Clinical analysis of 45 patients with thymic carcinoma

OBJECTIVE To retrospectively evaluate the prognostic factors for advanced thymic carcinoma. METHODS The data from 45 patients with advanced thymic carcinoma were retrospectively analyzed according to Masaoka stage criteria. There were 29 Stage Ⅲ patients and 16 Stage Ⅳ patients （13 Stage ⅣA patients and 3 Stage ⅣB patients）. According to the World Heath Organization Histological Criteria （2004）, 25 cases were identified as low-grade and 20 cases were identified as high-grade. All diagnoses were confirmed by biopsy. Five patients underwent gross total resection, 21 patients underwent subtotal resection and 19 patients underwent biopsy alone. Forty-two patients received radiotherapy with a median dose of 60 Gy, and 37 patients underwent conventional radiotherapy, including local irradiation and expanded irradiation. Local irradiation volume covered the primary tumor bed and approximately 1-2 cm^2 surrounding the tumor （according to preoperative imaging）. Expanded irradiation volume covered the full mediastinal and pericardium areas （with or without prophylactic irradiation in the supraclavicular area）. Five cases received stereotactic radiotherapy. Thirty-one patients were also treated with chemotherapeutics, including Cisplatin, VP-16, Endoxan, 5-FU and taxol. RESULTS The median follow-up period was 59 months. The overall 3-year survival rate was 57.8%, and the median survival was 45 months. Univariate statistical analysis showed that the histological subtype and Masaoka stage were prognostic factors. The 3-year survival rate was 61.9% in patients treated with gross total resection and 55.0% in those who underwent biopsy only. The 3-year survival rate was 59.5% in patients treated with conventional radiotherapy and 80% in those treated with stereotactic radiotherapy. The 3-year survival rate was 64.5% in patients treated with simultaneous chemotherapy and 42.9% in patients treated without simultaneous chemotherapy （P 〉 0.05）. Chemotherapy in combination with radiation treatment and surgery achieved better outcomes for Stage Ⅳ patients than radiation treatment and surgery without chemotherapy （P 〈 0.05）.
CONCLUSION For patients with Stage Ⅲ and Ⅳ thymic carcinoma, complete resection and postoperative radiotherapy or fractionated stereotactic radiotherapy constitute the best treatment solution. Chemotherapy can also be used in combination to improve prognosis. For patients with Stage Ⅳ thymic carcinoma, chemotherapy is necessary.     

局部晚期肝门部胆管癌根治术后放射治疗

Objective： To evaluate the outcome of radiotherapy （RT） in locally advanced hepatic hilar cholangiocarcinoma. Methods： During March 1992 to December 1997, 47 patients who had positive microscopic surgical margins after surgery were treated by postoperative radiotherapy （S＋RT, 28 patients, with a median dose of 50 Gy, 45-62 Gy） and surgery alone （S, 19 patients）. The median follow-up was 30 months （4-113 months）. Results： The overall 5-year survival rate was 28%, with a median survival length of 19.6 months while 5-year survival rates of S＋RT group and S group were 34% and 14%, with median survival lengths of 29 and 10 months respectively （P=0.015）. The occurrence rate of complications was 11% in either group. Conclusion： Postoperative radiotherapy significantly prolongs survival lengths in patients with hepatic hilar cholangiocarcinoma who had positive microscopic surgical margins. Radiation toxicities are tolerable.     

Clinical Analysis of 45 Patients with Thymic Carcinoma

OBJECTIVE To retrospectively evaluate the prognostic factors for advanced thymic carcinoma.METHODS The data from 45 patients with advanced thymic carcinoma were retrospectively analyzed according to Masaoka stage criteria. There were 29 Stage Ⅲ patients and 16 Stage Ⅳ patients (13 Stage IVA patients and 3 Stage IVB patients).According to the World Heath Organization Histological Criteria (2004), 25 cases were identified as low-grade and 20 cases were identified as high-grade. All diagnoses were confirmed by biopsy. Five patients underwent gross total resection, 21patients underwent subtotal resection and 19 patients underwent biopsy alone. Forty-two patients received radiotherapy with a median dose of 60 Gy, and 37 patients underwent conventional radiotherapy, including local irradiation and expanded irradiation.Local irradiation volume covered the primary tumor bed and approximately 1-2 cm2 surrounding the tumor (according to preoperative imaging). Expanded irradiation volume covered the full mediastinal and pericardium areas (with or without prophylactic irradiation in the supraclavicular area). Five cases received stereotactic radiotherapy. Thirty-one patients were also treated with chemotherapeutics, including Cisplatin, VP-16,Endoxan, 5-FU and taxol.RESULTS The median follow-up period was 59 months. The overall 3-year survival rate was 57.8%, and the median survival was 45 months. Univariate statistical analysis showed that the histological subtype and Masaoka stage were prognostic factors.The 3-year survival rate was 61.9% in patients treated with gross total resection and 55.0% in those who underwent biopsy only. The 3-year survival rate was 59.5% in patients treated with conventional radiotherapy and 80% in those treated with stereotactic radiotherapy. The 3-year survival rate was 64.5% in patients treated with simultaneous chemotherapy and 42.9%in patients treated without simultaneous chemotherapy (P >0.05). Chemotherapy in combination with radiation treatment and surgery achieved better outcomes for Stage Ⅳ patients than radiation treatment and surgery without chemotherapy (P < 0.05).CONCLUSION For patients with Stage Ⅲ and Ⅳ thymic carcinoma, complete resection and postoperative radiotherapy or fractionated stereotactic radiotherapy constitute the best treatment solution. Chemotherapy can also be used in combination to improve prognosis. For patients with Stage Ⅳ thymic carcinoma,chemotherapy is necessary.     

鼻咽癌根治放疗后残留病变的两种推量治疗方法疗效比较

Objective： To compare the efficacy between stereotactic radiotherapy （SRT） and intracavitary brachytherapy （brachytherapy） in residual tumor of nasopharyngeal carcinoma （NPC） after treating with conventional external beam radiotherapy. Methods： 60 patients with residual tumor of NPC after radical external beam radiotherapy （range 68 to 72 Gy） were randomized into SRT group （27 patients） and brachytherapy group （33 patients）. Patients in SRT group received boost treatment of 10-20 Gy, 2-3 fractions, once every other day; patients in brachytherapy group were treated with boost 10-20 Gy, 5 Gy per fraction, twice a week. Results： Efficacy in the near future： in SRT group, the complete recession （CR）, partial recession （PR） and no change （NC） rates were 77.8% （21/27）, 18.5% （5/27）, 3.7% （1/27）, respectively and the efficacy rate was 96.3% （CR ＋ PR）; in brachytherapy group： the CR, PR and NC rates were 75.8% （25/33）, 18.2% （6/33）, 6.1% （2/33）, respectively and the efficacy rate was 93.9% （CR ＋ PR）. The efficacy rates of the above two groups were compared （x^2 = 0.032, P 〉 0.05）. Long term efficacy： in SRT group, 1-year and 3-year survival rates were 96.3%, 66.5% respectively and the median live time was 48 months; in brachytherapy group： 1-year and 3-year survival rates were 93.9%, 60.2% respectively and the median live time was 46 months. The survival rates of two groups were compared （x^2 = 0.172, P 〉 0.05）. Conclusion： Both boost techniques of SRT and brachytherapy had elevated efficacy in patients with residual tumor of NPC and there was no obvious difference between the efficacy of the near and long term in SRT and brachytherapy group.     

Gefitinib combined with γ-ray stereotactic body radiation therapy has better efficacy than gefitinib alone for senile lung adenocarcinoma patients with EGFR mutations as first-line regimen

Objective： The senile lung adenocarcinoma patients harboring an activating epidermal growth factor receptor （EGFR） mutation shows good and rapid response to EGFR tyrosine kinase inhibitors （TKIs）. Whether gefitinib combined with y-ray stereotactic body radiation therapy has better efficacy than gefitinib alone for senile lung adenocarcinoma patients with EGFR mutations as first-line regimen is still under investigation. Methods： The 42 senile lung adenocarcinoma patients with EGFR mutations were divided into 2 groups according to the therapy method. Group A was the 22 patients treated with gefitinib combined with y-ray stereotactic body radiation therapy （SBRT）. Group B was the 20 patients treated with gefitinib alone. All of the patients received gefitinib of 250 mg/d from the first day until disease progression or other reasons. The patients of Group A were treated with y-ray stereotactic body radiation therapy from the second day. Radiation fields included the primary lesions and the integration of lymph nodes. Dose curve of this group was 50%-80%. Encircled dose was 4.0-6.5 Gy per fraction and the range of total dose was 40-52 Gy. We treated the patients 8-12 times and treated five times every week. Results： All the patients were examined by enhanced double helix CT at the second month. The tumor response rate （RR） of group A was 81.8% （18/22）. Disease control rate （DCR） was 90.9% （20/22）. The median overall survival （OS） was 24.2 months （range 8-58 months ） and the progression-free survival （PFS） was 18.6 months. The overall 1-year survival rate was 72.3% （16/22） and 2-year survival rate was 54.5% （12/22）. The main side effects included skin rash and diarrhea. The RR of group B was 50.0 % （10/20）. DCR was 75.0% （15/20）. OS was 17.4 months （range 6-32 months ） and PFS was 12.1 months. The overall 1-year survival rate was 60.0% （12/20） and 2-year survival rate was 40.0% （8/20）. The main side effects included skin rash and diarrhea. The g     

74例隆突型皮肤纤维肉瘤的治疗与预后分析

Objective： To study treatment and prognostic factor in 74 patients with dermatofibrosarcoma protuberans. Methods： From August 1990 to November 1999, 74 patients with dermatofibrosarcoma protuberans （DFSP） confirmed by pathology were treated in Cancer Hospital of Sun Yat-sen University. 72 cases were given wide excision and 2 cases were given local excision. All of 74 cases, 52 cases had surgical resection alone, and 22 cases had surgical resection combined with radiotherapy. Total dose of radiotherapy was 50-70 Gy. Results： The rate of recurrence was 36.1% for all patients. The 5-year recurrence-free survival （RFS） rate was 66%. The 5-year recurrence-free survival rates for resection alone and combined with radiotherapy were 58% and 90%, respectively （P=-0.0187）. The 5-year recurrence-free survival rates for positive microscopic margins and negative microscopic margins were 57% and 75%, respectively （P=0.0468）. Conclusion： Post-operation radiotherapy is an effective treatment to decrease the recurrence rate for the patients with positive microscope, or the patients without suitable surgical treatment.     

X线立体定向放射治疗44例腹膜后转移癌近期疗效观察

Objective： To investigate the therapeutic effects of stereotactic radiotherapy for retroperitoneal metastatic tumor. Methods： From August 1997 to October 2004, 44 patients with retroperitoneal metastatic tumors were treated with stereotactic radiotherapy. The planning target volume was encompassed by 90%-95% isodose line. Fractional dose was from 6 Gy to 8 Gy, and they were treated 2-3 times per-week and 4-8 times in all. The total radiation doses of PTV were from 32 Gy to 48 Gy. Results： After the radiotherapy, the pain was obviously relieved in 81.8% patients. Three months after completion of radiotherapy passed and then, abdominal CT was performed to evaluate the results. The whole effective rate was 81.8% [CR 27.7% （12/44） and PR 54.5% （24/44）], and six months after radiotherapy, CR was 27.7% （12/44） and PR was 59.1% （26/44）. The middle survival time was 12 months. Conclusion： It is suggested that stereotactic radiotherapy for retroperitoneal metastatic tumor is a safe and effective method.     

体部伽玛刀治疗原发性肝癌的疗效分析

Objective： To evaluate efficacy of the stereotactic body radiotherapy for patients with hepatocellular carcinoma. Methods： Twenty-seven patients with hepatocellular carcinoma were treated by technique of stereotactic body radiotherapy. Planning of treatment was made and the prescribed dose was adjusted depending on the site of the tumor, clinical target volume （GTV）, Kanofsky Performance and aim of treatment. Planning target volume received 50%-80% of the prescribed dose for 3.2-4.2 Gy per-fraction. Treatment total dose was 32-42 Gy （median dose 40 Gy） in daily fractions of 3.2-4.2 Gy for five fractions one week. Results： All the patients completed the planned radiotherapy. The tumor response rate was CR 25.9%, PR 55.6%, NR 18.59%＇, the response rate （CR ＋ PR） was 81.5%. Half-year local recurrence-free survival rate was 75%; 1-year local recurrence-free survival rate was 22%. There were no serious complications during radiotherapy and followup. Pain relieve rate in liver region was 83.3%. Conclusion： Stereotactic body radiotherapy can improve the local control and quality of life on the treatment of primary hepatic neoplasm while not increasing the treatment complication.     

High-risk endometrial cancer may be benefit from adjuvant radiotherapy plus chemotherapy

Objective:To present patterns of practice and outcomes in the adjuvant treatment of intermediate-and high-risk endometrial cancer.Methods:Retrospective data on 224 women with intermediate-risk and high-risk endometrial cancer from 1999 to 2006 were reviewed.All patients underwent surgical staging.Patterns of adjuvant treatment,consisting of pelvic radiotherapy,chemotherapy,and radiotherapy plus chemotherapy,were assessed.The 3and 5-year disease-specific survival(DSS) rates were calculated using the Kaplan-Meier method.Results:The difference in 5-year DSS rate was statistically significant between adjuvant group and non-adjuvant group(80.65% vs.63.80%,P=0.040).In 110 high-risk patients who underwent adjuvant treatment,both 5-year DSS rate and recurrent rate were significantly different in combined radiotherapy and chemotherapy group compared with radiotherapy alone and chemotherapy alone groups(DSS rate,P=0.049;recurrent rate,P=0.047).In 83 intermediate-risk women who underwent adjuvant treatment,there was no significant difference in 5-year DSS rate and recurrence rate among the combined radiotherapy and chemotherapy,radiotherapy alone and chemotherapy alone groups(DSS rate,P=0.776;recurrent rate,P=0.937).Conclusions:Adjuvant radiotherapy plus chemotherapy is associated with a higher 5-year DSS rate and lower recurrence rate compared with radiotherapy alone and chemotherapy alone in high-risk endometrial cancer patients.Patients with intermediate-risk endometrial cancer may be not likely to benefit from adjuvant combined radiotherapy and chemotherapy.     

Prognostic factors to predict survival in non-small-cell lung cancer with brain metastasis

Objective： The purpose of the study was to assess prognostic factors to predict overall survival （OS） and progres- sion-free survival （PFS） in non-small-cell lung cancer （NSCLC） with brain metastasis （BM）. Methods： From November 2011 to March 2013, the clinical data of 31 NSCLC cases with BM treated with multiple modalities including brain radiotherapy alone, systemic chemotherapy, whole brain radiotherapy （WBRT） combined with tyrosine kinase inhibitor （TKIs）. The efficacy and adverse reaction were evaluated after treatment. Results： In terms of intracranial lesions, the objective response rate （ORR） and the disease control rate （DCR） were 22.6% and 90.3%, respectively. As for systemic disease, ORR and DCR were 32.3% and 93.5%, respectively. The median time to progression-free survival （PFS） was 298 days （95% CI： 258.624-337.376 days）, whereas in the epidermal growth factor receptor （EGFR） mutation patients was 331 days. Patients who received EGFR-TKIs combined with brain radiation had better response rate （RR） than those only brain radiation. Univariate analysis showed that the EGFR-mutations could predictive factors for PFS, and not to other clinical pathological features. The most common toxicities were rash and diarrhea, but all were well-tolerated. Conclusion： EGFR-mutations is the independent prognostic factors affecting the survival rates of NSCLC patients with BM. Through the clinical observation, icotinib combined with WBRT may be effective on brain metastases in NSCLC patients, and toxicities are tolerable, which worth further study.     

389例脑胶质瘤立体定向放射治疗效果评价(英文)

目的探讨脑胶质瘤立体定向放射治疗的疗效及放疗副反应。方法从1995年6月到1998年12月,用立体定向放射治疗的方法共治疗脑胶质瘤病人389例,其中用立体定向放射外科(ster-eotactic radiosurgery,SYS)方法治疗151例,分次立体定向放射治疗(fractionated stereotatic radiotherapy,FSRT)方法治疗238例。SRS组单次周边剂量20～30Gy,靶点1～6个,平均2.48个,照射弧5～21个,平均8.45个;FSRT 组每日或隔日照射,每次周边剂量8～12Gy,共照射2～5次,靶点1～6个,平均2.53个,照射弧6～20个,平均8.25个。结果治疗结束后3个月,SRS 组完全缓解(CR)21例,占13.9%,部分缓解(PR)69例,占45.7%,稳定(SD)26例,占17.2%,进展(PD)35例,占23.2%,总有效率(PR+CR+SD)为76.8%;FSRT 组完全缓解(CR)47例,占19.7%,部分缓解(PR)114例,占47.9%,稳定(SD)49例,占20.6%,进展(PD)28例,占11.8%,总有效率(PR+CR+SD)为88.2%,两组差别有显著性(X~2=9.874,P=0.020)。全部病人的1、3、5年生存率分别为54.3%、29.3%、16.5%;SRS 组和 FSRT 组的1、3、5年生存率分别为52.3%、26.5%、11.9%和55.5%、31.1%、19.3%,两组差别没有显著性意义(X~2=2.16,P=0.1417);放射治疗的主要副反应为脑水肿,SRS组较 FSRT 组为重(X~2=4.916,P=0.027)。结论立体定向放射治疗对脑胶质瘤有较好的疗效,FSRT 与 SRS 相比,具有疗效好副作用小的优点。     

Stereotactic radiosurgery and fractionated stereotactic radiotherapy: comparison of efficacy and toxicity in 260 patients with brain metastases

We retrospectively evaluated and compared the efficacy and the toxicity profile of stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) for the treatment of patients with brain metastases (BM). Between 2000 and 2009, 260 patients with 1-3 BM were treated using either SRS (median dose 20 Gy; n = 138) or two different FSRT dose concepts: 7 × 5 Gy (n = 61) or 10 × 4 Gy (n = 61). The median survival for SRS, 7 × 5 Gy and 10 × 4 Gy was 8, 7 and 10 months (p = 0.575), respectively, and the overall survival (OS) was 9 months. Follow-up imaging data were available in 214 of the 260 patients. The 1-year local progression-free survival (LPFS) was 73, 75 and 71 %, respectively (p = 0.191). After a mean follow-up of 28 months (range: 2.1-77 months), the rate of complete remission, partial remission, stable disease and progressive disease were 29, 40, 21 and 10 %, respectively. On multivariate analysis, RPA class I was associated with better OS and regional progression-free survival (both p < 0.001). SRS was associated with a higher toxicity rate (grade I-III) compared to the 7 × 5 Gy and 10 × 4 Gy groups (14 vs. 6 vs. 2 %, respectively; p = 0.01). Although FSRT was used for large lesions and/or lesions near critical structures, the LPFS was comparable to SRS. Importantly, FSRT presented low toxicity and appears to be an effective and safe treatment for BM not amenable to SRS. The 10 × 4 Gy fractionation scheme warrants further investigation due to its efficacy and safe toxicity profile.     

Single dose versus fractionated stereotactic radiotherapy for recurrent high-grade gliomas

Purpose: To evaluate the efficacy of stereotactic radiotherapy (SRT) in patients with recurrent high-grade gliomas by comparing two different treatment regimens, single dose or fractionated radiotherapy.

Methods and Materials: Between April 1991 and January 1998, 71 patients with recurrent high-grade gliomas were treated with SRT. Forty-six patients (65%) were treated with single dose radiosurgery (SRS) and 25 patients (35%) with fractionated stereotactic radiotherapy (FSRT). For the SRS group, the median radiosurgical dose of 17 Gy was delivered to the median of 50% isodose surface (IDS) encompassing the target. For the FSRT group, the median dose of 37.5 Gy in 15 fractions was delivered to the median of 85% IDS.

Results: Actuarial median survival time was 11 months for the SRS group and 12 months for the FSRT group (p = 0.3, log-rank test). Variables predicting longer survival were younger age (p = 0.006), lower grade (p = 0.0006), higher Karnofsky Performance Scale (KPS) (p = 0.0005), and smaller tumor volume (p = 0.02). Patients in the SRS group had more favorable prognostic factors, with median age of 48 years, KPS of 70, and tumor volume of 10 ml versus median age of 53 years, KPS of 60, and tumor volume of 25 ml in the FSRT group. Late complications developed in 14 patients in the SRS group and 2 patients in the FSRT group (p < 0.05).

Conclusion: Given that FSRT patients had comparable survival to SRS patients, despite having poorer pretreatment prognostic factors and a lower risk of late complications, FSRT may be a better option for patients with larger tumors or tumors in eloquent structures. Since this is a nonrandomized study, further investigation is needed to confirm this and to determine an optimal dose/fractionation scheme.     

Salvage reirradiation for recurrent glioblastoma with radiosurgery: radiographic response and improved survival

Purpose To determine the radiographic and clinical efficacy of stereotactic single dose radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) as salvage therapy for glioblastoma (GBM) at recurrence. Methods Thirty-six patients with pathologically proven recurrent GBM were treated with salvage reirradiation by either SRS or FSRT between March of 2001 and August of 2006. Thirty-one patients had an initial diagnosis of GBM. Five patients had a malignant transformation. All patients had received radiotherapy with a dose of 50–60 Gy, a median 13.6 months prior to reirradiation (range: 0.8–119 months). At the time of recurrence, 26 patients were treated with SRS with a median dose of 18 Gy (range: 12–20 Gy). FSRT was performed in ten patients with a dose of 36 Gy in six fractions, twice weekly. Follow-up included MRI and clinical examination every 2 months. Results Median survival time after SRS was 8.5 months, compared to 7.4 months after FSRT (P = 0.81). Of 26 patients treated with SRS, radiographic tumor response or stable disease was observed in eight (35%) patients and tumor progression was seen in 18 (65%) patients. Of 10 patients treated by FSRT, radiographic tumor response or stable disease was observed in four (40%) patients and tumor progression was observed in four (40%) patients (two lost to follow-up). Patients who responded to treatment had statistically improved survival compared to non-responders, with median survival of 15.8 vs. 7.3 months (P < 0.05). Conclusion Salvage reirradiation with SRS or FSRT for recurrent GBM results in radiographic response in a proportion of patients. Survival was significantly improved among patients who either responded or had stable disease after salvage reirradiation, compared to non-responders. Further study is warranted to investigate the method and time of reirradiation for recurrent GBM.     

Fractionated stereotactic radiotherapy of optic pathway gliomas: tolerance and long-term outcome

PURPOSE: To evaluate the effectiveness and toxicity of fractionated stereotactically guided radiotherapy (FSRT) in the management of optic glioma. METHODS AND MATERIALS: Fifteen patients with optic pathway gliomas were treated with FSRT at our institution between 1990 and 2003. A median target dose of 52.2 Gy (range, 45.2-57.6 Gy) was applied using a median fractionation of 5 fractions of 1.8 Gy weekly using a linear accelerator. RESULTS: The median follow-up time was 97 months (range, 8-151 months). Of the 15 patients, 1 died of tumor progression during the follow-up period. The progression-free survival rate at 3 and 5 years was 92% and 72%, respectively. The median overall survival after FSRT was 90 months (range, 8-151 months). The 5-year survival rate after FSRT was 90%. We did not observe secondary malignancies. CONCLUSION: Fractionated stereotactic radiotherapy was safe and well tolerated in all patients. The good tumor control and the potential of sparing normal brain tissue, especially the pituitary gland in lesions involving the optic chiasm, permit effective treatment of patients with optic nerve gliomas. Longer follow-up is needed to assess the incidence of late effects fully.     

Fractionated stereotactic radiotherapy for acoustic neuroma: single-institution experience at The Princess Margaret Hospital

BACKGROUND: The clinical outcome and toxicity of fractionated stereotactic radiotherapy (FSRT) was assessed for acoustic neuroma in 60 patients treated in a single institution. METHODS: Between October 1996 and February 2005, 60 patients received FSRT for acoustic neuroma (AN). The mean total dose applied was 50 Gy in single daily 2-Gy fractions over 5 weeks. The median irradiated tumor volume was 4.9 cm(3) (range, 0.3-49.0 cm(3)). The median follow-up period was 31.9 months. RESULTS: FSRT was well tolerated in all patients. The 5-year actuarial local control rate was 96.2% (95% CI: 91.1%-100.0%). Five-year actuarial progression-free survival was 92.8% (95% CI: 84.8%-100.0%). The overall hearing preservation rate was 77.3%. Five of 6 patients with initial cranial nerve V (CNV) numbness remained stable post-FSRT. Two of 3 patients with baseline trigeminal neuralgia improved with the remaining patient stable. All 3 patients with nonsurgically related facial nerve weakness either improved or achieved stability in function. There were no cases of new cranial nerve toxicity post-FSRT. CONCLUSIONS: FSRT for the treatment of AN is safe, effective, and well tolerated. FSRT should thus be considered as an effective alternative treatment modality when compared with microsurgical resection or single fraction stereotactic radiosurgery.     

The role of salvage reirradiation for malignant gliomas that progress on bevacizumab

Bevacizumab and irinotecan are effective against recurrent malignant gliomas. However, at subsequent progression, patients rarely respond to a second bevacizumab-containing chemotherapeutic regimen. Salvage re-irradiation with bevacizumab for recurrent but bevacizumab naive malignant gliomas showed encouraging results. We performed a retrospective review of the medical records of 23 patients treated with either fractionated stereotactic radiotherapy (FSRT) or stereotactic radiosurgery (SRS) after progression on an initial bevacizumab regimen. Patients were treated after re-irradiation with bevacizumab but combined with a different chemotherapy. We then compared them to another 23 patients who progressed on an initial bevacizumab + chemotherapy regimen. These patients did not receive re-irradiation but bevacizumab was continued combined with a different chemotherapy. Patients treated with FSRT/SRS/bevacizumab had a longer median progression-free period (2.6 vs. 1. 7 months, P = 0.009), longer median post FSRT/SRS treatment survival (7.2 vs. 3.3 months, P = 0.03) and higher radiographic response rate (22 vs. 0%, P = 0.049). FSRT or SRS followed by bevacizumab + chemotherapy may have a role for patients who progress on bevacizumab.     

X射线立体定向放射治疗多发脑转移瘤的价值

目的　探讨X射线立体定向放射治疗多发脑转移瘤的疗效。方法　在 4种预后因素(年龄、治疗前卡氏评分、有无其他部位转移及转移灶数目 )相同或相似的条件下 ,配对选择两组病例。X射线立体定向放射治疗加常规放射治疗组 (研究组 )和常规放射治疗组 (对照组 )各 53例。在研究组中 ,X射线立体定向放射治疗采用单次照射 40例 ,分次照射 1 3例 ;单次靶区平均周边剂量为 2 0Gy,分次照射剂量为 4～ 1 2Gy/次 ,2次 /周 ,总剂量为 1 5～ 30Gy。X射线立体定向放射治疗结束后即开始全脑放射治疗。对照组采用全脑照射 30～ 40Gy,3～ 4周。结果　研究组和对照组中位生存期分别为1 1 .6、6 .7个月 (P <0 .0 5) ;1年生存率分别为 44 .3 %、1 7.1 % (P <0 .0 1 ) ;1年局部控制率分别为50 .9%、1 3 .2 % (P <0 .0 5) ;治疗后 1个月卡氏评分增加者分别占 69.8%、30 .2 % (P <0 .0 1 ) ;治疗后 3个月影像学上的有效率分别为 82 .0 %、55 .0 % (P <0 .0 1 )。在死因分析中 ,研究组死于脑转移的占2 3 .3 % ,比对照组的 51 .0 %低 (P <0 .0 5)。两组病例放射并发症的发生率相似。结论　对于多发脑转移瘤 ,X射线立体定向放射治疗加常规放射疗在提高局部控制率、延长生存期和提高生存质量方面均优于单纯放射治疗。     

82例脑胶质瘤立体定向放射治疗的疗效观察

目的探讨立体定向放射治疗（SRT）对于脑胶质瘤患者的治疗效果。方法采用SRT治疗82例脑胶质瘤，其中初治63例，复治19例。所有患者均采用分次立体定向放射治疗（FSRT）。中位照射剂量46Gy，中位随访期为25个月（12-36个月）。结果全组局部病灶控制率为68．3％（56／82），中位生存期（MST）为12．5个月。初治和复治者MST分别为19．5和9．5个月。1年生存率为58．5％（48／82）。结论SRT可有效控制局部病灶，可作为瘤体较小、边界较清楚胶质瘤的一种安全有效治疗手段。