RESUMEN
BACKGROUND: Pachymeningeal disease (PMD) is a newly recognized pattern of brain metastasis (BrM) failure that specifically occurs following surgery with adjuvant stereotactic radiosurgery (SRS) and has unique prognostic implications relative to leptomeningeal disease (LMD). Here, we report its prevalence, prognostic implications, and associated risk factors. METHODS: A literature search was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses on PUBMED and Cochrane from January 2000 to June 2023. RESULTS: We identified 12 studies that included a total of 3992 BrM patients, 659 (16.5%) of whom developed meningeal disease (MD) following surgery plus adjuvant SRS, including either PMD or LMD. The mean prevalence of MD across studies was 20.9% (7.9-38.0%), with PMD accounting for 54.6% of this prevalence and LMD comprising the remaining 45.4%. Mean of the median overall survivals following diagnosis of PMD and LMD was 10.6 months and 3.7 months p = 0.007, respectively, a significant difference. Only 2 risk factors for PMD were reported in ≥ 2 studies and also identified as statistically significant per our meta-analysis: infratentorial location and controlled systemic disease status. CONCLUSION: While PMD has a superior prognosis to LMD, it is nevertheless a critical oncologic event associated with significant mortality and remains poorly recognized. PMD is predominantly observed in patients with controlled systemic disease status and infratentorial location. Future treatment strategies should focus on reducing surgical seeding and sterilizing surgical cavities.
Asunto(s)
Neoplasias Encefálicas , Neoplasias Meníngeas , Radiocirugia , Humanos , Neoplasias Meníngeas/epidemiología , Neoplasias Meníngeas/terapia , Neoplasias Encefálicas/cirugía , Pronóstico , Factores de Riesgo , Radiocirugia/efectos adversos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Lung metastases are the second most common malignant neoplasms of the lung. It is estimated that 20-54% of cancer patients have lung metastases at some point during their disease course, and at least 50% of cancer-related deaths occur at this stage. Lung metastases are widely accepted to be oligometastatic when five lesions or less occur separately in up to three organs. Stereotactic body radiation therapy (SBRT) is a noninvasive, safe, and effective treatment for metastatic lung disease in carefully selected patients. There is no current consensus on the ideal dose and fractionation for SBRT in lung metastases, and it is the subject of study in ongoing clinical trials, which examines different locations in the lung (central and peripheral). This review discusses current indications, fractionations, challenges, and technical requirements for lung SBRT.
Asunto(s)
Neoplasias Pulmonares , Radiocirugia , Progresión de la Enfermedad , Fraccionamiento de la Dosis de Radiación , Humanos , Resultado del TratamientoRESUMEN
Se presentan 2 casos de pseudoartrosis corporales del escafoides carpiano, estadio I y se describe la tecnica de osteosintesis empleada en ambos con el tornillo esponjoso AO minifragmento. Se senala que los dos objetivos de la mencionada tecnica son: una fijacion solida y la comprension del foco pseudoartrosico. Finalmente se observa que el tratamiento de esta patologia es dificil como lo insinua la multiplicidad de metodos propuestos.