Robotic Stereotactic Body Radiation Therapy in Patients With Recurrent or Metastatic Abdominopelvic Tumors: A Single Institute Experience.

BACKGROUND: The aim of this study was to evaluate the efficacy and toxicity of robotic CyberKnife (Accuray Incorporated, Sunnyvale, California)-based stereotactic body radiation therapy (SBRT) in patients with recurrent or metastatic abdominopelvic tumors. METHODS AND MATERIALS: A total of 69 patients treated between May 2008 and January 2011 were evaluated retrospectively. Indication for SBRT was persistent disease in 3 (4%) patients, local recurrence in 29 (42%) patients, regional recurrence in 13 (19%) patients, and oligometastatic disease in 24 (35%) patients. Forty-two (61%) patients were previously irradiated to the same region and 27 (39%) patients were treated for the first time. The median age was 59 years (range, 24-86 years). There were 31 (45%) male and 38 (55%) female patients. The median total dose was 30 Gy (range, 15-60 Gy) delivered with a median 3 fractions (range, 2-5 fractions). The tumor response to treatment was assessed by computed tomography, magnetic resonance imaging, or positron emission tomography. RESULTS: At the 12-month (range, 2-44 months) median follow-up, local control was 65% and median overall survival (OS) was 20 months. A larger gross tumor volume (≥ 67 cm(3)) was significantly correlated with worse 1-year OS (81% vs 48%, P = .03). The patients with local recurrence occurring <11 months had a significantly shorter 1-year local control rate than patients with ≥ 11 months (31% vs 91%, P < .001). Grade 3-4 acute and late toxicities were seen in 7% and 15% of patients, respectively. The patients with previous radiotherapy history had significantly higher rate of acute toxicity (19% vs 0%, P = .019). Late toxicity was significantly higher in pelvic tumors than in abdominal tumors (3% vs 28%, P = .004). CONCLUSION: The SBRT seems to be feasible and resulted in good treatment outcomes in patients with recurrent or metastatic abdominopelvic tumors.

Two cases of HELLP syndrome with fatal outcomes.

Severe preeclampsia and HELLP syndrome are still the leading causes of maternal and perinatal morbidity and mortality. We present two cases of pregnancies which were complicated by HELLP syndrome at 31 weeks of gestation and 25 weeks of gestation, the first one with maternal and the second with perinatal fatal outcomes. The aim of this report is to draw attention to the life-threatening complications that might occur in cases of preeclampisa and HELLP syndrome. The importance of early diagnosis with implications for management is also discussed.

A rare case of early onset nephrotic syndrome in pregnancy.

Nephrotic syndrome occurs very rarely, about 0.012-0.025% of all pregnancies. Here, we report a rare case of early onset nephrotic syndrome developing de novo in the 17th week of pregnancy. A renal biopsy was done and the specimens revealed typical features of focal segmental glomerulosclerosis. The patient had a progressive clinical course of disease despite steroid treatment. Suffering from severe intrauterine growth restriction, the fetus died in utero. After delivery, steroid treatment was continued. The patient had normal renal function with a decrease in proteinuria in the second and fifth month postpartum. This report points out the poor fetal prognosis associated with an early onset nephrotic syndrome. Pregnant patients with early onset nephrotic syndrome should be carefully evaluated for the presence of chronic renal disease, and primary renal pathology should be included in the differential diagnosis of massive proteinuria in early pregnancy.