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1.
Childs Nerv Syst ; 39(5): 1173-1182, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36574012

RESUMO

PURPOSE: A multimodality approach is generally considered for pediatric low-grade gliomas (LGG); however, the optimal management remains uncertain. The objective of the study was to evaluate treatment outcomes of pediatric LGG, focusing on long-term survival and factors related to outcomes. METHODS: A retrospective review of 77 pediatric LGG cases treated at Ramathibodi Hospital, Thailand between 2000 and 2018 was performed. The inclusion criteria were all pediatric LGG cases aged ≤ 15 years. Diffuse intrinsic pontine gliomas and spinal cord tumors were excluded. RESULTS: The median follow-up time was 8.2 years (range, 0.6-19.7). The median age at diagnosis was 6.2 years (interquartile range, 3.6-11.4). Treatments modality included tumor surgery (93%), chemotherapy (40%), and radiation therapy (14%). The 10-year overall survival (OS) and 10-year progression-free survival were 94% and 59%, respectively, for the entire cohort. The 10-year OS was 100% in three subgroups of patients: pilocytic subtype, WHO grade 1 tumors, and recipient of gross total resection. After multivariable analysis, no tumor surgery had a significantly unfavorable influence on overall survival. CONCLUSIONS: With a multimodality approach, pediatric LGGs had excellent outcome. Gross total resection is the standard primary treatment. Chemotherapy is the alternative standard treatment in incomplete resection cases, unresectable patients, or patients with progressive disease. Radiation therapy should be reserved as a salvage treatment option because of late complications that usually affect patients' quality of life.


Assuntos
Neoplasias Encefálicas , Glioma , Criança , Humanos , Qualidade de Vida , Universidades , Glioma/patologia , Resultado do Tratamento , Hospitais , Neoplasias Encefálicas/patologia
2.
Childs Nerv Syst ; 35(8): 1313-1321, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31203397

RESUMO

PURPOSE: To report outcome of postoperative radiotherapy (RT) in both new and recurrent grade II and III intracranial ependymomas in children treated at Ramathibodi Hospital. MATERIALS AND METHODS: Between 2006 and 2017, 24 pediatric intracranial ependymomas treated with postoperative RT were retrospectively reviewed. The median age at diagnosis was 44.5 months (range, 4-165 months). There were 14 (58%) males. Fourteen (58%) patients had infratentorial tumor. The median maximal diameter of tumor at diagnosis was 4.45 cm (range, 2.2-10 cm). Fourteen (58%) patients had anaplastic tumor. Gross total resections were performed in 14 (58%) patients. The median prescribed dose was 54 Gy (range, 45-60 Gy). The median total treatment time was 43 days (range, 37-78 days). RESULTS: The median clinical follow-up time was 44.5 months (range, 1-146 months). There were nine recurrences, five of which occurred at the primary tumor site. The estimated 5-year progression-free survival rate was 56%. The estimated 5-year overall survival rate was 75%. Extent of resection was the only factor associated with improved progression-free survival and overall survival after univariate testing. Six from nine patients with recurrent diseases underwent further surgery or further RT. These six patients had better median overall survival than the three who did not. Acute complication was mostly transient and tolerable. No late radiation effect was found. CONCLUSIONS: Postoperative radiation is an effective treatment. GTR is associated with better PFS and OS. Aggressive salvage local treatments for recurrent patients can result in good overall survival. Longer follow-up is needed in account for late relapse.


Assuntos
Neoplasias Encefálicas/radioterapia , Ependimoma/radioterapia , Radioterapia Adjuvante/métodos , Adolescente , Neoplasias Encefálicas/mortalidade , Criança , Pré-Escolar , Ependimoma/mortalidade , Feminino , Humanos , Lactente , Masculino , Intervalo Livre de Progressão , Estudos Retrospectivos , Resultado do Tratamento
3.
J Neurooncol ; 139(3): 679-688, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29846895

RESUMO

INTRODUCTION: Stereotactic radiation technique is widely reported as an effective treatment for various types of benign intracranial tumors. However, single fraction radiosurgery (SRS) is not recommended for tumors located close to the optic apparatus due to the restricted radiation tolerance dose of the optic pathway. Recent advances in radiotherapy include advanced frameless radiosurgery using hypofractionated stereotactic radiotherapy (HSRT), and this has become an attractive treatment option for perioptic tumors within 2-3 mm of the optic pathway. Accordingly, the aim of this study was to investigate the clinical outcomes of perioptic tumors treated with HSRT using CyberKnife® (CK) robotic radiosurgery system relative to tumor control, vision preservation and toxicity. METHODS: This retrospective analysis of prospectively collected data included consecutive 100 patients that were diagnosed with and treated for perioptic tumor at the Radiosurgery center, Ramathibodi Hospital during the January 2009 to December 2012 study period. RESULTS: The median tumor volume was 6.81 cm3 (range 0.37-51.6), and the median prescribed dose was 25 Gy (range 20-35) in 5 fractions (range 3-5). After the median follow-up time of 37.5 months (range 21-103), two patients developed tumor progression at 6 and 34 months post-HSRT. The 5-year overall survival was 97%, and the 5-year local control was 97.5%. At the last follow-up, no vision deterioration or newly developed hypopituitarism was detected in our study. CONCLUSIONS: Although a longer follow-up is needed, HSRT yields a high level of local control and vision preservation, and should be considered a treatment of choice for perioptic tumor located close to the optic apparatus.


Assuntos
Neoplasias Meníngeas/radioterapia , Neoplasias de Tecido Vascular/radioterapia , Neoplasias do Sistema Nervoso/radioterapia , Neoplasias Hipofisárias/radioterapia , Radiocirurgia , Adolescente , Adulto , Idoso , Olho , Feminino , Seguimentos , Humanos , Masculino , Neoplasias Meníngeas/mortalidade , Pessoa de Meia-Idade , Neoplasias de Tecido Vascular/mortalidade , Neoplasias do Sistema Nervoso/mortalidade , Neoplasias Hipofisárias/mortalidade , Estudos Prospectivos , Hipofracionamento da Dose de Radiação , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
J Med Assoc Thai ; 99 Suppl 3: S23-9, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29901334

RESUMO

Objective: To evaluate outcomes of postoperative radiotherapy (RT) for residual WHO grade I meningioma based on subtype classification and relevant factors that may influence the outcomes. Material and Method: Medical records from 252 patients, with known histology of intracranial meningioma, who underwent stereotactic RT in Ramathibodi Hospital between 1998 and 2008, were reviewed. One hundred and two out of 252 patients were included. The data were categorized into 2 groups: common subtype (meningothelial and transitional subtypes) and uncommon subtype (fibroblastic, psammomatous, angiomatous, microcystic, secretory, lymphoplasmacyte-rich and metaplastic subtypes). Analysis of tumor control rate, tumor shrinkage rate and risk factors of treatment failure were conducted. Results: The median of follow-up period was 46 months (interquartile range (IQR): 53). The five-year tumor-control rates of overall, common and uncommon subtypes were 89.9%, 92.9% and 81.5%, respectively, which showed no significant difference between the two groups, p = 0.108. The five years tumor shrinkage rates of overall, common, and uncommon subtypes were 42.5%, 42.3% and 42.7%, respectively, there was no significant difference, p = 0.934. In univariate analysis, gender (male), total minimal dose and fraction demonstrated statistically significant impact on treatment failure. However, only a total minimal dose had any significant effect in multivariate analysis. Conclusion: Radiotherapy is highly effective in controlling postoperative residual meningioma. This study may be useful to evaluate patients' prognosis and possibility of recurrence based on histology subtypes. In addition, total minimal dosage was the sole risk factor of treatment failure found in the present study.


Assuntos
Neoplasias Meníngeas/radioterapia , Meningioma/radioterapia , Radiocirurgia/estatística & dados numéricos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Neoplasias Meníngeas/classificação , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Meningioma/classificação , Meningioma/patologia , Meningioma/cirurgia , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/cirurgia , Prognóstico , Estudos Retrospectivos
5.
J Med Assoc Thai ; 99 Suppl 3: S54-61, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29901342

RESUMO

Objective: En plaque sphenoid wing meningioma is a rare tumor. Complete surgical resection is difficult. Role of adjuvant radiation therapy in treatment of meningiomas is still controversial. This present study aimed to examine the clinical outcomes and to evaluate the role of adjuvant radiation for the residual tumors. Material and Method: A retrospective study was performed in 26 patients with en plaque sphenoid wing meningioma, who underwent operation at Prasat Neurological Institution between January 2008 and December 2012. Presenting symptoms, location of tumor, surgical approach, postoperative outcomes, and adjuvant radiation were reviewed and analyzed. Results: Among the 26 patients, their ages ranged from 31 to 57 years. All tumors were removed by transcranial approach. Eleven of the patients underwent adjuvant radiation therapy and post-radiation imaging revealed tumors being stable in size. Nine patients that had regrowth tumors were not radiated. Mean followed-up time was 51.77 months (range 18-96 months). Conclusion: Proptosis, visual acuity and cosmetic problems can be improved by surgery. Postoperative adjuvant radiation therapy may be an option for residual en plaque sphenoid wing meningioma.


Assuntos
Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Adulto , Seguimentos , Humanos , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/patologia , Meningioma/diagnóstico por imagem , Meningioma/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
6.
J Med Assoc Thai ; 97(6): 655-61, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25137883

RESUMO

OBJECTIVE: To identify the treatment outcome of glioblastoma multiforme (GBM) in Ramathibodi Hospital from overall survival rate and related prognostic factors. MATERIAL AND METHOD: Medical records of patients with histological diagnosis of GBM treated at Radiation Oncology Division, Radiology Department, Ramathibodi Hospital between 2000 and 2010 were reviewed and available data extracted for evaluation of treatment outcome. RESULTS: There were 47 patients with mean age at diagnosis of 51.9 years (range from 18 to 82 years). Surgery (partial 76.6%, total 12.8%, and biopsy 10.6%) followed by postoperative radiotherapy (mean dose 52 gray) was the treatment of choice with or without concurrent and adjuvant Temozolomide (TMZ). With median follow-up time of 0.9 years, the median survival of the patients was 2.1 years (95% CI 1.08-7.36), whereas one and two-year overall survival rates were 78.0% and 57.8%, respectively. In univariate analysis, persistent neurological deficit after surgery and presenting symptom of visual disturbance were identified to lower overall survival while multivariate analysis, younger age, and higher radiation dose were identified as favorable prognostic factors to improve overall survival. Re-surgery or re-irradiation in some selected cases of recurrent or progressive disease was considered as a choice for palliative treatment. CONCLUSION: Proper management of GBM patient was surgical removal and postoperative radiotherapy with or without chemotherapy. Proper palliative treatment modality was considered in selected cases of recurrent or progressive disease.


Assuntos
Neoplasias Encefálicas/radioterapia , Glioblastoma/radioterapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/mortalidade , Terapia Combinada , Feminino , Glioblastoma/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
7.
J Med Assoc Thai ; 96(5): 603-13, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23745317

RESUMO

OBJECTIVE: Evaluate the effectiveness of radiotherapy plan and physical parameters including local tumor response and clinical outcome of lung metastasis in patients who received CyberKnife treatment at Ramathibodi Hospital. MATERIAL AND METHOD: Six cases with twenty lesions of lung metastasis patients were evaluated for tumor response after having received CyberKnife treatment. The prescribed radiation dose was calculated approximately to biological equivalent dose (BED) around 60 to 100 gray (Gyz). The response of each lesion to treatment was evaluated from roentgenographic study during follow-up period along with adverse event, status of patients, and disease. RESULTS: At the third month after treatment, roentgenographic partial response (PR, 50% decrease in size) was demonstrated in eight lesions and stable disease (SD, unchanged size) in eight lesions with no complete response (CR, disappearance of tumor) detected. Progressive disease (PD, 25% increase in size) of six treated lesions was detected during the follow-up period. At the time of report, two patients were alive and still received palliative chemotherapy, two patients died from uncontrolled progressive metastases and failed palliative chemotherapy, and two patients lost follow-up after progressive metastases with unknown surviving status. No severe adverse event was observed. The treatment planning parameters demonstrated borderline of radiation dose homogeneity, and conformality coverage of the target volume. CONCLUSION: This preliminary report aimed to provide the idea of choosing the appropriate lung metastasis patient to receive CyberKnife treatment that must strictly clarify the real clinical benefit of each selected case to achieve the best outcome from this special treatment procedure.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Pulmonares , Neoplasias , Cuidados Paliativos/métodos , Radiocirurgia , Terapia Combinada/métodos , Progressão da Doença , Relação Dose-Resposta à Radiação , Feminino , Humanos , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias/classificação , Neoplasias/patologia , Radiocirurgia/efeitos adversos , Radiocirurgia/instrumentação , Radiocirurgia/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
J Med Assoc Thai ; 95(11): 1466-71, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23252214

RESUMO

OBJECTIVE: Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) for brain tumor is increasingly acceptable worldwide. In Thailand, the first Linac-based stereotactic radiation machine was implemented at the Radiosurgery Center, Ramathibodi Hospital since 1997. This is the first study in Thailand to report the results of pediatric brain tumor patients treated with SRS and FSRT MATERIAL AND METHOD: The clinical outcome of 39 pediatric patients treated with SRS/FSRT between 1998 and 2010 was retrospectively reviewed. RESULTS: The median follow-up time was 26 months (range, 1 to 154 months). The local progression free survival (LPFS) at one and five years after SRS/FSRT for all patients was 87.5% and 54.2%, respectively. The 5-year LPFS by tumor histology was as follow, pituitary adenoma 100%, meningioma 100%, ependymoma, and low-grade astrocytoma 75%, and craniopharyngioma 68.6%. High-grade tumor had the worst LPFS and the median LPFS of this group was only 12 months. On univariate analysis, low-grade tumor (pituitary adenoma and menigioma) and small tumor volume (< 10 ml) were the factors that correlated significantly with good local control. After multivariate analysis, small tumor volume was the only factor associated with good LPFS (HR = 2.35, p = 0.042). No other radiation complication except panhypopituitarism was reported. CONCLUSION: SRS/FSRT in pediatric brain tumor is technically feasible, with minimal acute side effects. SRS/FSRT plays an important role for the small low-grade tumor


Assuntos
Neoplasias Encefálicas/cirurgia , Radiocirurgia/métodos , Adolescente , Neoplasias Encefálicas/mortalidade , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Masculino , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de Sobrevida , Tailândia/epidemiologia , Resultado do Tratamento
9.
J Med Assoc Thai ; 95(10): 1335-43, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23193750

RESUMO

OBJECTIVE: Provide the effectiveness of treatment protocol, radiotherapy plan, technique, and early clinical results of inoperable primary non-small cell lung cancer (NSCLC) in patients who received CyberKnife treatment at Ramathibodi Hospital. MATERIAL AND METHOD: Six cases of inoperable primary NSCLC patients were evaluated for tumor response after having received CyberKnife treatment. The prescribed radiation dose was 45 gray (Gy) in three consecutive fractions for peripherally located tumor and 50 Gy in five fractions within two weeks for centrally located tumor (biological equivalent dose, BED, 112.5 Gy 10, and 100 Gy 10, respectively). The response to treatment was evaluated from roentgenographic study during follow-up period along with clinical outcome and adverse event. RESULTS: Overall response after the treatment was demonstrated in five cases with roentgenographic complete response (CR, disappearance of tumor) and partial response (PR, 50% decrease in size) in two and three cases, respectively without any severe adverse event. The treatment planning parameters demonstrated the effectiveness of radiation dose homogeneity and conformity coverage of the target volume. CONCLUSION: This preliminary report has provided the effectiveness of treatment plan and local tumor controlled without severe adverse event for primary inoperable NSCLC patients receiving CyberKnife treatment.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Radiocirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Estudos de Coortes , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Tailândia , Resultado do Tratamento
10.
Asia Pac J Clin Oncol ; 18(5): e247-e254, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34310064

RESUMO

AIM: The study aimed to evaluate the long-term clinical outcomes of patients with vestibular schwannoma (VS) treated with stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (HSRT) with frameless robotic whole-body radiosurgery system (CyberKnife® ). METHODS: This retrospective analysis of prospectively collected data included 123 consecutive patients with VS treated at the Radiosurgery center, Ramathibodi Hospital, Bangkok, Thailand. SRS was recommended for patients with unserviceable hearing and Koos grade I-III tumors, and HSRT for patients with serviceable hearing or Koos grade III-IV tumors. Between March 2009 and December 2015, 23 patients (19%) were treated with SRS, whereas 100 (81%) received HSRT. The commonly used regimen was 12 Gy in one fraction for SRS and 18 Gy in three fractions for HSRT. RESULTS: After a median follow-up of 72 months (range: 12-123 months), the 5-year and 8-year progression-free survival (PFS) rates for the whole cohort were 96% and 92%, respectively. The PFS was not significantly different between the SRS and HSRT groups (p = 0.23). Among 28 patients with serviceable hearing in the HSRT group, the 5-year and 8-year hearing preservation rates were 87% and 65%, respectively. The rate of nonauditory complications was 14%. Koos grade III/IV was a predictor of disease progression and was associated with nonauditory complications. CONCLUSION: SRS and HSRT with the CyberKnife® system provided excellent long-term tumor control with a low rate of nonauditory complications. HSRT may result in acceptable hearing preservation rates.


Assuntos
Neuroma Acústico , Radiocirurgia , Procedimentos Cirúrgicos Robóticos , Seguimentos , Humanos , Neuroma Acústico/patologia , Neuroma Acústico/radioterapia , Neuroma Acústico/cirurgia , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Tailândia , Resultado do Tratamento
11.
Curr Probl Cancer ; 46(4): 100876, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35687966

RESUMO

To evaluate and validate the minor lymphatic pathway for distant metastases in cervical cancer. This is a retrospective cohort of cervical cancer patients underwent curative concurrent chemoradiotherapy. We used original dataset from 1 university hospital and validation dataset from 3 university hospitals. Lymphadenopathy status in CT imaging was reviewed by radiologist in either the obturator and external iliac nodes (major pathway) or the internal iliac and presacral nodes (minor pathway). We then used Cox regression to adjust for all potential confounders, including paraaortic nodes, T stage, histology, age, total treatment time, total number of nodes, total short axis of nodes. 397 and 384 patients were in the original and validation datasets (median follow-up period, 59.5 month's). The minor pathway was independent prognostic factor in multivariable analysis [HR=2.64; 95%CI=1.07-6.55; P = 0.036] and [HR=14.84; 95%CI=3.15-70.01; P= 0.001] in original and validation datasets, respectively. Whereas, the major pathway was statistically non-significant. Further validation showed that the minor pathway had the highest HR for distant metastases with both the EMBRACE (HR=6.05; 95% CI=1.30-28.08; P = 0.022) and the FIGO 2018 (HR=7.43; 95% CI=2.94-18.78; P<0.001) in the original dataset. A similar result was found with the validation dataset: EMBRACE, HR=30.91; 95% CI=2.78-343.62; P = 0.005; and FIGO 2018, HR=42.41; 95% CI=8.83-203.60; P<0.001.This is the first clinical study to validate that the minor lymphatic pathway was predominantly associated with distant metastases in cervical cancer. This finding should be validated in larger cohort to further integrate in standard staging for prediction of distant metastases.


Assuntos
Neoplasias do Colo do Útero , Quimiorradioterapia/métodos , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologia
12.
Sci Rep ; 12(1): 9873, 2022 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-35701437

RESUMO

To develop and validate a prognostic model, including the minor lymphatic pathway (internal iliac and presacral nodes). STUDY DESIGN: Retrospective cohort. PARTICIPANTS: Locally advanced cervical cancer underwent concurrent chemoradiotherapy. SAMPLE SIZE: 397 and 384 patients in the development and validation data set. PREDICTORS: Our new nodal staging system with the minor lymphatic pathway. OUTCOME: Distant metastases. STATISTICAL ANALYSIS: Cox regression; net reclassification improvement (NRI) and decision curve analysis (DCA). Our new nodal system was the strongest predictor. The predictors in the final model were new nodal system, tumor stage, adenocarcinoma, initial hemoglobin, tumor size and age. The nodal system and the pretreatment model had concordance indices of 0.661 and 0.708, respectively, with good calibration curves. Compared to the OUTBACK eligibility criteria, the nodal system showed NRI for both cases (22%) and controls (16%). The pretreatment model showed NRI for cases (31%) and controls (18%). DCA in both models showed threshold probability of 15% and 12%, respectively, when compared with 24% in OUTBACK eligibility criteria. Our new nodal staging system and the pretreatment model could differentiate between high-risk and low-risk patients, thus facilitating decisions to provide more aggressive treatment to prevent distant metastases.


Assuntos
Neoplasias do Colo do Útero , Quimiorradioterapia , Feminino , Humanos , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologia
13.
Medicine (Baltimore) ; 100(19): e25752, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106604

RESUMO

ABSTRACT: This study was conducted to report long-term outcomes of the frameless robotic stereotactic radiosurgery (SRS) for brain arteriovenous malformation (AVM) at Ramathibodi Hospital.Retrospective data of patients with brain AVM (bAVM), who underwent CyberKnife SRS (CKSRS) at Ramathibodi Hospital from 2009 to 2014, were examined. Exclusion criteria were insufficient follow-up time (<36 months) or incomplete information. Patients' demographics, clinical presentation, treatment parameters, and results were analyzed. Excellent outcome was defined as AVM obliteration without a new neurological deficit. Risk factors for achieving excellent outcome were assessed.From a total of 277 CKSRS treatments for bAVM during the 6 years, 170 AVMs in 166 patients met the inclusion criteria. One hundred and thirty-nine cases (81.76%) presented with hemorrhages from ruptured bAVMs. Almost two-thirds underwent embolization before radiosurgery. With the median AVM volume of 4.17 mL, three-quarters of the cohort had single-fraction CKSRS, utilizing the median prescribed dose of 15 Gray (Gy). In the multisession group (25.29%), the median prescribed dose and the AVM volume were 27.5 Gy and 22.3 mL, respectively. An overall excellent outcome, at a median follow-up period of 72.45 months, was observed in 99 cases (58.24%). Seven AVMs (4.12%) ruptured after CKSRS but 1 patient suffered a new neurological deficit. Two patients (1.18%) were classified into the poor outcome category but there were no deaths. Negative factors for excellent outcome, by multivariate regression analysis, were the male sex and multisession SRS delivery, but not age, history of AVM rupture, previous embolization, or AVM volume.Despite relatively larger bAVM and utilizing a lower prescribed radiation dose, the excellent outcome was within the reported range from previous literature. This study offers one of the longest follow-ups and the largest cohorts from the frameless image-guided robotic SRS community.


Assuntos
Fístula Arteriovenosa/cirurgia , Malformações Arteriovenosas Intracranianas/cirurgia , Radiocirurgia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Assistida por Computador/métodos , Adolescente , Adulto , Feminino , Seguimentos , Hospitais Universitários , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
J Radiat Res ; 62(4): 707-717, 2021 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-33993271

RESUMO

Modern radiotherapy (RT) uses altered fractionation, long beam-on time and image-guided procedure. This study aimed to compare secondary cancer risk (SCR) associated with primary field, scatter/leakage radiations and image-guided procedure in prostate treatment using intensity-modulated RT (IMRT), CyberKnife stereotactic body RT (CK-SBRT) in relative to 3-dimensional conformal RT (3D-CRT). Prostate plans were generated for 3D-CRT, IMRT (39 fractions of 2 Gy), and CK-SBRT (five fractions of 7.25 Gy). Excess absolute risk (EAR) was calculated for organs in the primary field using Schneider's mechanistic model and concept of organ equivalent dose (OED) to account for dose inhomogeneity. Doses from image-guided procedure and scatter/leakage radiations were determined by phantom measurements. The results showed that hypofractionation relative to conventional fractionation yielded lower SCR for organs in primary field (p ≤ 0.0001). SCR was further modulated by dose-volume distribution. For organs near the field edge, like the rectum and pelvic bone, CK-SBRT plan rendered better risk profiles than IMRT and 3D-CRT because of the absence of volume peak in high dose region (relative risk [RR]: 0.65, 0.22, respectively, p ≤ 0.0004). CK-SBRT and IMRT generated more scatter/leakage and imaging doses than 3D-CRT (p ≤ 0.0002). But primary field was the major contributor to SCR. EAR estimates (risk contributions, primary field: scatter/leakage radiations: imaging procedure) were 7.1 excess cases per 104 person-year (PY; 3.64:2.25:1) for CK-SBRT, 9.93 (7.32:2.33:1) for IMRT and 8.24 (15.99:2.35:1) for 3D-CRT (p ≤ 0.0002). We conclude that modern RT added more but small SCR from scatter/leakage and imaging doses. The primary field is a major contributor of risk which can be mitigated by the use of hypofractionation.


Assuntos
Fracionamento da Dose de Radiação , Neoplasias da Próstata/radioterapia , Relação Dose-Resposta à Radiação , Humanos , Masculino , Especificidade de Órgãos/efeitos da radiação , Radiocirurgia , Dosagem Radioterapêutica , Radioterapia Conformacional , Radioterapia de Intensidade Modulada , Fatores de Risco
15.
Neurooncol Pract ; 7(2): 202-210, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32626588

RESUMO

BACKGROUND: Induction chemotherapy with carboplatin followed by radiotherapy has been used for many years for treating intracranial germ-cell tumors (IC-GCTs) in Thailand. The objective of this study was to assess treatment outcomes, focusing on survival and ototoxicity. METHODS: The outcomes of all patients with IC-GCT treated at Ramathibodi Hospital and the Prasat Neurological Institute between 2000 and 2017 were reviewed and analyzed, including all patient characteristics and treatment modalities. Five-year overall survival (OS) and event-free survival (EFS) were analyzed using the Kaplan-Meier method, and factors affecting survival were compared using the log-rank test. RESULTS: Fifty-three patients age 1-14 years (median, 11 years) were included in this study. The median follow-up time was 63 months. The 5-year EFS and OS rates were 94.3% and 96.2% for all patients, respectively. No statistical difference in OS or EFS was observed between the data of recipients in the carboplatin-based and historical cisplatin-based therapies in our institutes. Concerning radiotherapy, omission of radiotherapy or focal irradiation results in worse long-term survival outcomes, but reduction in dose of radiotherapy to less than 40 Gy did not cause any negative impact on survival rates. Furthermore, carboplatin was associated with lower rates of hearing loss than cisplatin (5.7% vs 87.5%). CONCLUSIONS: Induction chemotherapy with carboplatin-based regimens was associated with excellent survival rates and low ototoxicity in patients with IC-GCT. Radiotherapy should be given to all patients with a minimal volume equivalent to whole-ventricular radiotherapy, during which doses of lower than 40 Gy can be effectively used.

16.
J Med Assoc Thai ; 92(3): 382-9, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19301733

RESUMO

OBJECTIVE: To compare the results of pituitary adenoma treated with conventional external beam radiotherapy (EBRT) versus stereotactic radiosurgery and stereotactic radiotherapy (SRS/SRT). METHOD AND MATERIAL: Data of patients with pituitary adenoma treated at Radiotherapy and Oncology unit, Ramathibodi Hospital between 1990 from 2003 were retrospectively collected and analyzed. Twenty-two patients were treated with EBRT and 51 patients were treated with SRS/SRT. RESULTS: The 5-year overall survival and local control rates were not different between the EBRT and SRS/SRT group (91% vs 100%, p = 0.10; 95% vs 96%, p = 0.33). The 5-year freedom from newly initiated hormonal replacement was 50% in EBRT and 75% in SRS/SRT group (p = 0.38). CONCLUSION: At a similar outcome but with lower expense of resources, EBRT should be considered an acceptable radiation technique for patients with pituitary adenoma, especially in developing countries such as Thailand.


Assuntos
Adenoma/radioterapia , Adenoma/cirurgia , Neoplasias Hipofisárias/radioterapia , Neoplasias Hipofisárias/cirurgia , Radiocirurgia/métodos , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Radiocirurgia/efeitos adversos , Dosagem Radioterapêutica , Estudos Retrospectivos , Análise de Sobrevida , Tailândia , Dosimetria Termoluminescente , Resultado do Tratamento
17.
Neuro Oncol ; 10(4): 577-82, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18559468

RESUMO

The prognosis of children with diffuse intrinsic pontine glioma (DIPG) is very poor. Radiotherapy remains the standard treatment for these patients, but the median survival time is only 9 months. Currently, the use of concurrent radiotherapy with temozolomide (TMZ) has become the standard care for adult patients with malignant gliomas. We therefore investigated this approach in 12 children diagnosed with DIPG. The treatment protocol consisted of concurrent radiotherapy at a dose of 55.8-59.4 Gy at the tumor site with TMZ (75 mg/m(2)/day) for 6 weeks followed by TMZ (200 mg/m(2)/day) for 5 days with cis-retinoic acid (100 mg/m(2)/day) for 21 days with a 28-day cycle after concurrent radiotherapy. Ten of the 12 patients had a clinical response after the completion of concurrent radiotherapy. Seven patients had a partial response, four had stable disease, and one had progressive disease. At the time of the report, 9 of the 12 patients had died of tumor progression, one patient was alive with tumor progression, and two patients were alive with continuous partial response and clinical improvement. The median time to progression was 10.2 +/- 3.0 months (95% confidence interval [CI], 4.2-16.1 months). One-year progression-free survival was 41.7% +/- 14.2%. The median survival time was 13.5 +/- 3.6 months (95% CI, 6.4-20.5 months). One-year overall survival was 58% +/- 14.2%. The patients who had a partial response after completion of concurrent radiotherapy had a longer survival time (p = 0.036) than did the other patients (those with stable or progressive disease). We conclude that the regimen of concurrent radiotherapy and TMZ should be considered for further investigation in a larger series of patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/terapia , Glioma/terapia , Ponte/efeitos dos fármacos , Ponte/efeitos da radiação , Radioterapia , Fatores Etários , Idade de Início , Antineoplásicos Alquilantes/administração & dosagem , Antineoplásicos Alquilantes/efeitos adversos , Quimioterapia Adjuvante , Criança , Pré-Escolar , Terapia Combinada , Dacarbazina/administração & dosagem , Dacarbazina/efeitos adversos , Dacarbazina/análogos & derivados , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Prognóstico , Radioterapia/efeitos adversos , Temozolomida , Tretinoína/administração & dosagem , Tretinoína/efeitos adversos
18.
J Clin Neurosci ; 56: 139-142, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29960842

RESUMO

Medulloblastoma is the most common malignant brain tumor among children. Although molecular study has been included in the new classification, in developing countries with limited resources the previous Chang staging system is still used. Therefore, treatment with postoperative radiation and chemotherapy remains the standard treatment. One common complication after treatment is ototoxicity, mainly due to radiation and cisplatinum. We report a revised chemotherapy protocol, replacing cisplatinum with carboplatin in newly diagnosed medulloblastoma cases. All 23 patients in this study had high risk medulloblastoma. Mean (SD) age was 9.5 ±â€¯3.1 years. The 5-year progression free survival (PFS), 5-year overall survival (OS), and 10-year OS were 41.8 ±â€¯12.2%, 60.0 ±â€¯11.2%, and 48.0 ±â€¯14.0 respectively. Most patients had grade 3-4 hematologic toxicity. Twelve patients had hearing tests, with 11 patients having grade 0 and 1 patient having grade 1 according to the Brock criteria.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carboplatina/uso terapêutico , Neoplasias Cerebelares/tratamento farmacológico , Ciclofosfamida/uso terapêutico , Etoposídeo/uso terapêutico , Meduloblastoma/tratamento farmacológico , Vincristina/uso terapêutico , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carboplatina/administração & dosagem , Criança , Pré-Escolar , Ciclofosfamida/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Humanos , Lactente , Vincristina/administração & dosagem
19.
J Med Assoc Thai ; 89(10): 1665-9, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17128842

RESUMO

OBJECTIVE: To evaluate results of stereotactic radiotherapy for the treatment of optic nerve sheath meningioma (OM) at Ramathibodi Hospital. MATERIAL AND METHOD: Twelve patients with primary OM were treated with stereotactic radiation between 1998 and 2005. Five patients underwent surgery and had no light perception before radiation. All patients except one were treated with fractionated stereotactic radiotherapy (FSRT). Mean average dose of FSRT was 55. 7 Gy; 180 cGy/fraction. One patient was treated with 15-Gy stereotactic radiosurgery. RESULTS: With a median follow-up of 34 months, there was no visual improvement in the five patients who were completely blind before radiation. Visual acuity improved in four patients and remained stable in two patients. Four of six patients had improved visual field, and five of six decreased in proptosis. Follow-up images were available in six patients, showing minimal tumor regression in five and stable in one. No serious acute side effect was observed. Vision became worse in one patient, who developed vitreous hemorrhage two years after FSRT. CONCLUSION: Stereotactic radiotherapy is an effective treatment for primary OM. It provides tumor control and visual preservation with low risk of complications. However more patients and further follow-up are needed for long-term outcomes.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Neoplasias do Nervo Óptico/cirurgia , Radiocirurgia , Adulto , Idoso , Feminino , Hospitais , Humanos , Masculino , Neoplasias Meníngeas/patologia , Meningioma/patologia , Pessoa de Meia-Idade , Neoplasias do Nervo Óptico/patologia , Tailândia , Resultado do Tratamento
20.
Asian Pac J Cancer Prev ; 17(7): 3271-6, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27509962

RESUMO

BACKGROUND: Intracranial nonvestibular schwannomas arising from various cranial nerves excluding CN VIII are uncommon. Recently, stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) have been widely reported as effective treatment modalities for nonvestibular schwannomas. The purpose of this study was to study the long term clinical outcome for nonvestibular schwannomas treated with both XKnife and CyberKnife (CK) radiosurgery at one institution. MATERIALS AND METHODS: From 2004 to 2013, fiftytwo nonvestibular schwannoma patients were included in this study, 33 patients (63%) were treated with CK, and 19 (37%) were treated with XKnife. The majority of the tumors were jugular foramen schwannomas (38%) and trigeminal schwannomas (27%). HSRT was given for 45 patients (86%), whereas CSRT was for 6 (12%) and SRS for 1 (2%). RESULTS: The median pretreatment volume was 9.4 cm3 (range, 0.5752 cm3). With the median follow up time of 36 months (range, 3135), the 3 and 5 year progression free survival was 94 % and 88%, respectively. Tumor size was decreased in 13 (25%), stable in 29 (56%), and increased in 10 (19%). Among the latter, 3 (30%) required additional treatment because of neurologic deterioration. No patient was found to develop any new cranial nerve deficit after SRS/SRT. CONCLUSIONS: These data confirmed that SRS/ SRT provide high tumor control rates with low complications. Large volume tumors and cystic expansion after radiation should be carefully followed up with neurological examination and MRI, because it may frequently cause neurological deterioration requiring further surgery.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neurilemoma/cirurgia , Radiocirurgia/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Nervos Cranianos/patologia , Fracionamento da Dose de Radiação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neurilemoma/patologia , Prognóstico , Indução de Remissão , Taxa de Sobrevida , Adulto Jovem
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