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Journal of Neuro-oncology Sep 2023Despite aggressive management consisting of surgery, radiation therapy (RT), and systemic therapy given alone or in combination, a significant proportion of patients... (Review)
Review
Despite aggressive management consisting of surgery, radiation therapy (RT), and systemic therapy given alone or in combination, a significant proportion of patients with brain tumors will experience tumor recurrence. For these patients, no standard of care exists and management of either primary or metastatic recurrent tumors remains challenging.Advances in imaging and RT technology have enabled more precise tumor localization and dose delivery, leading to a reduction in the volume of health brain tissue exposed to high radiation doses. Radiation techniques have evolved from three-dimensional (3-D) conformal RT to the development of sophisticated techniques, including intensity modulated radiation therapy (IMRT), volumetric arc therapy (VMAT), and stereotactic techniques, either stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT). Several studies have suggested that a second course of RT is a feasible treatment option in patients with a recurrent tumor; however, survival benefit and treatment related toxicity of reirradiation, given alone or in combination with other focal or systemic therapies, remain a controversial issue.We provide a critical overview of the current clinical status and technical challenges of reirradiation in patients with both recurrent primary brain tumors, such as gliomas, ependymomas, medulloblastomas, and meningiomas, and brain metastases. Relevant clinical questions such as the appropriate radiation technique and patient selection, the optimal radiation dose and fractionation, tolerance of the brain to a second course of RT, and the risk of adverse radiation effects have been critically discussed.
Topics: Humans; Re-Irradiation; Neoplasm Recurrence, Local; Brain Neoplasms; Radiotherapy, Conformal; Radiosurgery; Cerebellar Neoplasms
PubMed: 37624529
DOI: 10.1007/s11060-023-04407-2 -
Critical Reviews in Oncology/hematology Aug 2023Primary central nervous system lymphoma (PCNSL) is a rare extranodal non-Hodgkin lymphoma. Stereotactic biopsy remains the gold standard for the pathological diagnosis... (Review)
Review
Primary central nervous system lymphoma (PCNSL) is a rare extranodal non-Hodgkin lymphoma. Stereotactic biopsy remains the gold standard for the pathological diagnosis of PCNSL. However, certain new auxiliary diagnostic methods are considered to have good application prospects; these include cytokine and tumor circulating DNA, among others. Although new drugs such as immunomodulators, immune checkpoint inhibitors, chimeric antigen receptor T-cells, and Bruton tyrosine kinase inhibitors have brought hope owing to their improved efficacy, the high recurrence rate and subsequent high mortality remain barriers to long-term survival. Increasing emphasis is therefore being placed on consolidation treatments. Consolidation treatment strategies include whole brain radiotherapy, autologous hematopoietic stem cell transplantation, and non-myeloablative chemotherapy. As studies directly comparing the effectiveness and safety of different consolidation treatment schemes are lacking, the optimal consolidation strategy remains uncertain. This article will review the diagnosis and treatment of PCNSL, focusing on the progress in research pertaining to consolidation therapy.
Topics: Humans; Lymphoma, Non-Hodgkin; Central Nervous System Neoplasms; Combined Modality Therapy; Antineoplastic Combined Chemotherapy Protocols; Transplantation, Autologous; Central Nervous System
PubMed: 37277008
DOI: 10.1016/j.critrevonc.2023.104042 -
Medicina (Kaunas, Lithuania) Jun 2024: As brain lesions present complex diagnostic challenges, accurate tissue sampling via biopsy is critical for effective treatment planning. Traditional frame-based... (Comparative Study)
Comparative Study
: As brain lesions present complex diagnostic challenges, accurate tissue sampling via biopsy is critical for effective treatment planning. Traditional frame-based stereotactic biopsy has been complemented by navigated biopsy techniques, leveraging advancements in imaging and navigation technology. This study aims to compare the navigated and frame-based stereotactic biopsy methods in a clinical setting, evaluating their efficacy, safety, and diagnostic outcomes to determine the optimal approach for precise brain lesion targeting. : retrospective analysis was conducted on patients who underwent brain biopsies between January 2017 and August 2023 at an academic medical center. Data on patient demographics, clinical characteristics, biopsy technique (navigated vs. frame-based), and outcomes including accuracy, complications, and hospital stay duration were analyzed. : The cohort comprised 112 patients, with no significant age or gender differences between groups. Symptoms leading to biopsy were predominantly diminished muscle strength (42.0%), cognitive issues (28.6%), and aphasia (24.1%). Tumors were most common in the deep hemisphere (24.1%). The median hospital stay was 5 days, with a rehospitalization rate of 27.7%. Complications occurred in 4.47% of patients, showing no significant difference between biopsy methods. However, navigated biopsies resulted in fewer samples ( < 0.001) but with comparable diagnostic accuracy as frame-based biopsies. : Navigated and frame-based stereotactic biopsies are both effective and safe, with comparable accuracy and complication rates. The choice of technique should consider lesion specifics, surgeon preference, and technological availability. The findings highlight the importance of advanced neurosurgical techniques in enhancing patient care and outcomes.
Topics: Humans; Female; Male; Middle Aged; Retrospective Studies; Stereotaxic Techniques; Adult; Aged; Cohort Studies; Biopsy; Brain Neoplasms
PubMed: 38929566
DOI: 10.3390/medicina60060949 -
Advances and Technical Standards in... 2024Paragangliomas are the most common tumors at jugular foramen and pose a great surgical challenge. Careful clinical history and physical examination must be performed to...
Paragangliomas are the most common tumors at jugular foramen and pose a great surgical challenge. Careful clinical history and physical examination must be performed to adequately evaluate neurological deficits and its chronologic evolution, also to delineate an overview of the patient performance status. Complete imaging evaluation including MRI and CT scans should be performed, and angiography is a must to depict tumor blood supply and sigmoid sinus/internal jugular vein patency. Screening for multifocal paragangliomas is advisable, with a whole-body imaging. Laboratory investigation of endocrine function of the tumor is necessary, and adrenergic tumors may be associated with synchronous lesions. Preoperative prepare with alpha-blockage is advisable in norepinephrine/epinephrine-secreting tumors; however, it is not advisable in exclusively dopamine-secreting neoplasms. Best surgical candidates are young otherwise healthy patients with smaller lesions; however, treatment should be individualized each case. Variations of infratemporal fossa approach are employed depending on extensions of the mass. Regarding facial nerve management, we avoid to expose or reroute it if there is preoperative function preservation and prefer to work around facial canal in way of a fallopian bridge technique. If there is preoperative facial nerve compromise, the mastoid segment of the nerve is exposed, and it may be grafted if invaded or just decompressed. A key point is to preserve the anteromedial wall of internal jugular vein if there is preoperative preservation of lower cranial nerves. Careful multilayer closure is essential to avoid at most cerebrospinal fluid leakage. Residual tumors may be reoperated if growing and presenting mass effect or be candidate for adjuvant stereotactic radiosurgery.
Topics: Humans; Jugular Foramina; Neurosurgical Procedures; Paraganglioma; Skull Base Neoplasms
PubMed: 38700686
DOI: 10.1007/978-3-031-42398-7_10 -
Cancer Journal (Sudbury, Mass.)Stereotactic body radiation therapy has emerged as a safe and effective treatment modality for properly selected hepatocellular cancer (HCC) patients with normal liver... (Review)
Review
Stereotactic body radiation therapy has emerged as a safe and effective treatment modality for properly selected hepatocellular cancer (HCC) patients with normal liver function. However, many HCC patients have reduced baseline liver function due to underlying cirrhosis or prior liver-directed therapies. Therefore, because of the increased risk of hepatotoxicity, the use of stereotactic body radiation therapy for patients with reduced liver function has been approached with caution. Individualized, response-based radiotherapy incorporates models, imaging tools, and biomarkers that determine the dose-response relationship of the liver before, during, and after treatment and has been useful in reducing the likelihood of liver damage without sacrificing tumor control. This review discusses the evolution of response-based radiotherapy for HCC and highlights areas for further investigation.
Topics: Humans; Liver Neoplasms; Carcinoma, Hepatocellular; Treatment Outcome; Radiotherapy Dosage; Radiosurgery
PubMed: 37796644
DOI: 10.1097/PPO.0000000000000679 -
Hepatobiliary & Pancreatic Diseases... Feb 2024Stereotactic body radiotherapy (SBRT) in pancreatic cancer allows high delivery of radiation doses on tumors without affecting surrounding tissue. This review aimed at... (Review)
Review
BACKGROUND
Stereotactic body radiotherapy (SBRT) in pancreatic cancer allows high delivery of radiation doses on tumors without affecting surrounding tissue. This review aimed at the SBRT application in the treatment of pancreatic cancer.
DATA SOURCES
We retrieved articles published in MEDLINE/PubMed from January 2017 to December 2022. Keywords used in the search included: "pancreatic adenocarcinoma" OR "pancreatic cancer" AND "stereotactic ablative radiotherapy (SABR)" OR "stereotactic body radiotherapy (SBRT)" OR "chemoradiotherapy (CRT)". English language articles with information on technical characteristics, doses and fractionation, indications, recurrence patterns, local control and toxicities of SBRT in pancreatic tumors were included. All articles were assessed for validity and relevant content.
RESULTS
Optimal doses and fractionation have not yet been defined. However, SBRT could be the standard treatment in patients with pancreatic adenocarcinoma in addition to CRT. Furthermore, the combination of SBRT with chemotherapy may have additive or synergic effect on pancreatic adenocarcinoma.
CONCLUSIONS
SBRT is an effective modality for patients with pancreatic cancer, supported by clinical practice guidelines as it has demonstrated good tolerance and good disease control. SBRT opens a possibility of improving outcomes for these patients, both in neoadjuvant treatment and with radical intent.
Topics: Humans; Pancreatic Neoplasms; Adenocarcinoma; Radiosurgery; Neoadjuvant Therapy; Chemoradiotherapy
PubMed: 36990839
DOI: 10.1016/j.hbpd.2023.03.002 -
Cancer Treatment Reviews Nov 2023Progresses of systemic treatments in advanced non-small cell lung cancer (NSCLC), such as immune checkpoint blockers (ICB) and targeted therapies, led to the increased... (Review)
Review
Progresses of systemic treatments in advanced non-small cell lung cancer (NSCLC), such as immune checkpoint blockers (ICB) and targeted therapies, led to the increased incidence of oligoprogressive disease (OPD). The OPD is a subtype of oligometastatic disease (OMD) defined as a progression of a limited number of lesions during systemic treatment exposure. The hypothesis was formulated that local radical treatments (LRT) could eradicate progressive lesions resulting from resistant clones, ultimately leading to systemic treatment sensitivity restoration. Recently published international consensuses and guidelines aim to obtain a uniform definition of OMD NSCLC, to standardize the inclusion of these patients in future clinical trials, as well as their management in daily practice. Although there is no specific definition of OPD, LRT strategies in OPD are supported after reporting promising results. Both retrospective and preliminary prospective randomized data of LRT for patients with OPD NSCLC are encouraging. More clinical and translational data are needed for selecting best scenarios where LRT should be delivered. In this review, we analyze the current available literature on LRT for patients with OPD in advanced NSCLC and discuss about future trial design and challenges.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Prospective Studies; Retrospective Studies; Disease Progression; Radiosurgery
PubMed: 37690180
DOI: 10.1016/j.ctrv.2023.102621 -
The Lancet. Oncology Mar 2024Stereotactic ablative body radiotherapy (SABR) is a novel non-invasive alternative for patients with primary renal cell cancer who do not undergo surgical resection. The...
BACKGROUND
Stereotactic ablative body radiotherapy (SABR) is a novel non-invasive alternative for patients with primary renal cell cancer who do not undergo surgical resection. The FASTRACK II clinical trial investigated the efficacy of SABR for primary renal cell cancer in a phase 2 trial.
METHODS
This international, non-randomised, phase 2 study was conducted in seven centres in Australia and one centre in the Netherlands. Eligible patients aged 18 years or older had biopsy-confirmed diagnosis of primary renal cell cancer, with only a single lesion; were medically inoperable, were at high risk of complications from surgery, or declined surgery; and had an Eastern Cooperative Oncology Group performance status of 0-2. A multidisciplinary decision that active treatment was warranted was required. Key exclusion criteria were a pre-treatment estimated glomerular filtration rate of less than 30 mL/min per 1·73 m, previous systemic therapies for renal cell cancer, previous high-dose radiotherapy to an overlapping region, tumours larger than 10 cm, and direct contact of the renal cell cancer with the bowel. Patients received either a single fraction SABR of 26 Gy for tumours 4 cm or less in maximum diameter, or 42 Gy in three fractions for tumours more than 4 cm to 10 cm in maximum diameter. The primary endpoint was local control, defined as no progression of the primary renal cell cancer, as evaluated by the investigator per Response Evaluation Criteria in Solid Tumours (version 1.1). Assuming a 1-year local control of 90%, the null hypothesis of 80% or less was considered not to be worthy of proceeding to a future randomised controlled trial. All patients who commenced trial treatment were included in the primary outcome analysis. This trial is registered with ClinicalTrials.gov, NCT02613819, and has completed accrual.
FINDINGS
Between July 28, 2016, and Feb 27, 2020, 70 patients were enrolled and initiated treatment. Median age was 77 years (IQR 70-82). Before enrolment, 49 (70%) of 70 patients had documented serial growth on initial surveillance imaging. 49 (70%) of 70 patients were male and 21 (30%) were female. Median tumour size was 4·6 cm (IQR 3·7-5·5). All patients enrolled had T1-T2a and N0-N1 disease. 23 patients received single-fraction SABR of 26 Gy and 47 received 42 Gy in three fractions. Median follow-up was 43 months (IQR 38-60). Local control at 12 months from treatment commencement was 100% (p<0·0001). Seven (10%) patients had grade 3 treatment-related adverse events, with no grade 4 adverse events observed. Grade 3 treatment-related adverse events were nausea and vomiting (three [4%] patients), abdominal, flank, or tumour pain (four [6%]), colonic obstruction (two [3%]), and diarrhoea (one [1%]). No treatment-related or cancer-related deaths occurred.
INTERPRETATION
To our knowledge, this is the first multicentre prospective clinical trial of non-surgical definitive therapy in patients with primary renal cell cancer. In a cohort with predominantly T1b or larger disease, SABR was an effective treatment strategy with no observed local failures or cancer-related deaths. We observed an acceptable side-effect profile and renal function after SABR. These outcomes support the design of a future randomised trial of SABR versus surgery for primary renal cell cancer.
FUNDING
Cancer Australia Priority-driven Collaborative Cancer Research Scheme.
Topics: Aged; Female; Humans; Male; Carcinoma, Renal Cell; Kidney Neoplasms; Prospective Studies; Radiosurgery; Treatment Outcome; Aged, 80 and over
PubMed: 38423047
DOI: 10.1016/S1470-2045(24)00020-2 -
IEEE Transactions on Bio-medical... Dec 2023Despite benefits brought by recent neurosurgical robots, surgical safety and surgeon-robot collaboration remain significant challenges. In this article, we analyze and...
OBJECTIVE
Despite benefits brought by recent neurosurgical robots, surgical safety and surgeon-robot collaboration remain significant challenges. In this article, we analyze and address these problems in the context of brain biopsy, by proposing a semi-autonomous system.
METHODS
A robotic module is designed for the automation of all the brain biopsy procedures, and a biopsy cannula with tissue blocker is developed to avoid tissue excess and haemorrhage. In addition, two methods are proposed for surgical safety and surgeon-robot collaboration enhancement. First, a priority-based control framework is proposed for neuronavigation with simultaneous optical tracking line-of-sight maintenance and surgeon avoidance. Second, after neuronavigation, an adaptive reconfiguration method is developed to optimize the arm angle of KUKA robot based on the surgeon's pose, for workspace interference minimization, high robot dexterity, and joint-limit avoidance.
RESULT
Effectiveness of the proposed solution demonstrated by simulations and experiments.
CONCLUSION
The system can perform automatic navigation with simultaneous optical tracking maintenance and surgeon avoidance, autonomous brain biopsy, and adaptive reconfiguration for workspace interference minimization.
SIGNIFICANCE
This work improves existing neurosurgical systems, in terms of autonomy level from mechanical guidance to task autonomy, surgical safety, and surgeon-robot collaboration.
Topics: Humans; Robotics; Robotic Surgical Procedures; Biopsy; Surgeons; Brain
PubMed: 37256817
DOI: 10.1109/TBME.2023.3281590 -
Cancer Radiotherapie : Journal de La... Sep 2023Ultracentral (UC) lung lesions are generally defined by the presence of the tumour or the Planning Target Volume (PTV) abutting proximal bronchial tree (PBT) or the... (Review)
Review
Ultracentral (UC) lung lesions are generally defined by the presence of the tumour or the Planning Target Volume (PTV) abutting proximal bronchial tree (PBT) or the esophagus. Initial reports rose awareness regarding the potential toxicity of stereotactic body radiotherapy (SBRT) when delivered to UC lesions. Major concerns include necrosis, stenosis, and bleeding of the PBT. Technological improvements now enable the delivery of more accurate treatments, possibly redefining the historical "no-fly zone". In this review, studies focusing on the treatment of UC lesions with SBRT are presented. The narrow therapeutic window requires a multidisciplinary approach.
Topics: Radiosurgery; Lung Neoplasms; Bronchi; Esophagus; Constriction, Pathologic; Necrosis; Blood Loss, Surgical; Humans; Margins of Excision
PubMed: 37516640
DOI: 10.1016/j.canrad.2023.06.021