surgery to SRT was 27 days (3–99). The median preoperative and SRT cavity volumes were 7.2 cc (ranges: 0.5–29.5) and 8 cc (ranges: 0.8–31), respectively. After margin expansion, the TV was increased to a median of 14.8 cc. The volumetric cavity changes were an increase by 2 cc in 35 %, whereas only 22.5 % decreased by 2 cc and 42.5% cavities were stable (defined as a change ≤2 cc). We noted that 11% of volume change were attributable to the delay (r2 = 0.11). forty-seven patients were treated within a delay of 30 days and experienced early LP in 10.6 % against 20 % beyond 30 days (p= 0.6). CONCLUSION In the interval between surgery and SRT, BM cavities dynamics are inconstant and unpredictable in function of time. Furthermore, delaying SRT may compromise local control, though the difference was not statistically significant due to the small size of our population. A preoperative SRT strategy looks more promising by alleviating the problem of time and reducing the volume of irradiated brain.

How to improve obliteration rates during volume-staged stereotactic radiosurgery for large arteriovenous malformations

OBJECTIVEThe management of large-volume arteriovenous malformations (AVMs) with stereotactic radiosurgery (SRS) remains challenging. The authors retrospectively tested the hypothesis that AVM obliteration rates can be improved by increasing the percentage volume of an AVM that receives a minimal threshold dose of radiation.METHODSIn 1992, the authors prospectively began to stage anatomical components in order to deliver higher single doses to AVMs > 15 cm3 in volume. Since that time 60 patients with large AVMs have undergone volume-staged SRS (VS-SRS). The median interval between the first stage and the second stage was 4.5 months (2.8–13.8 months). The median target volume was 11.6 cm3 (range 4.3–26 cm3) in the first-stage SRS and 10.6 cm3 (range 2.8–33.7 cm3) in the second-stage SRS. The median margin dose was 16 Gy (range 13–18 Gy) for both SRS stages.RESULTSAVM obliteration after the initial two staged volumetric SRS treatments was confirmed by MRI alone in 4 patients and by angiography in 11 patients at a median follow-up of 82 months (range 0.4–206 months) after VS-SRS. The post–VS-SRS obliteration rates on angiography were 4% at 3 years, 13% at 4 years, 23% at 5 years, and 27% at 10 years. In multivariate analysis, only ≥ 20-Gy volume coverage was significantly associated with higher total obliteration rates confirmed by angiography. When the margin dose is ≥ 17 Gy and the 20-Gy SRS volume included ≥ 63% of the total target volume, the angiographically confirmed obliteration rates increased to 61% at 5 years and 70% at 10 years.CONCLUSIONSThe outcomes of prospective VS-SRS for large AVMs can be improved by prescribing an AVM margin dose of ≥ 17 Gy and adding additional isocenters so that ≥ 63% of the internal AVM dose receives more than 20 Gy.

Taxonomy of the Brazilian firefly Cladodes illigeri (Coleoptera, Lampyridae): morphology and new records

ABSTRACT Cladodes illigeri (Kirby, 1818) is redescribed, and can be distinguished by the following features: color pattern overall black, paired spots and elytral margins pale yellow; pygidium bisinuate, posterior angles rounded, as long as median margin; and aedeagus with phallus 1/3 shorter than the parameres, which are sinuated apically. Cladodes lamellicornis (Motschulsky, 1854) is proposed as a junior synomym of C. illigeri. New records from the Atlantic Rainforest and illustrations for structural features are provided.