Results of salvage treatment with CyberKnife® fractioned radiosurgery in recurrent large chordoma.

AIM: Chordomas and chondrosarcomas are locally destructive tumors with high progression or recurrence rates after initial multimodality treatment. This report examined the role of radiosurgery in patients who were considered inoperable after the recurrence of large chordoma disease having undergone previous surgery and/or radiotherapy. METHODS: All patients who were referred to Okmeydani Education and Research Hospital between 2012 and 2019 for treatment of recurrent or metastatic chordoma and considered not suitable for surgical treatment were included in the study. We included patients presenting with recurrent or metastatic chordoma, those who had undergone surgery and/or radiotherapy and were now considered to be surgically inoperable, patients whose tumors could lead to severe neurologic or organ dysfunction when resected, and those who underwent salvage treatments for definitive or palliative purposes with radiosurgery. After radiosurgical salvage therapy was performed on 13 patients using a CyberKnife® device, the effect of this treatment in terms of local control and survival and the factors that might affect it was investigated. Thirteen lesions were local (in-field) recurrence, and five lesions were closer to the primary tumor mass or seeding metastatic lesions. Tumor response was evaluated using the Response Evaluation Criteria for Solid Tumors (RECIST) system and volumetric analysis. RESULTS: The median age of the 13 patients was 59 years, and the median tumor volume of 18 lesions was 30.506 cc (R: 6884.06-150,418.519 mL). The median dose was 35 Gy (R: 17.5-47.5), the median fraction was 5 (R: 1-5), and the median biological effective dose BED2.45 was 135 Gy (R: 63.82-231.68). The median time for radiosurgery was 30 months after the first radiotherapy and 45 months after the last surgery. The median follow-up time was 57 (R: 15-94) months. The progression-free survival was 24 months. The median survival was 33.9 months. Local control was achieved in 84.6% of patients after 1 year, and 76.9% after 2 years, with the mass shrinking or remaining stable. Survival after recurrence was 69.2% for the 1st year, 61.5% for the 2nd year, and 53.8% for the 5th year. CONCLUSION: In patients with recurrent and surgically inoperable chordomas, stereotactic body radiation therapy (SBRT) is a reliable and effective treatment method. Promising result has been obtained with radiosurgery treatment under local control of patients. LEVEL OF EVIDENCE: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Comprehensive analysis of stereotactic Radiosurgery outcomes in triple-negative breast cancer patients with brain metastases: The influence of immunotherapy and prognostic factors.

INTRODUCTION: Breast cancer stands as the second most common solid tumors with a propensity for brain metastasis. Among metastatic breast cancer cases, the brain metastasis incidence ranges from 10 % to 30 %, with triple-negative breast cancer (TNBC) displaying a heightened risk and poorer prognosis. SRS has emerged as an effective local treatment modality for brain metastases; however, data on its outcomes specifically in pure triple-negative subtype remain scarce. METHOD: We retrospectively reviewed the electronic medical records of all brain metastasis (BM) TNBC patients treated with SRS. Patient, tumour characteristics and treatment details data were collected. This retrospective cohort study aimed to evaluate local control (LC), distant brain metastasis free survival (DBMFS), and overall survival (OS) outcomes in TNBC patients undergoing SRS for brain metastases while identifying potential prognostic factors. RESULT: Forty-three patients with TNBC and brain metastases treated with SRS between January 2017 and 2023 were included. The study found rates of LC (99 % at 1 year) and DBMFS (76 % at 1 year) after SRS, with brain metastasis count (p = 0,003) and systemic treatment modality (p = 0,001) being significant predictors of DBMFS. The median OS following SRS was 19.5 months, with neurological deficit (p = 0.003) and systemic treatment modality (p = 0.019) identified as significant predictors of OS. CONCLUSION: SRS demonstrates favourable outcomes in terms of local control and distant brain metastasis-free survival in TNBC. Neurological deficit and systemic treatment significantly influence overall survival, emphasizing the importance of personalized treatment approaches and (magnetic resonance imaging) MRI surveillance based on these factors.

Radiosurgery effects and adverse effects in symptomatic eloquent brain-located Cavernomas.

In this study, the dose schedule efficacy, safety and late adverse effects of stereotactic radiosurgery (SRS) were evaluated for patients with symptomatic cavernomas who were not eligible for surgery and treated with SRS. Between January 2013 and December 2018, 53 patients with cavernomas were treated using SRS with the CyberKnife® system. Patients' diseases were deeply located or were in subcortical functional brain regions. In addition to bleeding, 23 (43.4%) patients had epilepsy, 12 (22.6%) had neurologic symptoms and 16 patients (30.2%) had severe headaches. The median volume was 741 (range, 421-1351) mm3, and the median dose was 15 (range, 14-16) Gy in one fraction. After treatment, six (50%) of 12 patients with neurologic deficits still had deficits. Rebleeding after treatment developed in only two (3.8%) patients. The drug was completely stopped in 14 (60.9%) out of 23 patients who received epilepsy treatment, and the dose of levetiracetam decreased from 2000 mg to 1000 mg in four (17.3%) of nine patients. Radiologically, complete response (CR) was observed in 13 (24.5%) patients, and partial responses (PR) were observed in 32 (60.2%) patients. Clinical response of CR was observed in 30 (56.6%) patients, PR was observed in 16 (30.2%), stable disease (SD) was observed in three (5.7%) and four (7.5%) patients progressed. In conclusion, SRS applied in the appropriate dose schedule may be an effective and reliable method in terms of symptom control and prevention of rebleeding, especially in patients with inoperable cavernomas.