Terms Of Local Tumor Control Research Articles

Techniques and outcomes of percutaneous tumour ablation for small renal masses.

Small renal masses suspected to be malignant have little potential for metastasis and disease-related mortality. Surgery remains the standard care but represents overtreatment in many cases. Percutaneous ablative technique, especially thermal ablation has emerged as a valid alternative. The increased availability of cross-sectional imaging has led to a large number of incidentally detected small renal masses (SRMs), many of which are of low grade and exhibit indolent behaviour. Since 1996, ablative techniques such as cryoablation, radiofrequency ablation, and microwave ablation have gained widespread acceptance for treatment of SRMs in patients who are not surgical candidates. In this review article, we provide an overview of each of the commonly used percutaneous ablative treatments for SRMs and summarize the current literature regarding the advantages and disadvantages of each technique. Although partial nephrectomy (PN) represents the standard treatment of SRMs, Thermal ablation techniques have been increasingly used showing acceptable efficacy, low complication rate, and equivalent survival. Cryoablation seems to be superior to radiofrequency ablation in terms of local tumour control and retreatment rates. However, selection criteria for thermal ablation are still under refinement.

Plaque brachytherapy - Radiating positivity.

Plaque brachytherapy is an evolving, yet effective globe and vision-sparing modality for the treatment of intraocular tumors by transscleral irradiation of the tumor base with a radioactive implant. The American Brachytherapy Society (ABS) along with the collaboration of the international multicenter Ophthalmic Oncology Task Force (OOTF) was assembled to reach a consensus regarding establishing practice guidelines and setting standards of care for intraocular tumors. The advent of plaque brachytherapy has revolutionized the outcomes of intraocular tumors, thus ensuring globe salvage, reducing morbidity and mortality, and avoiding cosmetic disfigurement. A well-planned dosimetry for plaque brachytherapy results in achieving local tumor control and excellent prognosis. This technique provides the advantage of focal radiation, thus eliminating the damage to the adjacent structures, minimal periorbital tissue damage, absence of cosmetic disfigurement owing to lack of retarded bone growth as seen in external beam radiotherapy. Thus, it reduces the risk of metastasis, and with the recent advances, it provides a shorter duration of treatment. : In this video, we shall display the concept of plaque brachytherapy, the various types of plaques available, different radiations sources, planning dosimetry and calculations, target disease spectrum, surgical placement, and post-radiation outcomes in terms of local tumor control and prognosis. This video highlights the history, basic principles and techniques of plaque brachytherapy and provides an understanding of its applications in the world of ocular oncology. https://youtu.be/7PX0mDQETRY.

Minimally Invasive Facetectomy and Fusion for Resection of Extensive Dumbbell Tumors in the Lumbar Spine.

Background and Objectives: Resection of dumbbell tumors can be challenging, and facet joint sparing approaches carry the risk of incomplete resection. In contrast, additional facetectomy may allow better surgical exposure at the cost of spinal stability. The aim of this study is to compare facet-sparing and facetectomy approaches for the treatment of lumbar spine dumbbell tumors. Materials and Methods: In a cohort study setting, we analyzed Eden type 2 and 3 tumors operated in our department. Conventional facet-sparing microsurgical or facetectomy approaches with minimally invasive fusions were performed according to individual surgeons' preference. Primary outcomes were extent of resection and tumor progression over time. Secondary outcomes were perioperative adverse events. Results: Nineteen patients were included. Nine patients were operated on using a facet-sparing technique. Ten patients underwent facetectomy and fusion. While only one patient (11%) in the facet-sparing group experienced gross total resection (GTR), this was achieved for all patients in the facetectomy group (100%). The relative risk (RR) for incomplete resection in the facet-sparing cohort was 18.7 (95% CI 1.23-284.047; p = 0.035). In addition, time to progression was shorter in the facet-sparing cohort (p = 0.022) and all patients with a residual tumor underwent a second resection after a median follow-up time of 42 months (IQR 25-66). Conclusions: Minimally invasive resection of lumbar Eden type 2 and 3 dumbbell tumors including facetectomy in combination with instrumentation appears to be safe and superior to the facet-sparing approach in terms of local tumor control.

Five-Fraction Radiotherapy for Breast Cancer: Which are the Most Suitable Patients?

<h3>Purpose/Objective(s)</h3> FAST-Forward trial reported that five-fraction radiotherapy (5fx-RT) schedule with 26 Gy in adjuvant setting after breast-conserving surgery for early-breast cancer (BC) was non-inferior to the standard hypo-fx (SHfx) schedule with 40 Gy in 15fx in terms of local tumor control. Since the COVID-19 pandemic started RT expert groups encouraged professionals to implement hypo-fx schedules in order to decrease visits of patients to hospitals. The aim of this study is to help radiation oncologists choose the most suitable patients for 5fx-RT schedule according to anatomical features. <h3>Materials/Methods</h3> Between March 2020 and December 2021, 239 patients suitable for 5fx-RT schedule were referred to our department. Prescribed RT dose was 26 Gy in 5fx to the whole breast plus a simultaneously integrated boost (SIB) up to 29 Gy to tumor bed if indicated. Patients were divided into 3 groups: Group A: Patients treated with 5fx-RT schedule that met all the FAST-Forward constraints for normal tissues; Group B: Patients treated with 5fx-RT schedule that slightly did not meet all constraints, Group C: Patients switched to SHfx schedule as they did not meet constraints in an acceptable way. For each patient, we draw an imaginary straight line connecting the medial and lateral borders of PTV in the axial slice of simulation CT where the longest anteroposterior diameter was found. From midpoint of this line, we measured the tangent distance to PTV margin and collected the data as medial-to-lateral tangent (MELT). Data was analyzed using statistical software. <h3>Results</h3> 150 patients were included in group A, 75 in group B and 14 in group C. The median MELT distance was: 1.91cm, 2.48cm and 3cm respectively. We found that the increase in MELT distance was significantly associated with a poorer compliance of normal tissue constraints (p<0.0001). Patient´s distribution among 3 groups for MELT distance intervals are shown in table 1. Median V8 for ipsilateral lung was: 13.1, 15.46 and 20.49% for groups A, B and C respectively. For the heart, median mean dose was: 1.06, 1.8 and 2.25 Gy for left breast cancer patients and 0.28, 0.33 and 0.48 Gy for right breast cancer patients for groups A, B and C respectively. We found a moderate positive correlation between MELT distance and dosimetric parameters assessed above (r=0.545, 0.475 and 0.418 respectively). According to laterality, for a higher MELT distance the % of left BC patients increased significantly (p=0.039). <h3>Conclusion</h3> MELT distance is an easy tool that helps radiation oncologists predict which BC patients are the most suitable for 5fx-RT before RT planning begins. This could avoid delays in starting RT for patients with a high MELT distance directly planning them with the SHfx schedule.

Safety and Efficacy of Hypofractionated Stereotactic Radiosurgery in Facial Nerve Schwannoma.

In the current era of modern neurosurgery, the treatment strategies have been shifted to "nerve-preservation approaches" for achieving a higher facial and hearing function preservation rate following facial nerve tumors. We have conducted this novel report on determining the outcome of patients with facial nerve schwannomas (FNS) treated with hypofractionated stereotactic radiosurgery (hfSRS). Retrospective chart review of a prospectively maintained database search was conducted. Patients who underwent hfSRS CyberKnife (Accuray Inc, Sunnyvale, CA, U.S.A.) for FNS were included. Outcomes consisted of tumor control, facial and hearing nerve function as graded by House-Brackmann and American Academy of Otolaryngology-Head and Neck Surgery recommendations, and adverse radiation effects. With an institutional board review approval, we retrospectively identified five patients with FNS (four intracranial [80%] and one extracranial [20%]) treated with hfSRS (2011-2019). Patients received definitive SRS in three patients (60.0%), whereas adjuvant to surgical resection in two patients (40.0%). A median tumor volume of 7.5 cm 3 (range, 1.5-19.6 cm 3 ) received a median prescription dose of 23.2 Gy (range, 21-25 Gy) administered in median of three fractions (range, three to five sessions). With a median radiographic follow-up of 31.4 months (range, 13.0-71.0 mo) and clinical follow-up of 32.6 months (range, 15.1-72.0 mo), the local tumor control was 100.0%. At the last clinical follow-up, the facial nerve function improved or remained unchanged House-Brackmann I-II in 80.0% of the patients, whereas the hearing nerve function improved or remained stable in 100.0% of the patients. Temporary clinical toxicity was observed in three patients (60.0%), which resolved. None of the patients developed adverse radiation effect. From our case series, hfSRS in FNS seems to be safe and efficacious in terms of local tumor control, and improved facial and hearing nerve function.

ФАКТОРЫ ПРОГНОЗА РАЗВИТИЯ ВТОРИЧНОЙ ГЛАУКОМЫ ПОСЛЕ СТЕРЕОТАКСИЧЕСКОЙ РАДИОХИРУРГИИ ПО ПОВОДУ МЕЛАНОМЫ ХОРИОИДЕИ

Stereotactic radiosurgery (SRS) demonstrates satisfactory results in terms of local tumor control and survival of patients with choroidal melanoma. At the same time, there are practically no studies aimed at establishing the dependence of the frequency and severity of SRS complications on the initial characteristics of the tumor and dose parameters of radiosurgery. The aim of this study was to analyze the incidence of post-radiation complications, as well as the relationship between the clinical characteristics of the tumor and the dosimetric parameters of stereotactic radiosurgery and secondary glaucoma. Material and methods. The prospective study included 43 patients with cT1-3N0M0 choroidal melanoma. The median prescribed dose per tumor margin at 50% isodose was 30 Gy, (23-35 Gy). The immediate effect of the treatment was assessed as positive in all the cases, except for increased blood flow according to Doppler ultrasound data, an increase in tumor size by more than 20% of the previously determined lesion according to MRI. Univariate and multivariate regression analyzes were performed using the Cox proportional hazards model, ROC analysis for statistically significant variables. Results. During the follow-up period (median was 16 months), an objective tumor response to treatment was recorded in 100% of cases. Secondary cataract after SRS developed in 4 (9.3%) cases, post-radiation retinopathy - in 9 (20.9%) cases, secondary retinal detachment - in 7 (16.3%) cases, secondary glaucoma - in 6 (14%) cases. After SRS during the observation period, the eyeball was preserved in 90.7% of patients. For the tumor volume parameter, the area under the curve was 0.92 (95% CI 0.84-1.00) with a cut-off point of 800 mm3. With a tumor volume less than this indicator, no cases of secondary glaucoma were detected. In the case of tumors with a volume equal to or greater than the calculated value, secondary glaucoma developed in 71% of cases. For the tumor thickness parameter, the area under the curve was 0.78 (95% CI 0.63-0.93) with a cut-off point of 7.6 mm. With a tumor thickness of less than 7.6 mm, the incidence of secondary glaucoma was 5% during the observation period, with a tumor thickness greater than this indicator - 72%. Conclusion. In the treatment of tumors with a volume of more than or equal to 800 mm3 and/or a thickness of more than or equal to 7.6 mm, radiosurgery as a monomethod is not recommended; it is necessary to resort to a combined method, including, along with SRS, tumor endoresection.

Adult Soft-Tissue Sarcomas of the Extremities.

Soft-tissue sarcomas (STS) in adults comprise a heterogeneous group of tumors of mesenchymal origin that share similar biological patterns of local tumor growth and metastatic dissemination. The judicious use of imaging studies, biopsy techniques, and pathological evaluations is essential for accurate diagnosis and for planning treatment strategy. Wide local resection and radiation therapy form the cornerstone of management of high-grade STS. The role of adjuvant radiation therapy is questionable in the management of small (≤5 cm) superficial lesions that can be resected with negative margins. Chemotherapy given to patients who have nonmetastatic, high-grade STS results in varying benefit in terms of local tumor control and overall survival. Coordinated care by a multidisciplinary team of trained surgeons, medical oncologists, radiologists, radiation oncologists, and pathologists has been documented to improve local tumor control and the overall survival of patients with STS. Although considerable progress in tumor diagnostics and targeted therapies has been made over the past 2 decades, recommendations and controversies relating to tumor imaging and margins of resection have not changed.

Radiotherapy after Breast-Preserving Surgery for Early Breast Cancer-Basic Principles and Our Experience

Breast cancer is the second most common malignant tumor worldwide and the most common oncological disease among women. This article presents our experience in postoperative Radiotherapy (RT) in 341 patients with Early Breast Cancer (EBC) after Breast-Preserving Surgery (BPS). Emphasis is placed on the indications and Clinical Target Volumes (CTV) for radiotherapy. The significant effect of postoperative RT in terms of Local Tumor Control (LTC), long-term recurrence-free survival and overall survival is reported. The main goal of this article is to establish high-tech radiotherapy after BPS in early BC as the main local method, optimizing the treatment and cosmetic results.

Brachytherapy for Oesophageal Carcinoma: A Comprehensive Review of Literature and Techniques

AbstractIntroduction:Oesophageal carcinoma is one of the fatal cancers mainly because of its rapid spread and poor prognosis. Treatment modalities involves a multimodality approach, including surgery, radiation therapy and chemotherapy. Radiation therapy includes brachytherapy in the form of intraluminal radiation therapy. Brachytherapy permits delivery of high tumouricidal doses to superficial cancerous growth of the oesophagus while delivering much lower doses to the surrounding tissue. It is mostly given in combination with external beam radiation in patients with poor performance scores not likely to tolerate an aggressive chemoradiation regimen or as a boost to concurrent chemoradiotherapy. It is very effective in terms of local tumour control as well as in relieving symptoms in advanced/recurrent disease. Intraoperative brachytherapy and seed brachytherapy have also been tried to address the nodal disease.Methods:We undertook a review of the available literature and techniques developed in the past three decades to emphasise the role of brachytherapy in curative or palliative settings in the treatment of oesophageal carcinoma.Conclusion:Oesophageal brachytherapy will remain a tangible treatment of oesophageal cancer, although it is less commonly used due to high expertise requirement, lack of established evidence, risk of life-threatening complications and lack of interest in brachytherapy. It offers quick and useful palliation for a prolonged period, along with good quality of life and superior dosimetry. Use of novel applicators may allow dose escalation and lower toxicity. Seed brachytherapy is also emerging as a promising option in nodal recurrences.

Gamma Knife Radiosurgery for Uveal Melanoma: A Retrospective Review of Clinical Complications in a Tertiary Referral Center

Introduction: Gamma knife radiosurgery (GKR) has shown promising results in the treatment of intraocular uveal melanoma (UM) in terms of local tumor control. However, GKR is not free from potentially sight-threatening side effects, including cataract, dry eye disease, vitreous hemorrhage, radiation retinopathy (RR), radiation maculopathy (RM), optic neuropathy, and neovascular glaucoma. The aim of this paper is to report our 20-year experience in UM management with GKR focusing on the rate of clinical treatment-induced complications. Methods: Single-center, retrospective, observational study, including all patients with UM treated at the Ocular Oncology and Uveitis Service, in the Department of Ophthalmology of the San Raffaele Scientific Institute, Milan from September 1993 to September 2018. Clinical charts comprised complete ophthalmological examination with measurement of best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement, gonioscopy, and indirect ophthalmoscopy at each visit. B-scan ultrasound (Aviso S, 10 MHz probe; Paris, France), optical coherence tomography (Heidelberg Spectralis; Heidelberg Engineering, Heidelberg, Germany), retinography, and fundus fluorescein angiography (standard or ultra-widefield [UWF; California, Optos, Dunfermline, Scotland, UK]) were performed aiding in the diagnosis of complications. Results: Overall, 194 patients (100 males, 51.6%) were reviewed. The median age at the time of the treatment was 65 years (range 27–89) and all participants were Caucasian. In 185 eyes (95.4%), the tumor was primarily located at the choroid. The median follow-up was 57.6 months; radiation-induced complications were found in 145 eyes (74.7%). Radiation-induced cataract and RR were the most frequent events, with a relative incidence of 41.2 and 34.5%, respectively, followed by neovascular glaucoma (27.3%), optic neuropathy (18.6%), RM (11.4%), vitreous hemorrhage (14.4%), phthisis bulbi (7.7%), hyphema (0.5%), and corneal melting (0.5%). The shorter onset of side effects involved the optic nerve (median 14.9 months) and the macula (median 13.7 months). Conclusion: Despite modern and advanced strategies introduced to limit GKR side effects, cataract and RR still represent a serious limitation of this treatment. Incidence of RR was higher in our cohort compared to other reports, probably due to increased diagnosis rate permitted by UWF retinal imaging.

Stereotactic radiofrequency ablation of subcardiac hepatocellular carcinoma: a case-control study

Purpose: The purpose of this study is to evaluate the safety and efficacy of stereotactic radiofrequency ablation (SRFA) for the treatment of subcardiac hepatocellular carcinoma (HCC).Material and methods: From 2003 to 2018, 79 consecutive patients underwent 104 multi-probe SRFA sessions for the treatment of 114 subcardiac HCC with a median size of 2.5 cm (0.5–9.5 cm). The results were compared with a randomly selected control group of 79 patients with 242 HCC with a median size of 2.0 cm (0.5–12 cm) following SRFA in other (non-subcardiac) locations with propensity score matching.Results: The 95.6% of the tumors were successfully treated by the first ablation session (primary technical efficacy rate) and 99.1% after the second session (secondary technical efficacy rate). Local tumor recurrence developed in 8 nodules (7.0%). Major complication and perioperative mortality rates were 7.7% (8/104) and 1% (1/104), respectively. The overall survival (OS) rates from the date of the first SRFA with single subcardiac HCCs were 92%, 77% and 65% at 1, 3 and 5 years, respectively, with a median OS of 90.6 months. The disease-free survival (DFS) after SRFA was 75, 34 and 34%, at 1, 3 and 5 years, respectively, with a median DFS of 19.1 months. There was no statistically significant difference with the control group in terms of local tumor control, safety, OS and DFS.Conclusion: SRFA of subcardiac tumors is as safe and efficacious as when treating tumors remote from the heart.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

BACKGROUND CONTEXT While the incidence of spinal metastases is constantly increasing, the combination of kyphoplasty and intraoperative radiation (Kypho-IORT) is a good possibility not only to gain additional histopathologic data but also to achieve excellent pain and local tumor control. The clinical effectiveness in terms of local tumor control is comparable to SBRT, the pain control far better. The pros of Kypho-IORT are the minimal invasiveness and the one-stop-shop-procedure with effective and instantaneous pain control. PURPOSE The aim of this study is the retrospective density-corrected dose planning in the tumor and the proof of safety for the risk-organ spinal canal on basis of consecutive clinical performed Kypho-IORTs. STUDY DESIGN/SETTING Experimental study, single cohort. PATIENT SAMPLE A total of 10 consecutive cases appointed for Kypho-IORT. OUTCOME MEASURES Sufficient dosing of the metastasis sparing of organs at risk. METHODS We performed Monte-Carlo-based 3D-dose planning in the tumor and in the spinal canal, by using the new planning-software Radiance (GMV Healthcare, Madrid, Spain) in 10 consecutive Kypho-IORTs (Dose 8 Gy in 13 mm distance from the isocenter, 50 kV-xray-source, Intrabeam XRS4, Zeiss meditech AG). Pre- and intraoperative imaging (cone-beam-CT: Siemens Zeego) was used for the dose calculation. Due to metal-artifacts in the intraoperative-cone-beam-CT a preoperative multislice-CT had to be used for calculating the dose, therefore a matching of both CTs had to be performed. RESULTS The distance of the geometrical centre of the metastasis and the coordinates of the applicator tip (isocenter of radiation) could be calculated by vector analysis, the dose distribution was calculated density-corrected. In 7 out of 10 cases, the distance was larger than 5 mm, not correlating to the size of the metastasis itself. In 8 of 10 cases, 70% of the metastasis volume was treated with the prescribed dose of 8 Gy, in 2 cases this treatment-goal was missed. In all 10 cases no dose over 8 Gy reached the spinal canal, the myelon was never exposed to a potential harmful dose. CONCLUSIONS We could show that the Kypho-IORT is not only an effective and safe method, but also an exact quantifiable method, especially in contrast to other methods like thermoablation. The organs at risk are not exposed to a critical dose, the metastasis volume was acceptable covered (8/10 cases >70% of the volume treated with >8 Gy).The next step to further enhance the potential of the procedure in terms of a patient individual dosage will be the intraoperative dose-planning and modification of the delivered dose. A different approach via inverse-planning could be the navigation of the applicator.But also without individual dose-planning Kypho-IORT reached excellent clinical results in terms of local tumor control by using the standard dose of the dose-escalation trial (8 Gy in 13 mm distance of the Isocenter).

Transarterial chemoembolization (TACE) using mitomycin and lipiodol with or without degradable starch microspheres for hepatocellular carcinoma: comparative study

BackgroundTo evaluate survival data and local tumor control after transarterial chemoembolization in two groups with different embolization protocols for the treatment of HCC patients.MethodsNinty-nine patients (mean age: 63.6 years), 78 male (78.8%) with HCC were repeatedly treated with chemoembolization in 4-week-intervals. Eighty-eight patients had BCLC-Stage-B and in 11 patients, chemoembolization was performed for bridging (BCLC-Stage-A). In total, 667 chemoembolization treatments were performed (mean 6.7 treatments/patient). The administered chemotherapeutic agent included mitomycin. For embolization, lipiodol only (n = 51;51.5%; mean age 63.8 years; 38 male), or lipiodol plus degradable starch microspheres (DSM) (n = 48; 48.5%; mean age 63.4 years; 40 male) were used. The local tumor response was assessed by MRI using Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1). Patient survival times were evaluated using Kaplan-Meier curves and log-rank tests.ResultsThe local tumor control in the lipiodol-group was: PR (partial response) in 11 (21.6%), SD (stable disease) in 32 (62.7%) and PD (progressive disease) in 8 cases (15.7%). In the lipiodol-DSM-group, PR was seen in 14 (29.2%), SD in 22 (45.8%), and PD in 12 (25.0%) individuals (p = 0.211). The median survival of patients after chemoembolization with lipiodol was 25 months and in the lipiodol-DSM-group 28 months (p = 0.845).ConclusionOur data suggest a slight benefit of the use of lipiodol and DSM in comparison of using lipiodol only for chemoembolization of HCC in terms of local tumor control and survival data, this trend did not reach the level of significance.

YI02.03 Dose Limitations for Radiotherapy of Lung Cancer

YI02.03 Dose Limitations for Radiotherapy of Lung Cancer

Ruthenium brachytherapy for uveal melanoma - single institution experience.

PurposeThe aim of this study was to report on results of uveal melanoma treatment with ruthenium-106 (106Ru) brachytherapy with long-term follow-up, in terms of local tumor control, eye retention rate, radiation retinopathy, and patients’ survival.Material and methodsMedical records of patients treated with ruthenium plaque due to uveal melanoma at the Department of Ophthalmology, Poznan University of Medical Sciences, Poland, between 1994 and 2014 were retrospectively reviewed.ResultsWe identified 126 patients: 53 men, 73 women, mean age 60.04 years (range, 21-89). The largest basal diameter ranged from 4.04 mm to 18.9 mm (median, 10.67 mm), tumor height was 1.9 mm to 7.42 mm (median, 4.8 mm). Median scleral radiation dose was 570 Gy (range, 235-1,500 Gy), median apical dose 100 Gy (range, 60-129 Gy). Median follow-up was 66.5 months (range, 2-261 months). We noted a total of 19 (15%) recurrences. The actuarial rate of recurrence was 9.5% at 3 years, and 13.5% at 5 years postoperatively. Nine (7%) eye globes were lost, median time to enucleation was 5 years. The eye retention rate at 5 years was 92.7% and 81% at 10 years. Forty-three (34%) patients died before the end of the study, 24 (19%) of them due to metastatic disease. Metastatic death was related to: tumor size and TNM stage at presentation (p = 0.002 vs. p = 0.0006, respectively) but not to age, gender, and plaque dosimetry.Conclusions 106Ru brachytherapy is an effective, globe sparing treatment that provides good tumor control and a high rate of survival. However, some ocular complications tend to appear late post-treatment, and therefore long-term follow-up is advised.

Intra-arterial chemotherapy of ENT cancers

The key element that has determined us to initiate a study concerning the benefits of intra-arterial chemotherapy is the fact that, despite progress regarding therapy, the ENT cancer prognosis is poor, especially in stages that have regional invasion, with a higher risk of therapeutic failure. ENT cancer treatment has raised many questions, the present therapeutic standard being simultaneous radio-chemotherapy with cisplatin, a quality regional control being obtained by hyper-fractionated radiotherapy, targeted on the tumour volume. The technical inconveniences that, in some cases, make impossible the accomplishment of a correct treatment, have determined us to make a retrospective analysis of the studies published in medical journals, with the aim of discerning a therapeutic method that has a role in increasing the loco-regional control of the disease. The studies speak about intra-arterial chemoinfusion with cisplatin, alongside radiotherapy, demonstrating with certainty the superiority of this method versus administrating the drug intravenously, in terms of local tumour control and tolerability. Because the benefits regarding the survival rate and the disease-free period have not reached the statistically significant level, intra-arterial chemoinfusion of cisplatin, alongside radiotherapy, remains a subject that is open to further studies. The efficacy of intra-arterial chemoinfusion of cisplatin hasn’t been studied in the case of a relapse, remaining still a subject that is worthy of being approached, seeing as this method was shown to be efficient regarding the safety profile, having a good tolerability and also having a good activity profile, leading to increase in the quality of life and an increase in survival through a local tumour control that is superior than in the case of intravenous administration of the drug.

Radiofrequency Ablation of Hepatocellular Carcinoma with a "Nodule-in-Nodule" Appearance: Long-Term Follow-up and Clinical Implications.

Hepatocellular carcinoma (HCC) with a "nodule-in-nodule" (NIN) appearance has unique histological characteristics as an early HCC. We assessed long-term therapeutic outcomes of radiofrequency ablation (RFA) in HCC patients considering this appearance. Our Institutional Review Board approved this retrospective study, and the requirement for written informed consent was waived. Between May 2006 and April 2012, a total of 572 patients underwent RFA for single HCC as a first-line treatment. Patients were divided into a NIN HCC group (n=22) and a non-NIN HCC group (n=550), according to the NIN feature on pretreatment imaging studies. Local tumor progression (LTP) and disease-free survival (DFS) were compared. Prognostic factors for LTP and DFS were assessed using a Cox proportional hazards model. The cumulative LTP rates were 4.6 and 4.6% at 3 and 5years, respectively, in the NIN HCC group, and 15.9 and 20.5% in the non-NIN HCC group, with borderline statistical significance (p=0.085). The corresponding DFS rates were 53.8 and 37.7% in the NIN HCC group and 44.0 and 31.7% in the non-NIN HCC group, with no significant difference (p=0.318). Although on multivariate analysis only tumor size was a significant prognostic factor for LTP, there was a trend bordering on the significance for the NIN feature [hazard ratio (HR)=0.19; p=0.099]. However, it was not a significant factor for DFS (HR=0.18; p=0.682). The NIN appearance, a rare (4%, 22/550) but unique feature of early HCC, may be a favorable prognostic factor for RFA in terms of local tumor control.

Uveal melanoma: evidence for efficacy of therapy.

More than 90% of all uveal melanomas involve the choroid, with the remainder being confined to the ciliary body and/or iris. Melanomas involving the choroid cause visual loss as a result of retinal pigment epitheliopathy overlying the tumor and serous retinal detachment. Ciliary body tumors can also cause astigmatism and cataract formation. Tumors in the anterior chamber can cause glaucoma with secondary visual loss. The eye can become painful as a result of neovascular glaucoma or uveitis. There can be extraocular spread into the episclera or orbit, causing proptosis. If neglected, uveal melanomas can form a fungating mass and can spread posteriorly to the brain. Almost 50% of all patients with uveal melanoma develop metastatic disease, which usually involves the liver and is nearly always fatal. Metastatic disease occurs almost exclusively in patients whose tumor shows chromosome 3 loss and/or a class 2 gene-expression profile. These abnormalities are highly lethal, with survival time correlating inversely with basal tumor diameter and mitotic count. The objectives of ocular treatment are to prevent metastatic spread, and if possible, to conserve the eye and useful vision. Eye-conserving therapeutic modalities include various forms of phototherapy, radiotherapy and local resection, which can be administered individually or in combination. Patient care also includes education, prognostication, counseling, and emotional support, to enhance quality of life. The aims of this review are: (1) to discuss the efficacy of ocular treatment in terms of local tumor control, preservation of vision, ocular conservation, quality of life, and survival; and (2) to discuss the evidence currently available. It is assumed that the reader is familiar with the therapeutic modalities mentioned in this review.

Significance of Administering Bevacizumab Combined With Boron Neutron Capture Therapy in Terms of Local Tumor Control and Lung Metastatic Potential

Significance of Administering Bevacizumab Combined With Boron Neutron Capture Therapy in Terms of Local Tumor Control and Lung Metastatic Potential

High-dose Radiotherapy Using Helical Tomotherapy for Vertebral Metastasis: Early Clinical Outcomes and Cord Dose Specification

For several decades, radiotherapy has been widely used to treat metastatic vertebral tumors. This study was designed to assess the feasibility and early clinical outcomes of high-dose radiotherapy to treat such tumors, using helical tomotherapy. Between June 2009 and December 2011, 51 sites in 36 patients were treated with high-dose radiotherapy using helical tomotherapy for vertebral metastasis. Treatment outcomes and dosimetric analyses of spinal cord were retrospectively evaluated. Median follow-up was 11.5 months (range, 6-34.6) for surviving patients. The median total dose and the number of fractions in the primary helical tomotherapy arm were 2700 cGy and 3 fractions, respectively. Actuarial 6-month local control rates were 85.7%, and symptomatic vertebral compression fractures developed in five patients after a median of 4.2 (range, 2.9-5.7) months. Among 13 patients with 19 metastatic sites who showed pre-treatment impairment in neurologic function, five patients (with seven sites) in whom symptoms were mild showed improvement in neuronal function. The median pre-treatment pain visual analog scale score of 7 decreased to a median of 3 after helical tomotherapy (P < 0.001) at a median of 1 month (range, 0.5-3.2) of follow-up. No significant morbidity developed during follow-up except for one grade 3 esophagitis. The use of helical tomotherapy to treat metastatic vertebral tumors appears to be both safe and reliable in terms of local tumor control and early pain relief. Local progression and the risk of compression fracture in patients with pre-existing spinal instability remain the principal factors of limiting improved clinical and functional outcomes. Optimal dose-fractionation schemes and appropriate patient selection are required to achieve better outcomes with high-dose radiotherapy using helical tomotherapy.