scholarly journals Radiosurgery and stereotactic radiotherapy for intracranial meningiomas

2003 ◽  
Vol 14 (5) ◽  
pp. 1-6 ◽  
Author(s):  
Rodrigo Couto Torres ◽  
Leonardo Frighetto ◽  
Antonio A. F. De Salles ◽  
Brian Goss ◽  
Paul Medin ◽  
...  
Keyword(s):  
Stereotactic Radiotherapy ◽  
Primary Treatment ◽  
Tumor Control ◽  
Intracranial Tumors ◽  
Stereotactic Irradiation ◽  
Intracranial Meningiomas ◽  
Skull Base Lesions ◽  
The Mean ◽  
Atypical Meningiomas

Object The authors report the evolution of linear accelerator (LINAC)–based radiosurgery in the treatment of patients with intracranial meningiomas. They describe the technical aspects as well as clinical and radiological outcomes. Methods The authors performed a retrospective review of 161 patients harboring 194 intracranial meningiomas treated with various types of stereotactic irradiation at their institution between May 1991 and July 2002. Clinical and radiological follow-up data (mean follow-up period 32.5 months, range 6–125 months) were obtained in 128 patients (79.5%) with 156 meningiomas (80.4%). There were 88 women and 40 men whose mean age was 57.2 years (range 18–87 years). Stereotactic irradiation was the primary treatment in 44 patients, and 84 patients underwent resection prior to radiosurgery. Stereotactic radiosurgery (SRS) was used to treat 79 lesions and fractionated stereotactic radiotherapy (SRT) was used to treat 77. The mean dose for SRS was 1567 cGy (range 1200–2285 cGy) prescribed to a mean isodose line of 66.6% (range 50–90%). Stereotactic radiotherapy was delivered using a mean dose of 4839 cGy (range 2380–5400 cGy), prescribed to a mean isodose line of 89% (range 50–90%). The mean follow-up periods were 40 and 24 months in SRS- and SRT-treated patients, respectively. Tumor control was achieved in 58 SRT-treated benign meningiomas (90%) and in 70 SRT-treated lesions (97.2%). In patients with atypical meningiomas a considerably poorer prognosis was seen. Clinical improvement or stabilization of symptoms was observed in the majority of patients. Symptomatic complications were limited to four patients (5%) treated with SRS and four (5.2%) treated with SRT. Conclusions Stereotactic irradiation techniques have changed the neurosurgical approach to intracranial meningiomas. Either SRS or SRT delivered as a primary treatment in selected cases of skull base lesions or as an adjuvant after conservative resection has improved the management of these complex intracranial tumors.

scholarly journals Treatment of Residual, Recurrent, or Metastatic Intracranial Hemangiopericytomas With Stereotactic Radiotherapy Using CyberKnife

2021 ◽  
Vol 11 ◽  
Author(s):  
Lichao Huang ◽  
Jingmin Bai ◽  
Yanyang Zhang ◽  
Zhiqiang Cui ◽  
Zhizhong Zhang ◽  
...  
Keyword(s):  
Stereotactic Radiotherapy ◽  
Progression Free Survival ◽  
Tumor Grade ◽  
Tumor Control ◽  
Intracranial Metastasis ◽  
Free Survival ◽  
The Mean ◽  
Aggressive Tumors

PurposeHemangiopericytomas are aggressive tumors known for their recurrence. The purpose of this study was to evaluate the management of residual, recurrent, and metastatic intracranial hemangiopericytomas using CyberKnife (CK) stereotactic radiotherapy (SRT).Materials and MethodsData were collected from 15 patients (28 tumors; eight men and seven women; 32–58 years) with residual, recurrent, or metastatic intracranial hemangiopericytomas, who were treated with stereotactic radiotherapy using CyberKnife between January 2014 and August 2019. All patients had previously been treated with surgical resection. Initial tumor volumes ranged from 0.84 to 67.2 cm3, with a mean volume of 13.06 cm3. The mean marginal and maximum radiosurgical doses to the tumors were 21.1 and 28.76 Gy, respectively. The mean follow-up time for tumors was 34.5 months, ranging from 13 to 77 months.Results15 patients were alive after treatment; the mean post-diagnosis survival at censoring was 45.6 months (range 13–77 months). The volumes of the 28 tumors in the 15 followed patients were calculated after treatment. Postoperative magnetic resonance imaging revealed a mean tumor volume of 6.72 cm3 and a range of 0–67.2 cm3, with the volumes being significantly lower than pretreatment values. Follow-up imaging studies demonstrated tumor disappearance in seven (25%) of 28 tumors, reduction in 14 (50%), stability in one (3.57%), and recurrence in six (21.4%). Total tumor control was achieved in 22 (78.5%) of 28 tumors. The tumor grade and fraction time were not significantly associated with progression-free survival. Intracranial metastasis occurred in three patients, and extraneural metastasis in one patient.ConclusionsOn the basis of the current results, stereotactic radiotherapy using CyberKnife is an effective and safe option for residual, recurrent, and metastatic intracranial hemangiopericytomas. Long-term close clinical and imaging follow-up is also necessary.

Long-term outcomes of staged Gamma Knife radiosurgery for giant cavernous sinus hemangiomas: a single-center retrospective study

2021 ◽  
pp. 1-7
Author(s):  
Ruyi Yang ◽  
Xinjun Wang ◽  
Ziqiang Xv ◽  
Puxue Zhao ◽  
Junwu Li ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Cavernous Sinus ◽  
Clinical Symptoms ◽  
Gamma Knife Radiosurgery ◽  
Primary Treatment ◽  
Treatment Center ◽  
Benign Tumors ◽  
Tumor Control ◽  
The Mean

OBJECTIVE Cavernous sinus hemangiomas (CSHs) are rare benign tumors originating from the cavernous sinus. Gamma Knife radiosurgery (GKRS) has been recommended as a primary treatment for small- to medium-sized CSHs. The optimal treatment for giant CSHs is still controversial. In this study, the authors retrospectively reviewed the effectiveness and safety of staged GKRS treatment for giant CSHs. METHODS Twenty-two patients with giant CSH who received staged GKRS treatment in the Gamma Knife Treatment Center of Henan Province during the period from January 1, 2011, to December 31, 2018, were enrolled in this study. Six patients had received microsurgery before GKRS, the other 16 patients were diagnosed according to clinical symptoms and MR images. All of the enrolled patients received 2-stage GKRS, and the mean interval between the two GKRS treatments was 6.5 months (range 6–12 months). For the first GKRS, the median isodose line was 48% (range 45%–50%), the median marginal dose was 13 Gy (range 11.5–14 Gy), and the median coverage of CSHs was 80% (range 70%–88%). For the second GKRS treatment, the median isodose line was 50% (range 45%–55%), the median marginal dose to the CSHs was 10.5 Gy (range 9–12.5 Gy), and the median coverage of the CSHs was 88% (range 80%–94%). RESULTS All of the patients received an outpatient review of an enhanced MR image of the head and a clinical physical check every 6 months after the first GKRS treatment. The mean follow-up duration was 52 months (range 24–84 months). The tumor control rate was 100% 24 months after staged GKRS, and at the last follow-up the mean tumor shrinkage rate was 96.7% (range 90.6%–100%) and the mean residual CSH volume was 2.1 ml (range 0–8.5 ml). Twenty patients suffered central nervous system (CNS) injury symptoms to varying degrees before staged GKRS treatment. Complete symptom recovery was found in 11 (55%) patients, improved symptoms in 5 (25%) patients, and no change in 4 (20%) patients after treatment. Only 1 patient suffered temporary preexisting headache aggravation and 1 patient suffered temporary preexisting diplopia aggravation 1 week after receiving the first GKRS treatment. Subacute or chronic complications were not detected after staged GKRS. CONCLUSIONS Staged GKRS is an effective treatment for giant CSHs. Because of the impressively low incidence of adverse effects, staged GKRS may be considered as a primary treatment for giant CSHs.

scholarly journals Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: a systematic review and meta-analysis

2019 ◽  
Vol 46 (6) ◽  
pp. E2 ◽  
Author(s):  
Nida Fatima ◽  
Antonio Meola ◽  
Erqi L. Pollom ◽  
Scott G. Soltys ◽  
Steven D. Chang
Keyword(s):  
Systematic Review ◽  
Stereotactic Radiosurgery ◽  
Stereotactic Radiotherapy ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Cochrane Library ◽  
Tumor Control ◽  
Case Control Studies ◽  
Intracranial Meningiomas

OBJECTIVEStereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) have been used as a primary treatment or adjuvant to resection in the management of intracranial meningiomas (ICMs). The aim of this analysis is to compare the safety and long-term efficacy of SRS and SRT in patients with primary or recurrent ICMs.METHODSA systematic review of the literature comparing SRT and SRS in the same study was conducted using PubMed, the Cochrane Library, Google Scholar, and EMBASE from January 1980 to December 2018. Randomized controlled trials, case-control studies, and cohort studies (prospective and retrospective) analyzing SRS versus SRT for the treatment of ICMs in adult patients (age > 16 years) were included. Pooled and subgroup analyses were based on the fixed-effect model.RESULTSA total of 1736 patients from 12 retrospective studies were included. The treatment modality used was: 1) SRS (n = 306), including Gamma Knife surgery (n = 36), linear accelerator (n = 261), and CyberKnife (n = 9); or 2) SRT (n = 1430), including hypofractionated SRT (hFSRT, n = 268) and full-fractionated SRT (FSRT, n = 1162). The median age of patients at the time of treatment was 59 years. The median follow-up duration after treatment was 35.5 months. The median tumor volumes at the time of treatment with SRS, hFSRT, and FSRT were 2.84 cm3, 5.45 cm3, and 12.75 cm3, respectively. The radiographic tumor control at last follow-up was significantly worse in patients who underwent SRS than SRT (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.27–0.82, p = 0.007) with 7% less volume of tumor shrinkage (OR 0.93, 95% CI 0.61–1.40, p = 0.72). Compared to SRS, the radiographic tumor control was better achieved by FSRT (OR 0.46, 95% CI 0.26–0.80, p = 0.006) than by hFSRT (OR 0.81, 95% CI 0.21–3.17, p = 0.76). Moreover, SRS leads to a significantly higher risk of clinical neurological worsening during follow-up (OR 2.07, 95% CI 1.06–4.06, p = 0.03) and of immediate symptomatic edema (OR 4.58, 95% CI 1.67–12.56, p = 0.003) with respect to SRT. SRT could produce a better progression-free survival at 4–10 years compared to SRS, but this was not statistically significant (p = 0.29).CONCLUSIONSSRS and SRT are both safe options in the management of ICMs. However, SRT carries a better radiographic tumor control rate and a lower incidence of posttreatment symptomatic worsening and symptomatic edema, with respect to SRS. However, further prospective studies are still needed to validate these results.

MANAGEMENT OF CYSTIC CRANIOPHARYNGIOMAS WITH STEREOTACTIC ENDOCAVITARY IRRADIATION USING COLLOIDAL 186

Neurosurgery ◽  
2008 ◽  
Vol 63 (6) ◽  
pp. 1045-1053 ◽  
Author(s):  
Stephane Derrey ◽  
Serge Blond ◽  
Nicolas Reyns ◽  
Gustavo Touzet ◽  
Philippe Carpentier ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Cognitive Dysfunction ◽  
Adjuvant Treatment ◽  
Primary Treatment ◽  
Effective Procedure ◽  
Tumor Control ◽  
Cyst Volume ◽  
The Mean ◽  
Endocavitary Irradiation

Abstract OBJECTIVE We retrospectively reviewed the results of stereotactic endocavitary irradiation with colloidal 186Re in the treatment of cystic craniopharyngiomas. METHODS Among 54 consecutive patients included in a 186Re stereotactic endocavitary irradiation procedure, 42 patients (29 male and 13 female; average age, 38.7 years) received therapeutic injection via intracystic catheter introduced under stereotactic conditions. The mean follow-up period was 43 months (range, 8–148 months). Endocavitary irradiation was the primary treatment for 15 patients and an adjuvant treatment for 27 patients. The mean volume before irradiation was 8.07 mm3, and the mean radiation dose was 381 MBq. RESULTS Cystic mean volume after irradiation was 2.6 cm3 (P < 0.001 with initial volume). The retraction of the cyst was complete for 17 patients (44%) and partial for 17 (44%). In partial retraction, cystic volume decreased more than 50% for 12 (3%) patients and less than 25% (13%) for 5. Cystic volume remained the same or increased for 5 (13%) patients. Concerning visual functions, 12 (44.5%) patients improved and 2 worsened, despite tumor control. No endocrinological deterioration occurred. Among 17 patients with preoperative cognitive dysfunction, 10 improved and 6 had no change. One patient showed memory alteration 4 months after stereotactic endocavitary irradiation despite cyst volume reduction. No mortality occurred. CONCLUSION 186Re stereotactic endocavitary irradiation for the treatment of cystic craniopharyngiomas is a safe and effective procedure with a tumor control rate greater than 70%. This treatment can be used for first-intention treatment of pure cystic craniopharyngiomas or for second-intention treatment of cystic recurrences.

scholarly journals Gamma Knife radiosurgery in the treatment of abducens nerve schwannomas: a retrospective study

2016 ◽  
Vol 125 (4) ◽  
pp. 832-837 ◽  
Author(s):  
Govindaraju Lakshmi Prasad ◽  
Manish Singh Sharma ◽  
Shashank S. Kale ◽  
Deepak Agrawal ◽  
Manmohan Singh ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Abducens Nerve ◽  
Symptomatic Improvement ◽  
Tumor Control ◽  
Imaging Features ◽  
Intracranial Tumors ◽  
The Mean

OBJECTIVE Of the intracranial schwannomas, those arising from the vestibular nerves are the most common. Abducens nerve (AN) schwannomas are very rare, and there is limited literature on their optimal management. Therapeutic options include surgery and/or stereotactic radiosurgery. The aim of this study was to evaluate the role of Gamma Knife radiosurgery (GKRS) in these sixth cranial nerve (CN) schwannomas. METHODS The authors performed a retrospective analysis of patients who had undergone GKRS for intracranial tumors at their institute in the period from 2003 to 2010. Inclusion criteria were as follows: isolated AN paresis on presentation, a lesion along the course of the sixth CN, and imaging features characteristic of a schwannoma. Patients with other CN deficits and neurofibromatosis Type 2 were excluded. Symptomatic improvement was defined as the resolution of or an improvement in diplopia noted on a subjective basis or as an improvement in lateral eyeball excursion noted objectively on follow-up. A reduction in tumor volume by at least 20%, as noted by comparing the pre- and post-GKRS images, was deemed significant. RESULTS Six patients with a mean age of 37.1 years (range 17–55 years) underwent primary GKRS. There were 2 prepontine cistern, 3 cavernous sinus, and 1 cisterno-cavernous tumor. The mean duration of symptoms was 6.1 months (range 3–12 months). The mean tumor volume was 3.3 cm3 (range 1.5–4.8 cm3). The mean tumor margin radiation dose was 12.5 Gy (range 12–14 Gy), while the median margin dose was 12 Gy (50% isodose line). The median number of isocenters used was 5 (range 4–8). The brainstem received an average 8.35-Gy radiation dosage (range 5.5–11 Gy). The mean follow-up duration was 44.3 months (range 24–78 months). Symptoms remained stable in 1 patient, improved in 3, and resolved in 2 (total improvement 83%). Magnetic resonance imaging at the last follow-up showed a stable tumor size in 3 patients (50%) and a reduction in the other 3. Thus, the tumor control rate achieved was 100%. No new CN deficits were noted. CONCLUSIONS Abducens nerve schwannomas are rare intracranial tumors. They can be cavernous, cisternal, or cisterno-cavernous in location. Excellent tumor control rates and symptomatic improvement can be achieved with GKRS, which appears to be a safe and effective, minimally invasive modality for the treatment of such lesions. Therefore, it is reasonable to consider GKRS as the initial treatment of choice for this rare pathology. Long-term follow-up will be essential for further recommendations.

Stereotactic radiotherapy for the treatment of acoustic neuromas

2004 ◽  
Vol 101 (Supplement3) ◽  
pp. 362-372 ◽  
Author(s):  
Michael T. Selch ◽  
Alessandro Pedroso ◽  
Steve P. Lee ◽  
Timothy D. Solberg ◽  
Nzhde Agazaryan ◽  
...  
Keyword(s):  
Stereotactic Radiotherapy ◽  
Tumor Size ◽  
Cranial Nerve ◽  
Target Volume ◽  
Tumor Control ◽  
Content Type ◽  
Seventh Cranial Nerve ◽  
Acoustic Neuromas ◽  
Fine Print

Object. The authors sought to assess the safety and efficacy of stereotactic radiotherapy when using a linear accelerator equipped with a micromultileaf collimator for the treatment of patients with acoustic neuromas. Methods. Fifty patients harboring acoustic neuromas were treated with stereotactic radiotherapy between September 1997 and June 2003. Two patients were lost to follow-up review. Patient age ranged from 20 to 76 years (median 59 years), and none had neurofibromatosis. Forty-two patients had useful hearing prior to stereotactic radiotherapy. The fifth and seventh cranial nerve functions were normal in 44 and 46 patients, respectively. Tumor volume ranged from 0.3 to 19.25 ml (median 2.51 ml). The largest tumor dimension varied from 0.6 to 4 cm (median 2.2 cm). Treatment planning in all patients included computerized tomography and magnetic resonance image fusion and beam shaping by using a micromultileaf collimator. The planning target volume included the contrast-enhancing tumor mass and a margin of normal tissue varying from 1 to 3 mm (median 2 mm). All tumors were treated with 6-MV photons and received 54 Gy prescribed at the 90% isodose line encompassing the planning target volume. A sustained increase greater than 2 mm in any tumor dimension was defined as local relapse. The follow-up duration varied from 6 to 74 months (median 36 months). The local tumor control rate in the 48 patients available for follow up was 100%. Central tumor hypodensity occurred in 32 patients (67%) at a median of 6 months following stereotactic radiotherapy. In 12 patients (25%), tumor size increased 1 to 2 mm at a median of 6 months following stereotactic radiotherapy. Increased tumor size in six of these patients was transient. In 13 patients (27%), tumor size decreased 1 to 14 mm at a median of 6 months after treatment. Useful hearing was preserved in 39 patients (93%). New facial numbness occurred in one patient (2.2%) with normal fifth cranial nerve function prior to stereotactic radiotherapy. New facial palsy occurred in one patient (2.1%) with normal seventh cranial nerve function prior to treatment. No patient's pretreatment dysfunction of the fifth or seventh cranial nerve worsened after stereotactic radiotherapy. Tinnitus improved in six patients and worsened in two. Conclusions. Stereotactic radiotherapy using field shaping for the treatment of acoustic neuromas achieves high rates of tumor control and preservation of useful hearing. The technique produces low rates of damage to the fifth and seventh cranial nerves. Long-term follow-up studies are necessary to confirm these findings.

Gamma Knife surgery for invasive pituitary macroadenoma

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 26-30 ◽  
Author(s):  
Mooseong Kim ◽  
Sunghwa Paeng ◽  
Seyoung Pyo ◽  
Yeonggyun Jeong ◽  
Sunil Lee ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Pituitary Macroadenoma ◽  
Female Ratio ◽  
Fractionated Radiotherapy ◽  
The Mean

ObjectPituitary adenomas have been treated using a variety of modalities including resection, medication, fractionated radiotherapy, and stereotactic radiosurgery. The policy has been that all adenomas should first be treated with resection to reduce the volume of the tumor. The authors' study was conducted to determine the efficacy of using Gamma Knife surgery (GKS) for pituitary adenomas invading the cavernous sinus.MethodsOf 397 patients with pituitary tumors who underwent GKS between October 1994 and October 2005, 68 patients had pituitary macroadenomas invading the cavernous sinus. Sixty-seven cases were available for follow up. The mean age of the patients in these cases was 42.8 years (range 14–73 years). The male/female ratio was 0.8:1. The mean adenoma volume was 9.3 cm3. A total of 24 patients had undergone craniotomies and resection, and 11 patients had undergone transsphenoidal surgery prior to GKS. The mean follow-up period was 32.8 months. Tumor control was defined as a decrease or no change in tumor volume after GKS. Endocrinological improvement was defined as a decline in hormone levels to below 50% of the pre-GKS level.Tumor control was achieved in 95.5% of the cases. Endocrinological improvement was achieved in 68% of 25 patients. One patient suffered hypopituitarism after GKS.Conclusions Gamma Knife surgery is a safe and effective treatment for invasive pituitary macroadenoma with few complications.

Primary Dermal Melanoma (PDM): Histological and Clinical Interdependence to Guide Therapy

2020 ◽  
pp. 120347542095763
Author(s):  
Hadas Zamir ◽  
Meora Feinmesser ◽  
Haim Gutman
Keyword(s):  
Mitotic Rate ◽  
Primary Treatment ◽  
Stage Iii ◽  
Sentinel Nodes ◽  
Time Period ◽  
Nodal Dissection ◽  
The Mean ◽  
Tight Correlation ◽  
Better Than

Background/purpose This study examined clinical and histological parameters of primary dermal melanoma (PDM) to aid in its distinction from dermal metastasis. Methods Retrospective analysis of a prospective cohort of PDM patients. Includes patients fulfilling the strict histologic criteria for PDM ( N = 9) and patients who did not, but clinically, unequivocally had an intradermal melanoma—clinical PDM (cPDM; N = 17). Histopathology slides were re-examined. Prognosticators and outcome measures were compared between groups. Sentinel nodes’ retrieval and wide local excision (WLE) were offered to all patients as primary treatment. Results 26 patients identified, 15 females with a median age of 69 years (range 3.5-85). Mean Breslow was 7.9 ± 5.7 mm (median 5.8, range 1.8-25.0), and the mean mitotic rate was 4.9 ± 3.8/mm2 (median 4.0, range 0-17). Initial treatment and follow-up were as for cutaneous melanoma. One patient in each group with a palpable stage III underwent primary radical dissection. Sentinel nodes were retrieved in all 20 lymphatic mappings performed and found to be metastatic in 5 (25%) patients. Treatment consisted of completion lymph-node dissection. At a median postoperative follow-up of 62 months (range 8-132), 20 patients were disease-free, including 6 of 7 patients with stage III disease at presentation. Six patients died all of cPDM; 5 of 6 patients had primary ulcerated or epidermal-abutting melanomas. Conclusions This is the first study to highlight cPDM. Diagnosis requires expert pathology review and a tight correlation to the clinical parameters. Patients seem to benefit from WLE with sentinel node retrieval and complete dissection when appropriate. However, clinical guidelines for dissection have changed since the time period of this retrospective review. Based on this series, complete nodal dissection in these melanomas is associated with better than expected outcome, for stage III disease.

Secondary intra-arterial chemotherapy and/or intravitreal chemotherapy as salvage treatment for retinoblastoma

2020 ◽  
pp. 112067212095758
Author(s):  
Ibadulla Mirzayev ◽  
Ahmet Kaan Gündüz ◽  
Kıvılcım Yavuz ◽  
Mehmet Zahid Şekkeli ◽  
Funda Seher Özalp Ateş ◽  
...  
Keyword(s):  
Survival Rates ◽  
Primary Treatment ◽  
Salvage Treatment ◽  
External Radiotherapy ◽  
Intravitreal Chemotherapy ◽  
The Mean ◽  
Group B ◽  
Group D

Purpose: To evaluate the results of secondary intra-arterial chemotherapy (IAC) and/or intravitreal chemotherapy (IVC) as a salvage treatment for retinoblastoma (RB). Materials and Methods: The medical records of 31 (20 male, 11 female) cases (with 38 eyes) who underwent secondary IAC and/or IVC between February 2010 and June 2019 were retrospectively reviewed. Results: Thirteen (41.9%) cases had unilateral and 18 (58.1%) had bilateral RB. According to the International Classification of RB, 6 (15.8%) eyes had group B, 9 (23.7%) eyes had group C, 16 (42.1%) eyes had group D, and 7 (18.4%) eyes had group E RB at diagnosis. All patients underwent six-cycle intravenous chemotherapy as primary treatment and 8 eyes received external radiotherapy before IAC/IVC. Secondary IAC was performed in 21 (55.3%) eyes, IVC in 10 (26.3%) eyes, and IAC + IVC in 7 (18.4%) eyes. External radiotherapy was applied in 2 (5.3%) eyes after IAC/IVC, one of which was later enucleated. In total, 17 (44.7%) eyes undergoing secondary IAC/IVC treatments were enucleated. Metastasis and death were not observed in any case during the mean follow-up period of 59.3 (median 61, range: 10–98) months. Discussion: Although 60.5% of the eyes undergoing IAC/IVC consisted of groups D and E RB, globe salvage and survival rates were 55.3% and 100.0%, respectively. External radiotherapy was required in 5.3% of the eyes after IAC/IVC. In conclusion, IAC and IVC are safe and effective treatment methods in eyes with RB unresponsive to other eye-preserving treatments and those demonstrating recurrence.

scholarly journals P14.78 Hypofractionated stereotactic radiotherapy as a salvage therapy for recurrent high-grade gliomas: Single-center experience

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii86-iii86
Author(s):  
T Reynaud ◽  
A Bertaut ◽  
W Farah ◽  
D Thibouw ◽  
G Crehange ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Stereotactic Radiotherapy ◽  
Tumor Control ◽  
High Grade ◽  
Single Center ◽  
Hypofractionated Stereotactic Radiotherapy ◽  
Number Of Patients ◽  
High Grade Gliomas ◽  
Grade Iii

Abstract BACKGROUND The standard of care for patients with recurrent glioblastoma or grade III glioma has not yet been clearly defined and many approaches are available for salvage strategies. These include surgery, re-irradiation or systemic agents. For the treatment of High-Grade (HGG) recurrence by radiation therapy, Hypofractionated Stereotactic Radiotherapy (HFSRT) is an interesting approach because it is minimally invasive, ambulatory, short-lasting and well tolerated. The aim of this study was to evaluate the efficacy of and safety to HFSRT as alvage treatment for patients suffering from HGG relapse in our cancer center and to compare these results with the literature. MATERIAL AND METHODS Between March 2012 and March 2017, 32 consecutive patients (12 women, 20 men) treated in a single-center were retrospectively included included in this study.Grade III gliomas were diagnosed in 14 patients and grade IV in 18 patients. Thirty-four lesions were treated with HFSRT on LINAC. HFSRT delivered a dose of 30 Gy in six fractions of 5Gy (27 Gy in three fractions for one patient) with two or three fractions per week. The treatment plans were normalized to 100% at the isocenter, and prescribed to the 80 % isodose line. Clinical outcomes and prognostic factors were analyzed. RESULTS HFSRT characteristics: The median tumor volume was of 6.1 (0.1–42.2) cm3 and the median PTV was 15 (0.6–67.5) cm3. The median maximum dose, median minimum dose and median mean dose were 38.7 (32.7–42.0) Gy, 29.1 (14.0–32.4) Gy and 35.1 (31.5–37.5) Gy, respectively. Median follow-up was 20.9 months. Median overall survival (OS) following HFSRT was 15.6 months (Median OS for patients patients with GBM and grade III glioma were 8.2 and 19.5 months, respectively; p=0.0496). Progression-free survival (PFS) was 3.7 months (Median PFS for patients with GBM and grade III glioma were 3.6 and 4.5months, respectively; p=0.2424). In multivariate analysis, tumor grade III (p=0.0027), an ECOG status <2 at the time of reirradiation (p=0.0023) and a mean dose >35 Gy (p=0.0055) significantly improved OS. A maximum reirradiation dose above 38 Gy (p=0.0179) was significantly associated with longer PFS. Treatment was well tolerated, no acute toxicity > grade 2 was observed. During the follow-up, ten patients (31.25%) had suspected radionecrosis. In six patients, this suspicion corresponded to tumor progression. For the other patients, radionecrosis was suggested on multi-modal MRI. CONCLUSION HFSRT appears to be a feasible and effective salvage treatment option for recurrent high-grade gliomas, with OS of 15.6 months. Prognostic factors associated with longer OS were a good general state of health and grade III glioma. Dosimetric data suggested that the dose gradient had an impact on tumor control and indicate that a study with dose-escalation is warranted. These results need to be confirmed in a prospective study with a greater number of patients.

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