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1.
World Neurosurg ; 130: 386-390, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295593

RESUMO

BACKGROUND: Pleomorphic xanthoastrocytomas (PXAs) are a rare type of astrocytoma, which, similar to other gliomas, can rarely arise from glial nests in the meninges, manifesting as an extra-axial mass. We describe a solitary extra-axial intracranial primary meningeal PXA in the pediatric age group, which was masquerading as a tentorial meningioma. CASE DESCRIPTION: A 9-year-old girl presented with features of raised intracranial pressure. Imaging revealed a dural-based mass in the tentorial region suggestive of a meningioma. This suspicion was further strengthened by intraoperative visualization of an extra-axial tumor with wide tentorial attachment. Near-total excision was achieved. Histopathologic examination established the diagnosis of PXA. Given the tumor's apparent meningeal origin and lack of connection with brain parenchyma in imaging and intraoperative findings, primary meningeal PXA was diagnosed. The absence of coexisting tumor foci on spinal magnetic resonance imaging further refined the diagnosis as solitary extra-axial intracranial primary meningeal PXA. The patient received radiotherapy for the residual tumor and was doing well at 6 months after presentation; however, she was lost to follow-up after that. CONCLUSIONS: Solitary extra-axial intracranial primary meningeal PXA is an extremely rare entity with only 3 reported cases in the literature including the present case. This is the first report of such a tumor in a pediatric patient. This report also highlights that primary meningeal PXA can manifest as an extra-axial mass lesion and may warrant inclusion in the differential diagnosis of extra-axial mass lesions.


Assuntos
Astrocitoma/cirurgia , Neoplasias Meníngeas/cirurgia , Astrocitoma/patologia , Astrocitoma/radioterapia , Criança , Craniotomia/métodos , Feminino , Humanos , Imagem por Ressonância Magnética , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/radioterapia , Neoplasia Residual/radioterapia , Doenças Raras
2.
Pediatr Blood Cancer ; 66(8): e27786, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31050179

RESUMO

PURPOSE: Proton therapy is currently used in the management of pediatric tumors to decrease late toxicities. However, one of the criticisms of proton therapy is the limited data regarding efficacy on disease control. The purpose of this study was to examine local and distant control rates after proton therapy for neuroblastoma. METHODS AND MATERIALS: Eighteen patients with high-risk (n = 16) and locally recurrent neuroblastoma (n = 2) were treated with curative intent and received proton therapy to the primary site and up to three post-induction MIBG-avid metastatic sites. Primary sites (n = 18) were treated to 21-36 Gy (relative biological effectiveness [RBE]), and metastatic sites (n = 16) were treated to 21-24 Gy (RBE). Local control and survival rates were calculated using the Kaplan-Meier method. RESULTS: With a median follow-up of 60.2 months, two- and five-year local control rates at the irradiated primary site were 94% and 87%, respectively. No failures at irradiated distant metastatic sites were observed. The five-year progression-free survival (PFS) was 64%, and the five-year overall survival (OS) was 94%. The extent of surgical resection was not associated with local control, PFS, or OS. No radiation-related nephropathy or hepatopathy was reported. CONCLUSIONS: Excellent local control was achieved using proton therapy to the primary and post-induction MIBG-positive distant sites. The predominant site of failure is progression in post-induction non-MIBG-avid distant sites. Although proton therapy provides high rates of local control with acceptable toxicity for neuroblastoma, further advances in systemic therapy are needed for the improved control of systemic disease.


Assuntos
Recidiva Local de Neoplasia/radioterapia , Neoplasia Residual/radioterapia , Neuroblastoma/radioterapia , Terapia com Prótons/métodos , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Recidiva Local de Neoplasia/patologia , Neoplasia Residual/patologia , Neuroblastoma/patologia , Estudos Prospectivos , Eficiência Biológica Relativa , Resultado do Tratamento
3.
Prog Neurol Surg ; 34: 166-172, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096223

RESUMO

Management of craniopharyngiomas remains challenging due to the tumor's often intimate relationship with the optic apparatus, the hypothalamus, and the pituitary gland. Often multimodal management is needed to achieve the best treatment outcome: tumor control coupled with endocrine, visual, and neurocognitive preservation. Many surgeons favor initial subtotal resection followed by adjunctive therapy to improve quality of life in a tumor with potentially long-term survival even if coupled with a need for periodic new interventions. During the patient's subsequent follow-up, solid or cystic tumor recurrence or progression often require additional management options. Leksell stereotactic radiosurgery (SRS) is a valuable adjuvant strategy that enhances long-term outcomes in patients with residual or recurrent craniopharyngiomas. Tumor control rates of 70-90% have been reported using 11- to 13-Gy tumor margin doses delivered using the Gamma Knife. Smaller tumors are associated with better radiosurgery outcomes. SRS is an effective management for residual or recurrent solid craniopharyngiomas with a favorable benefit-to-risk profile.


Assuntos
Craniofaringioma/radioterapia , Craniofaringioma/cirurgia , Recidiva Local de Neoplasia/radioterapia , Neoplasia Residual/radioterapia , Avaliação de Resultados em Cuidados de Saúde , Neoplasias Hipofisárias/radioterapia , Neoplasias Hipofisárias/cirurgia , Radiocirurgia/métodos , Humanos , Recidiva Local de Neoplasia/cirurgia , Neoplasia Residual/cirurgia
4.
Prog Neurol Surg ; 34: 207-214, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096236

RESUMO

Chordomas and chondrosarcomas are rare locally aggressive skull base tumors with high progression or recurrence rates. Ultimately, they have high mortality rates unless they respond to multimodality management options that include one or more surgical resections, fractionated radiation therapy, and stereotactic radiosurgery (SRS). SRS has become a standard management option for recurrent or residual chordomas and chondrosarcomas after failed surgical resection and fractionated radiation therapy. This report examines the role of SRS in these skull base tumors.


Assuntos
Condrossarcoma/radioterapia , Cordoma/radioterapia , Recidiva Local de Neoplasia/radioterapia , Neoplasia Residual/radioterapia , Radiocirurgia/métodos , Condrossarcoma/cirurgia , Cordoma/cirurgia , Humanos , Recidiva Local de Neoplasia/cirurgia , Neoplasia Residual/cirurgia , Neoplasias da Base do Crânio
5.
Prog Neurol Surg ; 34: 191-199, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096255

RESUMO

The outcome of patients with malignant gliomas has not substantially improved, even with advances in imaging, neurosurgery, molecular subtyping, and radiation, and newer oncologic options. Maximal safe resection when feasible remains the initial treatment of choice for most malignant gliomas. These tumors often recur and require additional therapy to control the tumor growth. Leksell stereotactic radiosurgery (SRS) is offered as salvage therapy in patients with recurrent or residual malignant gliomas. SRS is well tolerated and is associated with a relatively low risk of adverse radiation effects in malignant glial tumor patients who otherwise have relatively few options. SRS allows the surgeon more flexibility in terms of surgical options and may enhance quality of life for patients postoperatively. Although randomized controlled studies are lacking in the use of salvage SRS after the failure of initial standard of care management, preliminary data suggest that radiosurgery improves tumor control and overall survival for patients with recurrent malignant gliomas.


Assuntos
Neoplasias Encefálicas/radioterapia , Glioma/radioterapia , Recidiva Local de Neoplasia/radioterapia , Neoplasia Residual/radioterapia , Radiocirurgia/métodos , Terapia de Salvação/métodos , Neoplasias Encefálicas/cirurgia , Glioma/cirurgia , Humanos , Recidiva Local de Neoplasia/cirurgia , Neoplasia Residual/cirurgia
6.
Prog Neurol Surg ; 34: 232-237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096256

RESUMO

The classification of central neurocytoma (CN) by the WHO was upgraded to grade 2 in 1993 as it was recognized that at least some of these tumors can exhibit more aggressive behavior. Currently, as of 2016, CN is classified as WHO grade 2. Indeed, some atypical variants have been reported and residual postsurgical tumor is believed to have the potential for malignant transformation. Although gross total resection is usually curative for CN (5-year survival rate 99%), it is achieved in nearly 30-50% of cases due to its central location. Adjuvant treatments should be deliberately considered for the optimal management of CN. Recently, stereotactic radiosurgery is increasingly proposed as an adjuvant treatment for CN.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirurgia , Neoplasia Residual/radioterapia , Neurocitoma/radioterapia , Neurocitoma/cirurgia , Radiocirurgia/métodos , Humanos , Neoplasia Residual/cirurgia
7.
Endocrine ; 64(3): 639-647, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30798432

RESUMO

PURPOSE: To define the efficacy and complications of multisession Gamma Knife radiosurgery (MGKRS) delivered in three consecutive sessions for the treatment of residual or recurrent pituitary adenomas (PAs). METHODS: This was a retrospective study of data from the Neurosurgery and Gamma Knife Radiosurgery Department at San Raffaele Hospital between May 2008 and September 2017. We recruited 47 consecutive patients undergoing MGKRS in three consecutive fractions for residual or recurrent PA with a distance from the anterior optic pathway inferior to 2-3 mm. RESULTS: Thirty-eight (80.8%) patients had a nonfunctioning-PA (NFPA) while 9 (19.2%) had a hormone-secreting PA (HSPA). Tumor control was achieved in 100% of patients. Tumor shrinkage was seen in 33 out of 44 (75.0%) patients with a radiological follow-up. Mean tumor volume before MGKRS was 3.93 cm3. The mean tumor volume at last follow-up was 2.11 cm3, with a mean tumor shrinkage of 50.2%, as compared with baseline. One case of suspected radiation-induced optic neuropathy (RION) was documented while new-onset hypopituitarism for any axis occurred in 12 of the 31 (38.7%) patients at risk. The mean follow-up was 44.6 ± 4.0 months (range, 6-111 months). CONCLUSIONS: MGKRS is a valid alternative to external fractionated radiotherapy and other types of stereotactic radiosurgery for the treatment of PAs, achieving a high tumor control rate with a low risk of visual deterioration. Moreover, the majority of patients showed a significant reduction of tumor size in the long term.


Assuntos
Adenoma/radioterapia , Recidiva Local de Neoplasia/radioterapia , Neoplasia Residual/radioterapia , Neoplasias Hipofisárias/radioterapia , Radiocirurgia/efeitos adversos , Adenoma/patologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasia Residual/patologia , Neoplasias Hipofisárias/patologia , Radiocirurgia/instrumentação , Estudos Retrospectivos , Resultado do Tratamento
8.
Clin Cancer Res ; 25(4): 1226-1232, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30487127

RESUMO

PURPOSE: Spatial and temporal patterns of response of human glioblastoma to fractionated chemoradiation are described by changes in the bioscales of residual tumor volume (RTV), tumor cell volume fraction (CVF), and tumor cell kill (TCK), as derived from tissue sodium concentration (TSC) measured by quantitative sodium MRI at 3 Tesla. These near real-time patterns during treatment are compared with overall survival. EXPERIMENTAL DESIGN: Bioscales were mapped during fractionated chemoradiation therapy in patients with glioblastomas (n = 20) using TSC obtained from serial quantitative sodium MRI at 3 Tesla and a two-compartment model of tissue sodium distribution. The responses of these parameters in newly diagnosed human glioblastomas undergoing treatment were compared with time-to-disease progression and survival. RESULTS: RTV following tumor resection showed decreased CVF due to disruption of normal cell packing by edema and infiltrating tumor cells. CVF showed either increases back toward normal as infiltrating tumor cells were killed, or decreases as cancer cells continued to infiltrate and extend tumor margins. These highly variable tumor responses showed no correlation with time-to-progression or overall survival. CONCLUSIONS: These bioscales indicate that fractionated chemoradiotherapy of glioblastomas produces variable responses with low cell killing efficiency. These parameters are sensitive to real-time changes within the treatment volume while remaining stable elsewhere, highlighting the potential to individualize therapy earlier in management, should alternative strategies be available.


Assuntos
Quimiorradioterapia , Glioblastoma/diagnóstico por imagem , Neoplasia Residual/diagnóstico por imagem , Adulto , Idoso , Tamanho Celular/efeitos dos fármacos , Tamanho Celular/efeitos da radiação , Progressão da Doença , Fracionamento da Dose de Radiação , Feminino , Glioblastoma/tratamento farmacológico , Glioblastoma/patologia , Glioblastoma/radioterapia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasia Residual/tratamento farmacológico , Neoplasia Residual/patologia , Neoplasia Residual/radioterapia , Sódio/uso terapêutico , Carga Tumoral/efeitos dos fármacos , Carga Tumoral/efeitos da radiação
9.
Otol Neurotol ; 40(1): 103-107, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30015753

RESUMO

OBJECTIVES: Catecholamine-secreting jugular paragangliomas (JPs) represent a rare subset of head and neck paragangliomas that may present with hypertension, arrhythmia, or syncopal episodes. Subtotal resection to protect critical neurovascular structures may result in persistent catecholamine excess from residual tumor. Herein, we report our experience with stereotactic radiosurgery (SRS) for salvage treatment of catecholamine-secreting JP following subtotal microsurgical resection. PATIENTS: Adult patients treated with SRS after subtotal microsurgical resection of catecholamine-secreting JP. INTERVENTIONS: SRS. MAIN OUTCOME MEASURES: Post-treatment catecholamine and metanephrine levels, clinical outcomes, and tumor control. RESULTS: Of 85 patients with JPs treated with primary or salvage radiosurgery between 1990 and 2017, 2 (2%) harbored nonmalignant secreting tumors. Patient 1 developed catecholamine excess with elevated norepinephrine (NE) at 475 mcg/24 hours (normal < 80 mcg/24 h). Following subtotal resection, she developed catecholamine excess with radiographic evidence of tumor growth and therefore underwent SRS. Three years post-SRS and beyond, catecholamine levels remained normalized (NE 62 mcg/24 h at 10 yr) and tumor volume remained stable on serial MRI studies over the 17-year follow-up period.Patient 2 developed symptomatic arrhythmia and was found to have a JP. Urine norepinephrine (NE) was elevated at 213 mcg/24 hours. She underwent nerve-sparing subtotal resection and upfront SRS was used to treat residual tumor. Twenty months following SRS, the area of residual JP had not enlarged in size and catecholamine levels remained normal (NE 46 mcg/24 h). CONCLUSIONS: Radiosurgery can be used in salvage treatment of catecholamine-secreting JP, providing durable tumor control and resolution of catecholamine excess. For patients with large catecholamine-secreting JP and normal lower cranial nerve function, aggressive nerve-sparing subtotal resection with adjuvant radiosurgery may offer a low-morbidity alternative to gross total resection. Further study of this subset of patients is warranted to substantiate these promising, yet preliminary findings.


Assuntos
Tumor do Glomo Jugular/cirurgia , Neoplasia Residual/radioterapia , Radiocirurgia , Adulto , Progressão da Doença , Feminino , Tumor do Glomo Jugular/patologia , Tumor do Glomo Jugular/radioterapia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Terapia de Salvação , Resultado do Tratamento , Carga Tumoral
10.
Pediatr Blood Cancer ; 65(7): e27009, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29469198

RESUMO

BACKGROUND: Locoregional failure is common after subtotal resection in high-risk neuroblastoma. Although a dose of 21 Gy radiation therapy (RT) is standard for treatment of high-risk neuroblastoma after gross total resection, the dose needed for local control of patients with gross residual disease at the time of RT is unknown. We sought to evaluate local control after 21-36 Gy RT in patients with high-risk neuroblastoma undergoing subtotal resection. METHODS: All patients with high-risk neuroblastoma who received RT to their primary site from 2000 to 2016 were reviewed. Of the 331 patients who received consolidative RT to their primary site, 19 (5.7%) underwent subtotal resection and were included in our analysis. Local failure (LF) was correlated with biologic prognostic factors and dose of RT. RESULTS: Median follow-up among surviving patients was 6.0 years. Median RT dose was 25 Gy (range, 21 Gy-36 Gy). The 5-year cumulative incidence of LF among all patients was 17.2%. LF at 5 years was 30% in those who received <30 Gy versus 0% in those who received 30-36 Gy (P = 0.12). There was a trend towards improved local control in patients with tumor size ≤10 cm at diagnosis (P = 0.12). The 5-year event-free and overall survival were 44.9% and 68.7%, respectively. CONCLUSION: After subtotal resection, patients who received less than 30 Gy had poor local control. Doses of 30-36 Gy are likely needed for optimal control of gross residual disease at the time of consolidative RT in high-risk neuroblastoma.


Assuntos
Recidiva Local de Neoplasia/radioterapia , Neoplasia Residual/radioterapia , Neuroblastoma/radioterapia , Adolescente , Adulto , Criança , Pré-Escolar , Fracionamento da Dose de Radiação , Feminino , Seguimentos , Raios gama , Humanos , Lactente , Masculino , Recidiva Local de Neoplasia/patologia , Neoplasia Residual/patologia , Neuroblastoma/patologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
11.
Neuroradiology ; 60(2): 169-177, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29218370

RESUMO

PURPOSE: The aim of this study is to differentiate recurrent/residual gliomas from postradiation changes using arterial spin labeling (ASL) perfusion and diffusion tensor imaging (DTI)-derived metrics. METHODS: Prospective study was conducted upon 42 patients with high-grade gliomas after radiotherapy only or prior to other therapies that underwent routine MR imaging, ASL, and DTI. The tumor blood flow (TBF), fractional anisotropy (FA), and mean diffusivity (MD) of the enhanced lesion and related edema were calculated. The lesion was categorized as recurrence/residual or postradiation changes. RESULTS: There was significant differences between residual/recurrent gliomas and postradiation changes of TBF (P = 0.001), FA (P = 0.001 and 0.04), and MD (P = 0.001) of enhanced lesion and related edema respectively. The area under the curve (AUC) of TBF of enhanced lesion and related edema used to differentiate residual/recurrent gliomas from postradiation changes were 0.95 and 0.93 and of MD were 0.95 and 0.81 and of FA were 0.81 and 0.695, respectively. Combined ASL and DTI metrics of the enhanced lesion revealed AUC of 0.98, accuracy of 95%, sensitivity of 93.8%, specificity of 95.8%, positive predictive value (PPV) of 93.8%, and negative predictive value (NPV) of 95.8%. Combined metrics of ASL and DTI of related edema revealed AUC of 0.97, accuracy of 92.5%, sensitivity of 93.8%, specificity of 91.7%, PPV of 88.2%, and NPV of 95.7. CONCLUSION: Combined ASL and DTI metrics of enhanced lesion and related edema are valuable noninvasive tools in differentiating residual/recurrent gliomas from postradiation changes.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Imagem de Tensor de Difusão/métodos , Glioma/diagnóstico por imagem , Glioma/patologia , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Neoplasia Residual/diagnóstico por imagem , Neoplasia Residual/patologia , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/patologia , Anisotropia , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/patologia , Neoplasias Encefálicas/radioterapia , Diagnóstico Diferencial , Feminino , Gadolínio DTPA , Glioma/radioterapia , Humanos , Masculino , Necrose , Gradação de Tumores , Recidiva Local de Neoplasia/radioterapia , Neoplasia Residual/radioterapia , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Marcadores de Spin
12.
Strahlenther Onkol ; 194(3): 185-195, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29094172

RESUMO

BACKGROUND: Pancreatic cancer is one of the most aggressive human tumors and the incidence has increased over the last 6 years. In the majority of cases the disease is already in an advanced stage at the time of diagnosis where surgery, the only curative treatment, is no longer an option and explains the still abysmal overall survival. The role of radiation therapy as treatment option for patients with pancreatic cancer is controversially discussed although radiation oncology has emerged as a central pillar in the combined oncological treatment. PURPOSE: The present manuscript gives an overview of advanced radiotherapeutic strategies in the context of chemotherapy and surgery according to the current American Society of Clinical Oncology (ASCO) guidelines in comparison with the German guidelines and to elucidate the role of radiation therapy for the treatment of pancreatic cancer. CONCLUSION: Advanced modern radiotherapeutic techniques in combination with individualized high-precision radiation concepts are new therapeutic approaches for pancreatic cancer in a multimodal setting with tolerable side effects. Several clinical studies together with experimental approaches are in process, to deliver further evidence and ultimately allow true personalized medicine.


Assuntos
Neoplasias Pancreáticas/terapia , Radioterapia Adjuvante/métodos , Quimiorradioterapia/métodos , Ensaios Clínicos como Assunto , Terapia Combinada , Progressão da Doença , Intervalo Livre de Doença , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Período Intraoperatório , Estadiamento de Neoplasias , Neoplasia Residual/radioterapia , Cuidados Paliativos/métodos , Pancreatectomia , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Radiocirurgia , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/métodos , Radioterapia de Intensidade Modulada
13.
Curr Urol Rep ; 18(7): 55, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28589403

RESUMO

Radical prostatectomy (RP) is now the most common definitive treatment for high-risk prostate cancer. Unfortunately, many men will have residual microscopic disease after surgery alone. Despite level 1 evidence supporting the use of adjuvant radiation therapy (ART), <10% of men with adverse pathology (positive margins or T3 disease) receive ART in the USA. Early salvage radiation therapy (eSRT) at the time of biochemical recurrence has been proposed as an alternative strategy despite the lack of published randomized trials to support this approach. Multiple randomized trials are ongoing or recently completed to compare ART to eSRT, but given the long natural history of prostate cancer, long-term oncologic outcomes from these trials will not be reported for several years. In this review, we discuss the shifting trends in the diagnosis of high-risk prostate cancer given a decline in PSA screening, use of RP for high-risk disease, and compare and contrast the retrospective and randomized evidence regarding ART and SRT.


Assuntos
Neoplasia Residual/radioterapia , Prostatectomia , Neoplasias da Próstata/radioterapia , Radioterapia Adjuvante/métodos , Terapia de Salvação/métodos , Humanos , Masculino , Estadiamento de Neoplasias , Estudos Retrospectivos , Medição de Risco , Prevenção Secundária
14.
Ann Surg Oncol ; 24(6): 1596-1605, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28108827

RESUMO

BACKGROUND: Unplanned excisions (UE) of soft tissue sarcomas (STS) carry a high risk for local recurrence (LR) due to marginal/intralesional resections. However, there are reports about improved prognosis for UE patients who have re-resection compared with patients who undergo planned surgery. The present multicentre study was designed to define characteristics of UE patients and to investigate the impact of UE on subsequent therapy and patient outcomes. METHODS: A total of 728 STS patients (376 males, 352 females; mean age: 58 years) who underwent definite surgery at one of three tumour centres were retrospectively included. Time-to-event analyses were calculated with log-rank and Gray's tests, excluding patients with primary metastasis (n = 59). A propensity-score (PS) of being in the UE group was estimated, based on differences at baseline between the UE group and non-UE group. An inverse-probability-of-UE weight (IPUEW) was generated and time-to-event analyses calculated after IPUEW weighting. RESULTS: Before referral, 38.6% of patients (n = 281) had undergone UE. Unplanned excision patients were younger (p = 0.036), rather male (p = 0.05), and had smaller (p < 0.005), superficially located tumours (p < 0.005). Plastic reconstructions (p < 0.005) and adjuvant radiotherapy (p = 0.041) more often were needed at re-resection. In univariable analysis, re-resected patients had improved overall survival (OS; p = 0.027) and lower risk of distant metastasis (DM; p = 0.002) than primarily resected patients, whereas risk of LR was similar (p = 0.359). After weighting for the IPUEW, however, differences in terms of OS (p = 0.459) and risk of DM (p = 0.405) disappeared. CONCLUSIONS: The present study does not support prior findings of improved outcome for UE patients. Unplanned excisions have a major impact on subsequent therapy, yet they do not seem to affect negatively the long-term oncology outcome.


Assuntos
Recidiva Local de Neoplasia/cirurgia , Neoplasia Residual/cirurgia , Sarcoma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Metástase Neoplásica , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/radioterapia , Neoplasia Residual/patologia , Neoplasia Residual/radioterapia , Prognóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Sarcoma/patologia , Sarcoma/radioterapia , Taxa de Sobrevida , Adulto Jovem
15.
Clin Cancer Res ; 23(4): 908-917, 2017 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-27998887

RESUMO

Purpose: This phase I study aimed to determine the recommended dose (RD), safety profile, and feasibility of a procedure combining intratumoral injection of hafnium oxide nanoparticles (NBTXR3; a radioenhancer) and external beam radiotherapy (EBRT) for preoperative treatment of adults with locally advanced soft tissue sarcoma (STS).Experimental Design: Patients had a preoperative indication of EBRT for STS of the extremity or trunk. Baseline tumor volume (TV) was calculated by MRI. NBTXR3 was injected percutaneously into tumors at 53.3 g/L. Dose escalation was based on four levels equivalent to 2.5%, 5%, 10%, and 20% of baseline TV. NBTXR3 was visualized in the tumor 24 hours postinjection, and EBRT was initiated (50 Gy over 5 weeks). Surgery was performed 6 to 8 weeks after EBRT completion.Results: Twenty-two patients completed NBTXR3 injection, EBRT, and surgery and were followed for a median 22 months (range, 6-40). At NBTXR3 20% of TV, two dose-limiting toxicities occurred: injection-site pain and postoperative scar necrosis. The RD was defined as 10%. No leakage of NBTXR3 into surrounding tissues occurred; intratumor NBTXR3 levels were maintained during radiotherapy. At the RD, median tumor shrinkage was 40% (range 71% shrinkage, 22% increase); median percentage of residual viable tumor cells was 26% (range, 10%-90%). Patients receiving 20% of TV demonstrated pathologic complete responses. Seven grade 3 adverse events occurred, which were reversible.Conclusions: A single intratumoral injection of NBTXR3 at 10% of TV with preoperative EBRT was technically feasible with manageable toxicity; clinical activity was observed. Clin Cancer Res; 23(4); 908-17. ©2016 AACR.


Assuntos
Nanopartículas/administração & dosagem , Recidiva Local de Neoplasia/radioterapia , Neoplasia Residual/radioterapia , Sarcoma/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Háfnio/administração & dosagem , Háfnio/química , Humanos , Masculino , Pessoa de Meia-Idade , Nanopartículas/química , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Neoplasia Residual/tratamento farmacológico , Neoplasia Residual/patologia , Óxidos/administração & dosagem , Óxidos/química , Cuidados Pré-Operatórios , Dosagem Radioterapêutica , Radioterapia Adjuvante/efeitos adversos , Sarcoma/tratamento farmacológico , Sarcoma/patologia
17.
Stereotact Funct Neurosurg ; 94(4): 273-278, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27721314

RESUMO

BACKGROUND: Supratentorial primitive neuroectodermal tumors (PNETs) are highly malignant and rare tumors of the central nervous system. OBJECTIVES: The aim of this study was to determine the role of Gamma Knife surgery (GKS) as a salvage treatment option for patients with recurrent or residual supratentorial PNETs. METHODS: Between 1998 and 2014, 11 patients with supratentorial PNETs were retrospectively analyzed. This series consisted of 7 male and 4 female patients. The median age was 17 years. All patients received surgical resection followed by adjuvant therapy. The median time from operation to the first GKS treatment was 72.5 months. The median tumor volume was 17.5 cm3, and the median marginal dose was 11.5 Gy. RESULTS: 15 (65%) of the 23 tumors had been controlled. The actuarial local tumor control rate was 91% at 3 months, 73% at 6 months, and 44% at 12 months. At the time of analysis, 9 (82%) of the patients had died. The median survival time after the first GKS session was 17 months. The median survival time from the initial diagnosis was 65 months. No adverse radiation effect after GKS treatment occurred in any patient. CONCLUSIONS: GKS treatment might be an effective salvage treatment option for recurrent or residual supratentorial PNETs after multimodal treatment.


Assuntos
Recidiva Local de Neoplasia/radioterapia , Neoplasia Residual/radioterapia , Tumores Neuroectodérmicos Primitivos/radioterapia , Radiocirurgia , Neoplasias Supratentoriais/radioterapia , Adolescente , Adulto , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia/cirurgia , Neoplasia Residual/cirurgia , Tumores Neuroectodérmicos Primitivos/cirurgia , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Terapia de Salvação , Neoplasias Supratentoriais/cirurgia , Adulto Jovem
18.
Theranostics ; 6(10): 1611-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27446495

RESUMO

PURPOSE: Radionuclide therapy is increasingly seen as a promising option to target minimal residual disease. Copper-67, scandium-47 and terbium-161 have a medium-energy ß(-) emission which is similar to that of lutetium-177, but offer the advantage of having diagnostic partner isotopes suitable for pretreatment imaging. The aim of this study was to compare the efficacy of (67)Cu, (47)Sc and (161)Tb to irradiate small tumors. METHODS: The absorbed dose deriving from a homogeneous distribution of (67)Cu, (47)Sc or (161)Tb in water-density spheres was calculated with the Monte Carlo code CELLDOSE. The diameters of the spheres ranged from 5 mm to 10 µm, thus simulating micrometastases or single tumor cells. All electron emissions, including ß(-) spectra, Auger and conversion electrons were taken into account. Because these radionuclides differ in electron energy per decay, the simulations were run assuming that 1 MeV was released per µm(3), which would result in a dose of 160 Gy if totally absorbed. RESULTS: The absorbed dose was similar for the three radionuclides in the 5-mm sphere (146-149 Gy), but decreased differently in smaller spheres. In particular, (161)Tb delivered higher doses compared to the other radionuclides. For instance, in the 100-µm sphere, the absorbed dose was 24.1 Gy with (67)Cu, 14.8 Gy with (47)Sc and 44.5 Gy with (161)Tb. Auger and conversion electrons accounted for 71% of (161)Tb dose. The largest dose differences were found in cell-sized spheres. In the 10-µm sphere, the dose delivered by (161)Tb was 4.1 times higher than that from (67)Cu and 8.1 times that from (47)Sc. CONCLUSION: (161)Tb can effectively irradiate small tumors thanks to its decay spectrum that combines medium-energy ß(-) emission and low-energy conversion and Auger electrons. Therefore (161)Tb might be a better candidate than (67)Cu and (47)Sc for treating minimal residual disease in a clinical setting.


Assuntos
Neoplasia Residual/radioterapia , Neoplasias/radioterapia , Radioisótopos/farmacologia , Simulação por Computador , Radioisótopos de Cobre/farmacologia , Escândio/farmacologia , Térbio/farmacologia
19.
World J Surg Oncol ; 14: 89, 2016 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-27012522

RESUMO

BACKGROUND: Salvage surgery has been recommended as the approach of choice for neck residue or recurrence of nasopharyngeal carcinoma (NPC) after primary radiotherapy (RT). This study aimed to assess the outcome and prognostic factors, options for different surgical methods, and the extent of neck dissection (ND) for patients. METHODS: NPC patients who had undergone RT and received salvage surgery for neck residue or recurrence from January 2001 to December 2011 were retrospectively analyzed. The overall survival (OS) rate was calculated by Kaplan-Meier method, and prognostic factors were determined by log-rank test and Cox regression analysis. RESULTS: In 153 cases, 96 cases have level I dissections. The metastasis rate was 20/153 (13.07%) for level I metastasis and 7/153 (4.58%) for parotid gland cases. The 3- and 5-year OS rate was 57.2 and 40.6%, respectively, and median survival time was 49 months. By univariate analysis, the age, rN staging, size of lymph nodes (LN), extra-capsular spread (ECS), and surgical procedure were significant prognostic factors. By multivariable analysis, the age, rN staging, and size of LN were significant prognostic factors. CONCLUSIONS: Salvage surgery is effective for neck failure of NPC after primary treatment, but patients with age >50 years, stage rN3, or LN >6 cm have poor prognosis.


Assuntos
Neoplasias Nasofaríngeas/cirurgia , Esvaziamento Cervical , Pescoço/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasia Residual/cirurgia , Terapia de Salvação , Adolescente , Adulto , Idoso , Carcinoma , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasofaríngeas/radioterapia , Pescoço/patologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/radioterapia , Estadiamento de Neoplasias , Neoplasia Residual/patologia , Neoplasia Residual/radioterapia , Prognóstico , Radioterapia , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
20.
J Oral Maxillofac Surg ; 74(2): 302-6, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26272005

RESUMO

Ameloblastic carcinoma (AC) is a rare malignant odontogenic tumor. Surgical resection of the tumor is the mainstay of its treatment. To date, radiotherapy for this tumor remains controversial. This report describes a case of AC with intracranial extension and provides the first report of the efficacy of single-fraction helical tomotherapy for the treatment of residual AC after surgical resection.


Assuntos
Tumores Odontogênicos/radioterapia , Radioterapia de Intensidade Modulada/métodos , Seguimentos , Humanos , Masculino , Neoplasias do Seio Maxilar/radioterapia , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasia Residual/radioterapia , Tumores Odontogênicos/cirurgia , Dosagem Radioterapêutica , Neoplasias da Base do Crânio/radioterapia
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