The effect of targeted agents on outcomes in patients with brain metastases from renal cell carcinoma treated with Gamma Knife surgery.

OBJECT: Gamma Knife surgery (GKS) has been reported as an effective modality for treating brain metastases from renal cell carcinoma (RCC). The authors aimed to determine if targeted agents such as tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors, and bevacizumab affect the patterns of failure of RCC after GKS. METHODS: Between 1999 and 2010, 61 patients with brain metastases from RCC were treated with GKS. A median dose of 20 Gy (range 13-24 Gy) was prescribed to the margin of each metastasis. Kaplan-Meier analysis was used to determine local control, distant failure, and overall survival rates. Cox proportional hazard regression was performed to determine the association between disease-related factors and survival. RESULTS: Overall survival at 1, 2, and 3 years was 38%, 17%, and 9%, respectively. Freedom from local failure at 1, 2, and 3 years was 74%, 61%, and 40%, respectively. The distant failure rate at 1, 2, and 3 years was 51%, 79%, and 89%, respectively. Twenty-seven percent of patients died of neurological disease. The median survival for patients receiving targeted agents (n = 24) was 16.6 months compared with 7.2 months (n = 37) for those not receiving targeted therapy (p = 0.04). Freedom from local failure at 1 year was 93% versus 60% for patients receiving and those not receiving targeted agents, respectively (p = 0.01). Multivariate analysis showed that the use of targeted agents (hazard ratio 3.02, p = 0.003) was the only factor that predicted for improved survival. Two patients experienced post-GKS hemorrhage within the treated volume. CONCLUSIONS: Targeted agents appear to improve local control and overall survival in patients treated with GKS for metastastic RCC.

Clinical outcomes of brain metastases treated with Gamma Knife radiosurgery with 3.0 T versus 1.5 T MRI-based treatment planning: have we finally optimised detection of occult brain metastases?

INTRODUCTION: The goal of this study was to determine if clinically relevant endpoints were changed by improved MRI resolution during radiosurgical treatment planning. METHODS AND MATERIALS: Between 2003 and 2008, 200 consecutive patients with brain metastases treated with Gamma Knife radiosurgery (GKRS) using either 1.5 T or 3.0 T MRI for radiosurgical treatment planning were retrospectively analysed. The number of previously undetected metastases at time of radiosurgery, distant brain failures, time delay to whole brain radiotherapy (WBRT), overall survival and likelihood of neurological death were determined. RESULTS: Additional metastases were detected in 31.3% and 24.5% of patients at time of radiosurgery with 3.0 T and 1.5 T MRI, respectively (P = 0.27). Patients with multiple metastases at diagnostic scan were more likely to have additional metastases detected by 3.0 T MRI (P < 0.1). Median time to distant brain failure was 4.87 months and 5.43 months for the 3.0 T and 1.5 T cohorts, respectively (P = 0.44). Median time to WBRT was 5.8 months and 5.3 months for the 3.0 T and 1.5 T cohorts, respectively (P = 0.87). Median survival was 6.4 months for the 3.0 T cohort, and 6.1 months for the 1.5 T cohort (P = 0.71). Likelihood of neurological death was 25.3% and 16.7% for the 3.0 and 1.5 T populations, respectively (P = 0.26). CONCLUSIONS: The 3.0 T MRI-based treatment planning for GKRS did not appear to affect the likelihood of distant brain failure, the need for WBRT or the likelihood of neurological death in this series.

Direct Raman evidence for a weak continuous phase transition in liquid water.

This paper presents the Raman depolarization ratio of degassed ultrapure water as a function of temperature, in the range 303.4-314.4 K (30.2-41.2 degrees C). The pressure of the sample was the vapor pressure of water at the measurement temperature. The data provide a direct indication of the existence of a phase transition in the liquid at 307.7 K, 5.8 kPa (34.6 degrees C, 0.057 atm). The minimum in the heat capacity, C(p)(), of water occurs at 34.5 degrees C, 1.0 atm (J. Res. Natl. Bur. Stand. 1939, 23, 197(1)). The minimum in C(p)() is shallow, and the transition is a weak-continuous phase transition. The pressure coefficient of the viscosity of water changes sign as pressure increases for temperatures below 35 degrees C (Nature 1965, 207, 620(2)). The viscosity minimum tracks the liquid phase transition in the P, T plane where it connects with the minimum in the freezing point of pure water in the same plane (Proc. Am. Acad. Arts Sci. 1911-12, 47, 441(3)). Previously we argued (J. Chem. Phys. 1998, 109, 7379(4)) that the minimum in the pressure coefficient of viscosity signaled the elimination of three-dimensional connectivity in liquid water. These observations coupled with recent measurements of the coordination shell of water near 300 K (Science 2004, 304, 995(5)) suggest that the structural component that changes during the phase transition is tetrahedrally coordinated water. At temperatures above the transition, there is no tetrahedrally coordinated water in the liquid and locally planar water structures dominate the liquid structure. Water is a structured liquid with distinct local structures that vary with temperature. Furthermore, liquid water has a liquid-liquid phase transition near the middle of the normal liquid range.