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Outcome for Children with Metastatic Solid Tumors over the Last Four Decades  [PDF]
Stephanie M. Perkins, Eric T. Shinohara, Todd DeWees, Haydar Frangoul
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0100396
Abstract: Background Outcomes for pediatric solid tumors have significantly improved over the last 30 years. However, much of this improvement is due to improved outcome for patients with localized disease. Here we evaluate overall survival (OS) for pediatric patients with metastatic disease over the last 40 years. Procedure The United States Surveillance, Epidemiology, and End Results (SEER) database was used to conduct this study. Patients diagnosed between 0 and 18 years of age with metastatic Ewings sarcoma, neuroblastoma, osteosarcoma, rhabdomyosarcoma or Wilms tumor were included in the analysis. Results 3,009 patients diagnosed between 1973–2010 met inclusion criteria for analysis. OS at 10 years for patients diagnosed between 1973–1979, 1980–1989, 1990–1999 and 2000–2010 was 28.3%, 37.2%, 44.7% and 49.3%, respectively (p<0.001). For patients diagnosed between 2000–2010, 10-year OS for patients with Ewing sarcoma, neuroblastoma, osteosarcoma, rhabdomyosarcoma and Wilms tumor was 30.6%, 54.4%, 29.3%, 27.5%, and 76.6%, respectively, as compared to 13.8%, 25.1%, 13.6%, 17.9% and 57.1%, respectively, for patients diagnosed between 1973–1979. OS for neuroblastoma significantly increased with each decade. For patients with osteosarcoma and Ewing sarcoma, there was no improvement in OS over the last two decades. There was no improvement in outcome for patients with rhabdomyosarcoma or Wilms tumor over the last 30 years. Conclusions OS for pediatric patients with metastatic solid tumors has significantly improved since the 1970s. However, outcome has changed little for some malignancies in the last 20–30 years. These data underscore the importance of continued collaboration and studies to improve outcome for these patients.
A simple fixation and monitoring method for treating choroidal and orbital tumors using the CyberKnife system
Ayhan KILI?,Nadir Kü?üK,Cemile CEYLAN,Hande BA?
Turkish Journal of Oncology , 2009,
Abstract: OBJECTIVES: A simple fixation and monitoring system has been adapted to treat choroidal and orbital tumors using the CyberKnife robotic radiosurgery system. METHODS: We adapted and simplified a technique in our clinic to treat orbital tumor in two patients using the CyberKnife robotic radiosurgery system. This system used computerized tomography and magnetic resonance scanning during the treatment. The system is based on the principle that the affected eye of the patient watches a fixed point. During the treatment, lens movement of the patient was monitored via a closed circuit television camera from the control room. RESULTS: We treated two patients with right eye orbital tumors using this system. Treatment took 38 minutes per fraction. Both treatments were finished successfully without any problem. CONCLUSION: This simple fixation and monitoring system in the treatment of choroidal and orbital tumors has shown that treatment is possible without an invasive application.
CyberKnife for hilar lung tumors: report of clinical response and toxicity
Keith Unger, Andrew Ju, Eric Oermann, Simeng Suy, Xia Yu, Saloomeh Vahdat, Deepa Subramaniam, K William Harter, Sean P Collins, Anatoly Dritschilo, Eric Anderson, Brian T Collins
Journal of Hematology & Oncology , 2010, DOI: 10.1186/1756-8722-3-39
Abstract: Patients presenting with primary and metastatic hilar lung tumors, treated using the CyberKnife system with Synchrony fiducial tracking technology, were retrospectively reviewed. Hilar location was defined as abutting or invading a mainstem bronchus. Fiducial markers were implanted by conventional bronchoscopy within or adjacent to tumors to serve as targeting references. A prescribed dose of 30 to 40 Gy to the gross tumor volume (GTV) was delivered in 5 fractions. Clinical examination and PET/CT imaging were performed at 3 to 6-month follow-up intervals.Twenty patients were accrued over a 4 year period. Three had primary hilar lung tumors and 17 had hilar lung metastases. The median GTV was 73 cc (range 23-324 cc). The median dose to the GTV was 35 Gy (range, 30 - 40 Gy), delivered in 5 fractions over 5 to 8 days (median, 6 days). The resulting mean maximum point doses delivered to the esophagus and mainstem bronchus were 25 Gy (range, 11 - 39 Gy) and 42 Gy (range, 30 - 49 Gy), respectively. Of the 17 evaluable patients with 3 - 6 month follow-up, 4 patients had a partial response and 13 patients had stable disease. AAT t a median follow-up of 10 months, the 1-year Kaplan-Meier local control and overall survival estimates were 63% and 54%, respectively. Toxicities included one patient experiencing grade II radiation esophagitis and one patient experiencing grade III radiation pneumonitis. One patient with gross endobronchial tumor within the mainstem bronchus developed a bronchial fistula and died after receiving a maximum bronchus dose of 49 Gy.CyberKnife radiosurgery is an effective palliative treatment option for hilar lung tumors, but local control is poor at one year. Maximum point doses to critical structures may be used as a guide for limiting toxicities. Preliminary results suggest that dose escalation alone is unlikely to enhance the therapeutic ratio of hilar lung tumors and novel approaches, such as further defining the patient population or employing th
Radiation-induced glioma following CyberKnife treatment of metastatic renal cell carcinoma: a case report  [cached]
Abedalthagafi Malak,Bakhshwin Ahmed
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-271
Abstract: Introduction Post-stereotactic radiation-induced neoplasms, although relatively rare, have raised the question of benefit regarding CyberKnife treatments versus the risk of a secondary malignancy. The incidence of such neoplasms arising in the nervous system is thought to be low, given the paucity of case reports regarding such secondary lesions. Case presentation Here we describe a case of a 43-year-old Middle Eastern woman with primary clear cell renal cell carcinoma and a metastatic focus to the left brain parenchyma who presented with focal neurologic deficits. Following post-surgical stereotactic radiation in the region of the brain metastasis, the patient developed a secondary high-grade astrocytoma nearly 5 years after the initial treatment. Conclusion Although the benefit of CyberKnife radiotherapy treatments continues to outweigh the relatively low risk of a radiation-induced secondary malignancy, knowledge of such risks and a review of the literature are warranted.
Frequency of metastatic tumors in the heart  [PDF]
Rafajlovski Sa?a I.,Tati? Vujadin,Ili? Srbislav,Kanjuh Vladimir
Vojnosanitetski Pregled , 2005, DOI: 10.2298/vsp0512915r
Abstract: Introduction. Secondary or metastatic tumors in the heart occur more frequently than primary ones, and, according to the published series, their frequency found in autopsic material ranges from 1.6% to 20.6%. Metastatic tumors in the heart are rarely clinically symptomatic, and, therefore, they are rarely diagnosed within the lifetime. They are mostly diagnosed at autopsy. The aim of this study was to analyze the frequency of metastatic tumors of the heart, their primary localization, as well as the localization of the metastases found in the autopsic material within the period 1972 2004. Metods. During the autopsy of the patients died of metastatic tumors, we microscopically and macroscopically analyzed all the organs and tissues to determine the metastases of primary tumors in other organs, especially in the heart and pericardium. Results. Within the period from 1972 2004, 11 403 autopsies were performed. In 2 928 (25.6%) out of 11 403 autopsies, the presence of malignant tumor was diagnosed, and in 79 (2.7%) of these cases, metastasis of the heart was found out. Only in 5 of the cases, the presence of metastasis in the heart was diagnosed during the lifetime. The most frequent metastases in the heart were caused by pulmonary carcinoma (18 cases), leukemia and malignant lymphoma (8 cases, each), then pancreatic and breast carcinoma, while the metastases of other carcinomas were rather rare. In 40 (60.76%) cases, the metastasis was localized in the myocardium, but more often in the left ventricle, in 24 (30.38%) cases in the pericardium, in 4 cases in the epicardium and in the 3 of them in the mitral and tricuspid valve. Only in one case of renal carcionoma, metastasis was found in the right atrium and it occurred by spreading (dissemination) through the lumen of the inferior vena cava. Conclusion. Metastatic tumors of the heart are rather rare, and rarely clinically symptomatic, and, thus, rarely diagnosed during life. The methods of choice for the diagnosis of the metastasis in the heart are echocardiography, computerized tomography, magnetic resonance imaging, cytological analysis of the pericardial effusion and biopsy. The treatment includes surgery, chemotherapy and radiotherapy.
Treatment outcome and cost-effectiveness analysis of two chemotherapeutic regimens (BEP vs. VIP) for poor-prognosis metastatic germ cell tumors  [cached]
Attili Venkata,Chandra Rama,Anupama G,Loknath D
Journal of Cancer Research and Therapeutics , 2007,
Abstract: Background: In patients with small-volume disseminated disease of germ cell tumors, cure can be achieved with four cycles of bleomycin, etoposide, and cisplatin (BEP). However, around 20% of these cases are not curable. Strategies to improve cure rates have shown that none of the currently available modalities were superior to the others. Among the most used ones, BEP and VIP (etoposide, cisplatin, and ifosfamide) have been the most studied. However, there are no reports comparing the two, except for a few in abstract forms from southern India. Therefore, we did a treatment outcome and cost-effectiveness analysis of two chemotherapeutic regimens (BEP vs VIP) that are used in poor-prognosis metastatic germ cell tumors. Materials and Methods: All male patients with germ cell tumors, diagnosed as having poor risk by IGCCCG, between January 2002 and December 2004 were included in the study. Clinical, laboratory, and other data were recorded. The patients were stratified into two categories on the basis of the type of chemotherapeutic regimen they received. Results: In all, 46 patients were analyzed, with a median follow up of 26.6 months. The baseline characteristics (age, stage, PS, histology, and serum markers) were not different in the two treatment arms. There is no significant difference in the outcome with either of the chemotherapeutic modalities. VIP is less cost effective and more toxic compared to BEP. Conclusion: In view of the greater toxicity and cost of therapy, as well as lack of either overall or disease free survival advantage, VIP is not a preferred option for patients with high-risk germ cell tumors in the Indian setting and it is still advisable to treat patients with BEP.
CyberKnife Stereotactic Radiosurgery for Recurrent, Metastatic, and Residual Hemangiopericytomas
Anand Veeravagu, Bowen Jiang, Chirag G Patil, Marco Lee, Scott G Soltys, Iris C Gibbs, Steven D Chang
Journal of Hematology & Oncology , 2011, DOI: 10.1186/1756-8722-4-26
Abstract: In a review of the Stanford radiosurgery database between 2002 and 2009, the authors found 14 patients who underwent CK therapy for recurrent, metastatic, and residual hemangiopericytomas. A total of 24 tumors were treated and the median patient age was 52 years (range 29-70 years) at the time of initial CK therapy. The median follow-up period was 37 months (10-73 months) and all patients had been previously treated with surgical resection. Mean tumor volume was 9.16 cm3 and the mean marginal and maximum radiosurgical doses to the tumors were 21.2 Gy and 26.8 Gy, respectively.Of the 24 tumors treated, 22 have clinical follow-up data at this time. Of those 22 tumors, 12 decreased in size (54.5%), 6 remained unchanged (27.3%), and 4 showed recurrence (18.2%) after CK therapy. Progression-free survival rate was 95%, 71.5%, and 71.5% at 1, 3, and 5 years after multiple CK treatments. The 5-year survival rate after CK was 81%.CK is an effective and safe management option for hemangiopericytomas. The current series demonstrates a tumor control of 81.8%. Other institutions have demonstrated similar outcomes with stereotactic radiosurgery, with tumor control ranging from 46.4% to 100%.Hemangiopericytomas (HPCs) are rare vascular tumors arising from Zimmerman pericytes associated with capillary walls. Central nervous systems HPCs are rare and account for 0.4% of primary CNS tumors and 2.4% of meningiomas[1,2]. Both clinically and radiographically, hemangiopericytomas resemble meningiomas but are known for their aggressiveness, high recurrence rates, and propensity for extracranial metastasis. Patients with HPCs present with a wide spectrum of symptoms, dependent upon location and histologic grade of the tumor.Treatment of CNS HPCs is aggressive and consists of gross total resection combined with adjuvant radiotherapy[3]. Given the proposed cellular origin, dural sinus invasion, anatomic inaccessibility, and high vascularity of HPCs, gross total resection is often not suffici
Treating Adrenal Tumors in 26 Patients with CyberKnife: A Mono-Institutional Experience  [PDF]
Jing Li, ZhaoRong Shi, Zhen Wang, Zhibing Liu, Xinhu Wu, Zetian Shen, Bing Li, Yong Song, Xixu Zhu
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0080654
Abstract: Background CyberKnife (CK) is a novel stereotactic radiosurgery system for treating tumors in any part of the body. It is a non-invasive or minimally invasive tumor treatment modality that can deliver high doses of spatially precise radiation and minimize exposure to neighboring healthy tissues or vital organs. The purpose of this study was to investigate the safety and efficacy of CK in the treatment of adrenal tumors. Methods and Results We performed a retrospective analysis of 26 patients with adrenal tumors who had been treated with CK in the radiotherapy center of our hospital between March 2009 and March 2012. Eight patients had primary adrenal tumors and 18 patients had metastatic adrenal tumors. In addition to CK, 4 patients received chemotherapy and 2 patients received immunotherapy. The average tumor volume was 72.1 cm3 and the prescribed radiation dosage ranged from 30 to 50 Gy and was fractionated 3 to 5 times with a 58% to 80% isodose line. Abdominal CT was performed between 1 to 3 months after the CK treatment to evaluate the short-term efficacy with follow-up examinations once every 3 months. Three patients had complete remission, 12 patients had partial remission, 5 patients had stable disease, and 6 patients had progressive illness. The effective rate of pain relief was 93.8% and the disease control rate was 77% with a median overall survival of 17 months and a median progression-free survival of 14 months. Treatment Related toxicity was well-tolerated, but preventative measure need to be taken for radiation enteritis. Conclusions CK is safe and effective for treating adrenal tumors with few adverse reactions. Nonetheless, its long-term effects requires further follow-up.
Sinonasal Metastatic Tumors in Taiwan  [PDF]
Hsueh-Hsin Huang,Tuan-Jen Fang,Po-Hung Chang,Ta-Jen Lee
Chang Gung Medical Journal , 2008,
Abstract: Background: To analyze the incidence of the metastatic tumors within sinonasal tract inTaiwan and review the data in the English literature.Methods: Retrospective reviewed of patients from 1990 to 2005 with a histologicallyproven diagnosis of metastatic malignancies in the sinonasal tract.Results: Among seventeen enrolled patients, 9 were men and 8 were women, withages ranging from 24 to 76 years old, with a mean of 50.8 years. In order offrequency, sinonasal metastatic tumors originated from the gastrointestinaltract (30%), liver (18%), kidney (18%), breast (18%), thyroid gland (12%)and lung (6%).Conclusion: The incidence and characteristics of metastatic neoplasms in Taiwanesepatients are comparable to other countries in East Asia, except for Japan.However, our data are very different when compared with European andNorth American reports. Different incidences of malignant neoplasms in theprimary site may explain the result of different incidences of sinonasalmetastatic tumor.
CyberKnife? radiosurgery in the treatment of complex skull base tumors: analysis of treatment planning parameters
Sean P Collins, Nicholas D Coppa, Ying Zhang, Brian T Collins, Donald A McRae, Walter C Jean
Radiation Oncology , 2006, DOI: 10.1186/1748-717x-1-46
Abstract: At Georgetown University Hospital from March 2002 through May 2005, the CyberKnife? was used to treat 80 patients with 82 base of skull lesions. Tumors were classified as simple or complex based on their proximity to adjacent critical structures. All planning and treatments were performed by the same radiosurgery team with the goal of minimizing dosage to adjacent critical structures and maximizing target coverage. Treatments were fractionated to allow for safer delivery of radiation to both large tumors and tumors in close proximity to critical structures.The CyberKnife? treatment planning system was capable of generating highly conformal and homogeneous plans for complex skull base tumors. The treatment planning parameters did not significantly vary between spherical and non-spherical target volumes. The treatment parameters obtained from the plans of the complex base of skull group, including new conformity index, homogeneity index and percentage tumor coverage, were not significantly different from those of the simple group.Our data indicate that CyberKnife? treatment plans with excellent homogeneity, conformity and percent target coverage can be obtained for complex skull base tumors. Longer follow-up will be required to determine the safety and efficacy of fractionated treatment of these lesions with this radiosurgical system.Lesions of the base of skull are typically slow growing, but potentially morbid tumors [1]. They rarely metastasize making local control the primary determinant of long-term survival [2]. Although surgical resection may still be the treatment "gold-standard" [3,4], radiosurgery is an appropriate treatment option for many patients [5]. However, single-fraction radiosurgical treatment may be difficult because of the potentially large size and irregular shapes of these tumors. Their proximity to critical structures also leads to a risk of radiation-induced, long-term, neurological complication [6].The CyberKnife? is a newly FDA approved radi
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