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Minimally Invasive Stereotactical Radio-ablation of Adrenal Metastases as an Alternative to Surgery
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Ciro Franzese, Davide Franceschini, Luca Cozzi, Giuseppe D’Agostino, Tiziana Comito, Fiorenza De Rose, Pierina Navarria, Pietro Mancosu, Stefano Tomatis, Antonella Fogliata, Marta Scorsetti
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Cancer Res Treat. 2017;49(1):20-28. Published online April 27, 2016
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DOI: https://doi.org/10.4143/crt.2016.057
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 Abstract
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- Purpose
The purpose of this study was to study the clinical outcome for patients with metastases of the adrenal gland treated with stereotactic body radiation therapy.
Materials and Methods
Forty-six patients were studied retrospectively. The dose prescription was 40 Gy in four fractions. Dosimetric analysis was performed using the dose volume histograms while clinical outcome was assessed using actuarial analysis with determination of the overall survival (OS) and local control (LC) rates.
Results
The planning objectives were met for all patients. With a median follow-up period of 7.6 months, at the last follow-up 42 patients (91.3%) were alive and four had died because of distant progression. The actuarial mean OS was 28.5±1.6 months, the median was not reached. One-year and 2-year OS were 87.6±6.1%. None of the risk factors was significant in univariate analysis. Actuarial mean LC was 14.6±1.8 months (95% confidence interval [CI], 11.0 to 18.2) and median LC was 14.5±2.0 months (95% CI, 10.5 to 18.5). One-year and 2-year LC were 65.5±11.9% and 40.7±15.8%, respectively. A mild profile of toxicity was observed in the cohort of patients. Forty patients (86.9%) showed no complication (grade 0); two patients reported asthenia, six patients (13.1%) reported either pain, nausea, or vomiting. Of these six patients, five patients (10.9%) were scored as grade 1 toxicity while one patient (2.2%) was scored as grade 2.
Conclusion
Stereotactic body radiation therapy treatment provided an adequate clinical response in the management of adrenal gland metastases.
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Hypofractionated Stereotactic Radiation Therapy in Recurrent High-Grade Glioma: A New Challenge
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Pierina Navarria, Anna Maria Ascolese, Stefano Tomatis, Giacomo Reggiori, Elena Clerici, Elisa Villa, Giulia Maggi, Lorenzo Bello, Federico Pessina, Luca Cozzi, Marta Scorsetti
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Cancer Res Treat. 2016;48(1):37-44. Published online February 23, 2015
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DOI: https://doi.org/10.4143/crt.2014.259
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Abstract
PDFPubReaderePub
- Purpose
The aim of this study was to evaluate outcomes of hypofractionated-stereotactic-radiationtherapy (HSRT) in patients re-treated for recurrent high-grade glioma. Materials and Methods From January 2006 to September 2013, 25 patients were treated. Six patients underwent radiation therapy alone, while 19 underwent combined treatment with surgery and/or chemotherapy. Only patients with Karnofsky Performance Status (KPS) > 70 and time from previous radiotherapy greater than 6 months were re-irradiated. The mean recurrent tumor volume was 35 cm3 (range, 2.46 to 116.7 cm3), and most of the patients (84%) were treated with a total dose of 25 Gy in five fractions (range, 20 to 50 Gy in 5-10 fractions).
Results
The median follow-up was 18 months (range, 4 to 36 months). The progression-free survival (PFS) at 1 and 2 years was 72% and 34% and the overall survival (OS) 76% and 50%, respectively. No severe toxicity was recorded. In univariate and multivariate analysis extent of resection at diagnosis significantly influenced PFS and OS (p < 0.01). Patients with smaller recurren tumor volume treated had better local control and survival. Indeed, the 2-year PFS was 40% (≤ 50 cm3) versus 11% (p=0.1) and the 2-year OS 56% versus 33% (> 50 cm3), respectively (p=0.26). Conclusion In our experience, HSRT could be a safe and feasible therapeutic option for recurrent high grade glioma even in patients with larger tumors. We believe that a multidisciplinary evaluation is mandatory to assure the best treatment for selected patients. Local treatment should also be considered as part of an integrated approach.
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Citations
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