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Current Opinion in Supportive and... Sep 2018The oligometastases is considered an intermediate state of the disease between localized and wide spread metastases. Local ablative therapy to oligometastatic prostate... (Review)
Review
PURPOSE OF REVIEW
The oligometastases is considered an intermediate state of the disease between localized and wide spread metastases. Local ablative therapy to oligometastatic prostate cancer is gaining significant traction and stereotactic body radiotherapy (SBRT) is an emerging treatment modality for this patient population. In this review, we report our literature review of SBRT to prostate oligometastases. Current evidence on the role of SBRT in oligometastatic prostate cancer reported in the last 10 years was summarized. Criteria for inclusion included studies with prostate cancer only as the primary site.
RECENT FINDINGS
The unique properties of the oligometastatic prostate cancer appear to carry a better prognosis than wide spread metastatic disease, especially if these metastases are amenable to local ablative therapies. Our literature review revealed that local ablative therapy, using SBRT to prostate oligometastases, is associated with significant 2-years local control and acceptable toxicity profile.
SUMMARY
SBRT to oligometastatic prostate cancer patients is feasible and carries an acceptable toxicity profile. The randomized phase II and III trials, currently underway, should clearly define the real benefit of this approach on progression-free and overall survival outcomes.
Topics: Humans; Male; Neoplasm Metastasis; Prostatic Neoplasms; Radiofrequency Ablation; Radiosurgery
PubMed: 29979320
DOI: 10.1097/SPC.0000000000000371 -
Acta Neurochirurgica Apr 2019Stereotactic radiosurgery (SRS) is increasingly used as a minimally invasive alternative in many neurosurgical conditions, including benign and malignant tumors,...
INTRODUCTION
Stereotactic radiosurgery (SRS) is increasingly used as a minimally invasive alternative in many neurosurgical conditions, including benign and malignant tumors, vascular malformations, and functional procedures. As for any surgical procedure, strict safety guidelines and checklists are necessary to avoid errors and the inherent unnecessary complications. With regard to the former, other groups have already reported human and/or technical errors. We describe our safety checklist for Gamma Knife radiosurgical procedures.
METHODS
We describe our checklist protocol after an experience gained over 1500 radiosurgical procedures, using Gamma Knife radiosurgery, performed over a period of 8 years, while employing the same list of items. Minor implementation has been performed over time to address some safety issues that could be improved.
RESULTS
Two types of checklist are displayed. One is related to the indications when a specific tissue volume is irradiated, including tumors or vascular disorders. The second corresponds to functional disorders, such as when the dose is prescribed to one specific point. Using these checklists, no human error had been reported during the past 8 years of practice in our institution.
CONCLUSION
The use of a safety checklist for SRS procedures promotes a zero-tolerance attitude for errors. This can lower the complications and is of major help in promoting multidisciplinary cooperation. We highly recommend the use of such tool, especially in the context of the increased use of SRS in the neurosurgical field.
Topics: Checklist; Humans; Radiosurgery; Stereotaxic Techniques; Treatment Outcome
PubMed: 30790090
DOI: 10.1007/s00701-019-03843-2 -
World Neurosurgery Jul 2016Recurrent World Health Organization (WHO) grade II and III meningiomas have traditionally been treated by surgery alone, but early literature suggests that adjuvant...
OBJECTIVE
Recurrent World Health Organization (WHO) grade II and III meningiomas have traditionally been treated by surgery alone, but early literature suggests that adjuvant stereotactic radiosurgery may greatly improve outcomes. We present the long-term tumor control and safety of a hypofractionated stereotactic radiosurgery regimen.
METHODS
Prospectively collected data of 44 WHO grade II and 9 WHO grade III meningiomas treated by CyberKnife for adjuvant or salvage therapy were reviewed. Patient demographics, treatment parameters, local control, regional control, locoregional control, overall survival, radiation history, and complications were documented.
RESULTS
For WHO grade II patients, recurrence occurred in 41%, with local, regional, and locoregional failure at 60 months recorded as 49%, 58%, and 36%. For WHO grade III patients, recurrence occurred in 66%, with local, regional, and locoregional failure at 12 months recorded as 57%, 100%, and 43%. The 60-month locoregional control rates for radiation naïve and experienced patients were 48% and 0% (P = 0.14). Overall, 7 of 44 grade II patients and 8 of 9 grade III patients had died at last follow-up. The 60-month and 12-month overall survival rates for grade II and III meningiomas were 87% and 50%, respectively. Serious complications occurred in 7.5% of patients.
CONCLUSIONS
Stereotactic radiosurgery for adjuvant and salvage treatment of WHO grade II meningioma using a hypofractionated plan is a viable treatment strategy with acceptable long-term tumor control, overall survival, and complication rates. Future studies should focus on radiation-naïve patients and local management of malignant meningioma.
Topics: Adult; Aged; Aged, 80 and over; Brain Neoplasms; Female; Humans; Magnetic Resonance Imaging; Male; Meningioma; Middle Aged; Patient Care Planning; Postoperative Complications; Prospective Studies; Radiosurgery; Survival Analysis; Tomography, X-Ray Computed
PubMed: 27108030
DOI: 10.1016/j.wneu.2016.04.019 -
Practical Radiation Oncology 2021Myositis of the paraspinal muscles can be a clinically significant side effect of spinal radiation surgery. This report describes the typical clinical scenario, relevant...
Myositis of the paraspinal muscles can be a clinically significant side effect of spinal radiation surgery. This report describes the typical clinical scenario, relevant radiologic findings, treatment, and management with the best available evidence.
Topics: Humans; Imaging, Three-Dimensional; Myositis; Radiosurgery
PubMed: 33941351
DOI: 10.1016/j.prro.2021.02.004 -
International Journal of Radiation... Jan 2022We sought to determine whether a more widely accessible, noninvasive, frameless approach to radiosurgical thalamotomy would improve objective measures of refractory... (Clinical Trial)
Clinical Trial Observational Study
PURPOSE
We sought to determine whether a more widely accessible, noninvasive, frameless approach to radiosurgical thalamotomy would improve objective measures of refractory essential or parkinsonian tremor without added toxicity compared with reports of frame-based radiosurgery.
METHODS AND MATERIALS
We conducted a single-arm pilot observational prospective trial of adult patients with essential or parkinsonian tremor from 2013 to 2019 and report results at 1-year follow-up. Patients were treated with frameless unilateral radiosurgical ablation of the thalamic ventral intermediate nucleus to a maximum dose of 160 Gy. Treatment response was measured by the Fahn-Tolosa-Marin (FTM) tremor rating scale and the Quality of Life in Essential Tremor or Parkinson's Disease Questionnaire obtained before treatment and at 3, 6, 9, and 12 months.
RESULTS
Thirty-three patients, including 23 with essential tremor and 10 with Parkinson's disease, were enrolled. Overall treatment response rate per FTM was 83% (15 of 18) at 6 months. There was a marked improvement in tremor, with an average total FTM reduction of 21% at 3 months (from 46 to 30 points; P = .003) and 41% at 6 months (from 46 to 24 points; P = .001). At 6 months, functional decline had regressed by 54% (from 15 to 7 points; P = .001). Quality of life improved by 57% (P = .001) at 6 months in patients with essential tremor, and patients with Parkinson's disease had unchanged quality of life. At 1-year follow-up, grade 2 neurologic adverse events were observed in 6% (2 of 33) of patients without any grade ≥ 3 events.
CONCLUSION
Noninvasive, frameless radiosurgical thalamotomy may be a feasible treatment for patients with refractory tremor and demonstrates short-term safety at 1-year follow-up. This pilot study provides promising preliminary descriptions of efficacy, and definitive estimates of long-term safety and benefit require further study with longer follow-up.
Topics: Adult; Humans; Pilot Projects; Prospective Studies; Quality of Life; Radiosurgery; Thalamus; Treatment Outcome; Tremor
PubMed: 34454047
DOI: 10.1016/j.ijrobp.2021.08.021 -
Radiotherapy and Oncology : Journal of... Nov 2022To report the long-term results of stereotactic radiosurgery and fractionated stereotactic radiation therapy (SRS/FSRT) in patients with uveal melanoma (UM).
BACKGROUND AND PURPOSE
To report the long-term results of stereotactic radiosurgery and fractionated stereotactic radiation therapy (SRS/FSRT) in patients with uveal melanoma (UM).
MATERIALS AND METHODS
We retrospectively evaluated the results of patients treated between 2007 and 2019. The primary endpoints were local control (LC), local recurrence-free survival (LRFS), enucleation-free survival (EFS) and treatment toxicity.
RESULTS
443 patients with 445 UMs were treated via CyberKnife®. According to the COMS classification, 70% of the tumors were small/medium and 30% were large. Median total RT dose was 54 Gy, median BED10 was 151 Gy. After a median 74-months follow-up, SRS/FSRT yielded an 83% overall LC rate. The 5- and 10-year LRFS rate was 74% and 56%, respectively. Patient age and the COMS size were prognostic for all survival endpoints. An increased SRS/FSRT dose was associated with higher LRFS and EFS rates. SRS/FSRT-related toxicity was observed in 49% of the eyes. Median visual acuity (VA) significantly deteriorated after SRS/FSRT in 76% of the treated eyes. The overall eye preservation rate was 62%, and the 5- and 10-year EFS rate was 64% and 36%, respectively. The delivery of FSRT every other day resulted in a significantly lower rate of toxicity and enucleation compared to FSRT on consecutive days.
CONCLUSION
A total dose of ≥45 Gy and BED ≥ 112.5 SRS/FSRT is associated with a higher LC rate in patients with UM. Despite the favorable outcomes, treatment toxicity is the major limitation of this treatment. Toxicity and enucleation can be minimized by treating the eye every other day.
Topics: Humans; Radiosurgery; Retrospective Studies; Uveal Neoplasms; Melanoma; Treatment Outcome
PubMed: 36184996
DOI: 10.1016/j.radonc.2022.09.010 -
Cancer Letters Sep 2016As an accurate external beam irradiation method, stereotactic body radiotherapy (SBRT) has been increasingly used to deliver high dose in less fractions. The liver is... (Review)
Review
As an accurate external beam irradiation method, stereotactic body radiotherapy (SBRT) has been increasingly used to deliver high dose in less fractions. The liver is one of the most common organs for cancer metastasis. Recently, there have been several trials applying SBRT to cancer liver metastasis and have proved to be effective and safe with local control (LC) rates ranging from 70% to 100% within one or two years and 2-year overall survival (OS) rates ranging from 30% to 38%. Many published studies indicate that SBRT for cancer liver metastasis results in good outcomes without severe toxicities. However, the validated contribution of SBRT to an improved progression-free survival is still missing and more randomized trials should be conducted.
Topics: Disease Progression; Disease-Free Survival; Dose Fractionation, Radiation; Humans; Liver Neoplasms; Patient Selection; Radiosurgery; Risk Factors; Time Factors; Treatment Outcome
PubMed: 26704306
DOI: 10.1016/j.canlet.2015.10.029 -
Nature Reviews. Clinical Oncology Sep 2022Metastases remain the leading cause of cancer-related mortality. The oligometastasis hypothesis postulates that a spectrum of metastatic spread exists and that some... (Review)
Review
Metastases remain the leading cause of cancer-related mortality. The oligometastasis hypothesis postulates that a spectrum of metastatic spread exists and that some patients with a limited burden of metastases can be cured with ablative therapy. Over the past decade, substantial advances in systemic therapies have resulted in considerable improvements in the outcomes of patients with metastatic cancers, warranting re-examination of the oligometastatic paradigm and the role of local ablative therapies within the context of the improved therapeutic responses, shifting patterns of disease recurrence and possible synergy with systemic treatments. Herein, we reframe the oligometastatic phenotype as a dynamic state for which locally ablative, metastasis-directed therapy improves clinical outcomes, including by prolonging survival and increasing cure rates. Important risk factors defining the metastatic spectrum are highlighted that inform both staging and therapy. Finally, we synthesize the literature on combining local therapies with modern systemic treatments, identifying general themes to optimally integrate ablative therapies in this context.
Topics: Humans; Neoplasm Metastasis; Neoplasms; Radiosurgery
PubMed: 35831494
DOI: 10.1038/s41571-022-00655-9 -
Anticancer Research Feb 2018Surgical resection is the standard therapy for solitary primary or metastatic liver tumors. However, liver tumors are often unresectable at diagnosis and hepatectomy is... (Review)
Review
Surgical resection is the standard therapy for solitary primary or metastatic liver tumors. However, liver tumors are often unresectable at diagnosis and hepatectomy is invasive. Local therapies, such as radiofrequency ablation, are used instead, which can be challenging. Recent advances in modern radiotherapy, including stereotactic body radiation therapy (SBRT), have increased the use of radiotherapy as a curative modality. SBRT delivers ablative high doses of irradiation in small volumes. SBRT for liver tumors provided local control with potential survival benefits in patients with inoperable status. However, the following issues remain: primary vs. metastatic liver cancers; SBRT-related toxicity and prevention; pathological features of liver cancers; and potential SBRT strategies. We summarized a literature review to summarize the effectiveness of SBRT and patient tolerance and present the current status and future perspective of SBRT for liver tumors. SBRT is a potential game changer for multimodal therapy.
Topics: Humans; Liver Neoplasms; Radiosurgery; Radiotherapy Dosage
PubMed: 29374681
DOI: 10.21873/anticanres.12263 -
Acta Neurochirurgica Jan 2016
Topics: Female; Humans; Radiosurgery; Tolosa-Hunt Syndrome
PubMed: 26611688
DOI: 10.1007/s00701-015-2649-4