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Clinical & Experimental Metastasis Dec 2022Androgen deprivation therapy (ADT) is the standard treatment of metastatic prostate cancer (PCa). However, metastases-directed therapies can delay the initiation or...
Androgen deprivation therapy (ADT) is the standard treatment of metastatic prostate cancer (PCa). However, metastases-directed therapies can delay the initiation or switch of systemic treatments and allow local control (LC) and prolonged progression-free survival (PFS), particularly in patients with lymph nodes (LN) oligometastases. We performed a systematic review on stereotactic body radiotherapy (SBRT) in this setting. Papers reporting LC and/or PFS were selected. Data on ADT-free survival, overall survival, and toxicity were also collected from the selected studies. Fifteen studies were eligible (414 patients), 14 of them were retrospective analyses. A high heterogeneity was observed in terms of patient selection and treatment. In one study SBRT was delivered as a single 20 Gy fraction, while in the others the median total dose ranged between 24 and 40 Gy delivered in 3-6 fractions. LC and PFS were reported in 15 and 12 papers, respectively. LC was reported as a crude percentage in 13 studies, with 100% rate in seven and 63.2-98.0% in six reports. Five studies reported actuarial LC (2-year LC: 70.0-100%). PFS was reported as a crude rate in 11 studies (range 27.3-68.8%). Actuarial 2-year PFS was reported in four studies (range 30.0-50.0%). SBRT tolerability was excellent, with only two patients with grade 3 acute toxicity and two patients with grade 3 late toxicity. SBRT for LN oligorecurrences from PCa in safe and provides optimal LC. However, the long-term effect on PFS and OS is still unclear as well as which patients are the best candidate for this approach.
Topics: Humans; Male; Androgen Antagonists; Prostatic Neoplasms; Radiosurgery; Retrospective Studies; Treatment Outcome
PubMed: 35980556
DOI: 10.1007/s10585-022-10183-6 -
Journal of Neuro-oncology Jan 2023To compare the efficacy, outcomes, and complications of single session (SS-SRS) and multisession (MS-SRS) stereotactic radiosurgery in the treatment of intracranial... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To compare the efficacy, outcomes, and complications of single session (SS-SRS) and multisession (MS-SRS) stereotactic radiosurgery in the treatment of intracranial meningiomas.
METHODS
Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane. A systematic review and meta-analysis of treatment protocols and outcomes were conducted. After the selection process, 20 articles describing 1483 cases were included.
RESULTS
A total of 1303 patients who underwent SS-SRS and 180 patients who underwent MS-SRS for the management of their intracranial meningioma were reported in the included studies. SS-SRS and MS-SRS had comparable one-year (SS-SRS: 98% vs. MS-SRS: 100%, p > 0.99) and five-year (SS-SRS: 94% vs. MS-SRS: 93%, p = 0.71) tumor control rates. The groups also had comparable tumor volume reduction/tumor regression rates (SS-SRS: 44% vs. MS-SRS: 25%, p = 0.25), tumor volume stability rates (SS-SRS: 51% vs. MS-SRS: 75%, p = 0.12), and tumor progression rates (SS-SRS: 4% vs. MS-SRS: 4%, p = 0.89). SS-SRS and MS-SRS yielded similar complication rates (10.4% vs. 11.4%, p = 0.68) and comparable functional improvement rates (MS-SRS: 44% vs. SS-SRS: 36%, p = 0.57). However, MS-SRS was used for significantly larger tumor volumes (MS-SRS: 23.8 cm vs. SS-SRS: 6.1 cm, p = 0.02).
CONCLUSION
SS-SRS and MS-SRS resulted in comparable tumor control, tumor volumetric change, and functional outcomes despite significant biases in selecting patients for SS- or MS-SRS.
Topics: Humans; Meningioma; Radiosurgery; Treatment Outcome; Tumor Burden; Meningeal Neoplasms; Retrospective Studies
PubMed: 35976546
DOI: 10.1007/s11060-022-04112-6 -
Quantitative Imaging in Medicine and... Aug 2022Conventionally, identifying isocitrate dehydrogenase () mutation in gliomas is based on histopathological analysis of tissue specimens acquired via stereotactic biopsy...
Deep learning for prediction of isocitrate dehydrogenase mutation in gliomas: a critical approach, systematic review and meta-analysis of the diagnostic test performance using a Bayesian approach.
BACKGROUND
Conventionally, identifying isocitrate dehydrogenase () mutation in gliomas is based on histopathological analysis of tissue specimens acquired via stereotactic biopsy or definitive resection. Accurate pre-treatment prediction of mutation status using magnetic resonance imaging (MRI) can guide clinical decision-making. We aim to evaluate the diagnostic performance of deep learning (DL) to determine mutation status in gliomas.
METHODS
A systematic search of Cochrane Library, Web of Science, Medline, and Scopus was conducted to identify relevant publications until August 1, 2021. Articles were included if all the following criteria were met: (I) patients with histopathologically confirmed World Health Organization (WHO) grade II, III, or IV gliomas; (II) histopathological examination with the mutation; (III) DL was used to predict the mutation status; (IV) sufficient data for reconstruction of confusion matrices in terms of the diagnostic performance of the DL algorithms; and (V) original research articles. Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and Checklist for Artificial Intelligence in Medical Imaging (CLAIM) was used to assess the studies' quality. Bayes theorem was utilized to calculate the posttest probability.
RESULTS
Four studies with a total of 1,295 patients were included. In the training set, the pooled sensitivity, specificity, and area under the summary receiver operating characteristic (SROC) curve were 93.9%, 90.9% and 0.958, respectively. In the validation set, the pooled sensitivity, specificity, and area under the SROC curve were 90.8%, 85.5% and 0.939, respectively. With a known pretest probability of 80.2%, the Bayes theorem yielded a posttest probability of 97.6% and 96.0% for a positive test and 27.0% and 30.6% for a negative test for training sets and validation sets, respectively.
DISCUSSION
This is the first meta-analysis that summarizes the diagnostic performance of DL in predicting mutation status in gliomas via the Bayes theorem. DL algorithms demonstrate excellent diagnostic performance in predicting mutation in gliomas. Radiomic features associated with mutation, and its underlying pathophysiology extracted from advanced MRI may improve prediction probability. However, more studies are required to optimize and increase its reliability. Limitations include obtaining some data via email and lack of training and test sets statistics.
PubMed: 35919062
DOI: 10.21037/qims-22-34 -
Medicine Jul 2022Robust evidence from real-world studies is needed to aid decision-makers and other stakeholders in choosing the best treatment options for patients. The objective of...
BACKGROUND
Robust evidence from real-world studies is needed to aid decision-makers and other stakeholders in choosing the best treatment options for patients. The objective of this work was to assess real-world outcomes of treatment strategies for limited- and extensive-stage small cell lung cancer (SCLC) prior to the global introduction of immunotherapies for this disease.
METHODS
Searches were conducted in MEDLINE and Embase to identify articles published in English from October 1, 2015, through May 20, 2020. Searches were designed using a combination of Medical Subject Heading (Medline), Emtree (Embase subject headings), and free-text terms such as SCLC. Observational studies reporting data on outcomes of initial treatment strategies in patients with limited- and extensive-stage SCLC were included. Studies with limited sample sizes (<100 patients), enrolled all patients prior to 2010, or did not report outcomes for limited- and extensive-stage SCLC separately were excluded. Data were extracted into a predesigned template by a single researcher. All extractions were validated by a second researcher, with disagreements resolved via consensus.
RESULTS
Forty articles were included in this review. Most enrolled patients from the United States (n = 18 articles) or China (n = 12 articles). Most examined limited-stage (n = 27 articles) SCLC. All studies examined overall survival as the primary outcome. Articles investigating limited-stage SCLC reported outcomes for surgery, chemotherapy and/or radiotherapy, and adjuvant prophylactic cranial irradiation. In studies examining multiple treatment strategies, chemoradiotherapy was the most commonly utilized therapy (56%-82%), with chemotherapy used in 18% to 44% of patients. Across studies, median overall survival was generally higher for chemoradiotherapy (15-45 months) compared with chemotherapy alone (6.0-15.6 months). Studies of extensive-stage SCLC primarily reported on chemotherapy alone, consolidative thoracic radiotherapy, and radiotherapy for patients presenting with brain metastases. Overall survival was generally lower for patients receiving chemotherapy alone (median: 6.4-16.5 months; 3 years, 5%-14.9%) compared with chemotherapy in combination with consolidative thoracic radiotherapy (median: 12.1-18.0 months; 3 years, 15.0%-18.1%). Studies examining whole-brain radiotherapy for brain metastases reported lower median overall survival (5.6-8.7 months) compared with stereotactic radiosurgery (10.0-14.5 months).
CONCLUSIONS
Under current standard of care, which has remained relatively unchanged over the past few decades, prognosis remains poor for patients with SCLC.
Topics: Brain Neoplasms; Cranial Irradiation; Humans; Lung Neoplasms; Small Cell Lung Carcinoma; Treatment Outcome
PubMed: 35777024
DOI: 10.1097/MD.0000000000029783 -
International Journal of Radiation... Nov 2022There is increasing evidence for the integration of locally ablative therapy into multimodality treatment of oligometastatic disease (OMD). To support standardised data...
Completeness of Reporting Oligometastatic Disease Characteristics in the Literature and Influence on Oligometastatic Disease Classification Using the ESTRO/EORTC Nomenclature.
PURPOSE
There is increasing evidence for the integration of locally ablative therapy into multimodality treatment of oligometastatic disease (OMD). To support standardised data collection, analysis, and comparison, a consensus OMD classification based on fundamental disease and treatment characteristics has previously been established. This study investigated the completeness of reporting the proposed OMD characteristics in literature and evaluated whether the proposed OMD classification system can be applied to the historical data.
METHODS AND MATERIALS
A systematic literature review was performed in Medline, Embase, and Cochrane, searching for prospective and retrospective studies, where stereotactic body radiation therapy was a treatment component of OMD. Reporting of the OMD characteristics as described in the European Organisation for Research and Treatment of Cancer/European Society for Radiotherapy and Oncology classification was analyzed, feasibility to retrospectively classify the proposed OMD states was investigated, and the effect of the categorization on overall survival (OS) was evaluated.
RESULTS
Our study shows incomplete reporting of the proposed OMD characteristics. The most fully reported characteristic was type of involved organs (88/95 studies); history of cancer progression was the least reported (not mentioned in 50/95 studies). Retrospective OMD classification of existing literature was only possible for 7 of the 95 studies. With respect to categorization as de novo, repeat, or induced OMD, homogeneous patient cohorts were observed in 21 of the 95 studies, most frequently de novo OMD in 20 studies. Differences in OS at 2, 3, or 5 years were not statistically significant between the different states. OS was significantly influenced by primary tumor histology, with superior OS observed for prostate cancer and worst OS observed for non-small cell lung cancer.
CONCLUSIONS
The largely incomplete reporting of the proposed OMD characteristics hampers a retrospective classification of existing literature. To facilitate future comparison of individual studies, as well as validation of the OMD classification, comprehensive reporting of OMD characteristics using standardised terminology is recommended, as proposed by the European Organisation for Research and Treatment of Cancer/European Society for Radiotherapy and Oncology classification system and following the European Society for Radiotherapy and Oncology/American Society for Radiation Oncology consensus.
Topics: Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Male; Prospective Studies; Radiosurgery; Retrospective Studies
PubMed: 35738308
DOI: 10.1016/j.ijrobp.2022.06.067 -
Journal of Neuro-oncology Aug 2022Petroclival meningioma (PM) is a challenging neuro oncology case and stereotactic radiosurgery (SRS) is proposed as one treatment option. This systematic review aimed to... (Review)
Review
PURPOSE
Petroclival meningioma (PM) is a challenging neuro oncology case and stereotactic radiosurgery (SRS) is proposed as one treatment option. This systematic review aimed to examine the role of SRS in treating PM cases.
METHODS
We constructed a systematic review using the PRISMA guidelines using peer-reviewed English literature until 16 February 2022 from EuroPMC and PubMed. We used the terms petroclival meningioma, clival meningioma, apex petrous meningioma, spheno petroclival meningioma, stereotactic radiosurgery, radiosurgery, CyberKnife, Gamma Knife, linear accelerator, LINAC, and radiotherapy.
RESULTS
10 out of 266 studies were chosen for this systematic review, two of which are case reports. The study comprised 719 patients, 73.7% of whom were female (n = 530) and had a median age of 56.99 years (18-90 years). At the time of diagnosis, the median tumor volume was 6.07 cm (0.13-64.9 cm). The tumors were frequently located near the petroclival junction (83.6%, n = 598). Following SRS, the median follow-up was 64.52 months (3-252 months). 46.5% of 719 PMs exhibited a decrease in tumor size. 46% and 7.5% showed no change and increase in tumor volume, respectively. At the last radiographic follow-up (7-21.2 years), tumor control with a median of 98.8% (85-100%). Complications occurred in 6% of patients, with hydrocephalus (2.2%) as the prevalent complication. The use of SRS as a primary treatment for petroclival cases was not associated with increased complication rate RR 0.62 (95% CI [0.11, 3.59], p = 0.59) but statistically correlated with clinical failure clinical failure RR 0.56 (95% CI [0.32, 0.98], p = 0.04).
CONCLUSIONS
We found a low number of complications following SRS intervention and has been effectively controlling tumor progression.
Topics: Female; Follow-Up Studies; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Radiosurgery; Retrospective Studies; Skull Base Neoplasms; Treatment Outcome
PubMed: 35717468
DOI: 10.1007/s11060-022-04041-4 -
Frontiers in Surgery 2022Stereotactic and functional neurosurgery (SFN) is a rapidly evolving field and some emerging countries, especially Mexico, have made significant contributions to this...
BACKGROUND
Stereotactic and functional neurosurgery (SFN) is a rapidly evolving field and some emerging countries, especially Mexico, have made significant contributions to this discipline. A bibliometric analysis has never been performed in Latin America, and this would be particularly important to show the areas that remain poorly studied, and design research strategies for the future.
METHODS
Scopus was queried using keywords pertaining to functional neurosurgery, restricting the affiliation country to Mexico, and considering documents published after 1949. Added to the initial search, a complementary literature exploration by author, considering the publications of the most productive neurosurgeons, was performed. A descriptive statistical analysis was carried out.
RESULTS
From 5,109 articles, only 371 were eligible. Scientific production has gradually increased with time. Epilepsy (31%) and movement disorders (27.4%) were the most studied neurological conditions, whereas the other 41.6% corresponded to pain, behavior disorders, spinal cord injuries, neuromodulation, stereotactic biopsies, and SFN history. Level of evidence was predominantly level V (59.1%). Publication output is highly skewed to Mexico City, which represents 78.4% of national production. Relative to factors associated with impact of research, publications in English had more citations (28.5 mean citations per paper), and journals with an impact factor greater than one had more than 10 mean citations per paper.
CONCLUSIONS
Mexico has experienced an increase in the productivity of SFN literature, addressing the most prevalent issues in the country (epilepsy and motor disorders). However, it is necessary to report studies with a higher level of evidence, as well as to decentralize the research collaborating with national institutions outside Mexico City. On the other hand, it is imperative to promote scientific production in English and in high-impact indexed journals to increase the visibility of our production. We would like to call upon our colleagues in other countries to reproduce our methodology, in order to determine the factors associated with the impact and productivity on SFN research.
PubMed: 35615655
DOI: 10.3389/fsurg.2022.886391 -
Neurosurgical Review Aug 2022Malignant meningioma is a rare, aggressive form of meningioma. Radiation is commonly included in treatment guidelines either as adjuvant radiotherapy (RT) or... (Meta-Analysis)
Meta-Analysis Review
Malignant meningioma is a rare, aggressive form of meningioma. Radiation is commonly included in treatment guidelines either as adjuvant radiotherapy (RT) or stereotactic radiosurgery (SRS). Nevertheless, the treatment recommendations are not supported by prospective comparative trials and systematical, critical evaluation of supportive evidence is lacking. For this systematic review, studies analyzing the effectiveness of adjuvant RT and SRS in grade 3 (gr. 3) meningioma were reviewed. Thirty studies met the inclusion criteria for qualitative synthesis, and 6 studies were assessed in quantitative analysis. In quantitative analysis, the weighted average of hazard ratios for adjuvant RT in univariate analyses of overall survival (OS) was 0.55 (CI: 0.41; 0.69). The median 5-year OS after adjuvant RT in gr. 3 meningiomas was 56.3%, and the median OS ranged from 24 to 80 months for patients treated with adjuvant RT versus 13 to 41.2 months in patients not treated. For SRS, the 3-year progression free survival was 0% in one study and 57% in another. The 2-year OS ranged from 25 to 75% in 2 studies. The quality of evidence was rated as "very low" in 14 studies analyzed, and considerable allocation bias was detected. Treatment toxicity was reported in 47% of the studies. The severity, according to the CTCAE, ranged from grades I-V and 5.3 to 100% of patients experienced complications. Adjuvant RT is usually considered standard of care for WHO grade 3 meningiomas, although supporting evidence was of low quality. Better evidence from registries and prospective trials can improve the evidence base for adjuvant fractionated RT in malignant meningiomas.
Topics: Child; Humans; Meningeal Neoplasms; Meningioma; Prospective Studies; Radiosurgery; Radiotherapy, Adjuvant; Retrospective Studies; Treatment Outcome
PubMed: 35543810
DOI: 10.1007/s10143-022-01773-9 -
Neurosurgery Jul 2022Dural arteriovenous fistulas (dAVFs) are often treated with stereotactic radiosurgery (SRS) to achieve complete obliteration (CO), prevent future hemorrhages, and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dural arteriovenous fistulas (dAVFs) are often treated with stereotactic radiosurgery (SRS) to achieve complete obliteration (CO), prevent future hemorrhages, and ameliorate neurological symptoms.
OBJECTIVE
To summarize outcomes after SRS for dAVFs and propose relevant practice recommendations.
METHODS
Using a PICOS/PRISMA/MOOSE protocol, we included patients with dAVFs treated with SRS and data for at least one of the outcomes of the study. Relevant outcomes were CO, symptom improvement and cure, and post-SRS hemorrhage or permanent neurological deficits (PNDs). Estimated outcome effect sizes were determined using weighted random-effects meta-analyses using DerSimonian and Laird methods. To assess potential relationships between patient and lesion characteristics and clinical outcomes, mixed-effects weighted regression models were used.
RESULTS
Across 21 published studies, we identified 705 patients with 721 dAVFs treated with SRS. The CO rate was 68.6% (95% CI 60.7%-76.5%) with symptom improvement and cure rates of 97.2% (95% CI 93.2%-100%) and 78.8% (95% CI 69.3%-88.2%), respectively. Estimated incidences of post-SRS hemorrhage and PNDs were 1.1% (95% CI 0.6%-1.6%) and 1.3% (95% CI 0.8%-1.8%), respectively. Noncavernous sinus (NCS) dAVFs were associated with lower CO (P = .03) and symptom cure rates (P = .001). Higher grade was also associated with lower symptom cure rates (P = .04), whereas previous embolization was associated with higher symptom cure rates (P = .01).
CONCLUSION
SRS for dAVFs results in CO in the majority of patients with excellent symptom improvement rates with minimal toxicity. Patients with NCS and/or higher-grade dAVFs have poorer symptom cure rates. Combined therapy with embolization and SRS is recommended when feasible for clinically aggressive dAVFs or those refractory to embolization to maximize the likelihood of symptom cure.
Topics: Central Nervous System Vascular Malformations; Embolization, Therapeutic; Humans; Intracranial Arteriovenous Malformations; Radiosurgery; Retrospective Studies; Societies; Treatment Outcome
PubMed: 35383682
DOI: 10.1227/neu.0000000000001953 -
Current Oncology Reports Jun 2022Based on good local control rates and an excellent safety profile, guidelines consider thermal ablation the gold standard to eliminate small unresectable colorectal... (Meta-Analysis)
Meta-Analysis Review
Microwave Ablation, Radiofrequency Ablation, Irreversible Electroporation, and Stereotactic Ablative Body Radiotherapy for Intermediate Size (3-5 cm) Unresectable Colorectal Liver Metastases: a Systematic Review and Meta-analysis.
PURPOSE OF REVIEW
Based on good local control rates and an excellent safety profile, guidelines consider thermal ablation the gold standard to eliminate small unresectable colorectal liver metastases (CRLM). However, efficacy decreases exponentially with increasing tumour size. The preferred treatment for intermediate-size unresectable CRLM remains uncertain. This systematic review and meta-analysis compare safety and efficacy of local ablative treatments for unresectable intermediate-size CRLM (3-5 cm).
RECENT FINDINGS
We systematically searched for publications reporting treatment outcomes of unresectable intermediate-size CRLM treated with thermal ablation, irreversible electroporation (IRE) or stereotactic ablative body-radiotherapy (SABR). No comparative studies or randomized trials were found. Literature to assess effectiveness was limited and there was substantial heterogeneity in outcomes and study populations. Per-patient local control ranged 22-90% for all techniques; 22-89% (8 series) for thermal ablation, 44% (1 series) for IRE, and 67-90% (1 series) for SABR depending on radiation dose. Focal ablative therapy is safe and can induce long-term disease control, even for intermediate-size CRLM. Although SABR and tumuor-bracketing techniques such as IRE are suggested to be less susceptible to size, evidence to support any claims of superiority of one technique over the other is unsubstantiated by the available evidence. Future prospective comparative studies should address local-tumour-progression-free-survival, local control rate, overall survival, adverse events, and quality-of-life.
Topics: Colorectal Neoplasms; Electroporation; Humans; Liver Neoplasms; Microwaves; Radiofrequency Ablation
PubMed: 35298796
DOI: 10.1007/s11912-022-01248-6