Early neurological complications after stereotactic radiosurgery/radiotherapy.

OBJECTIVE: To evaluate the neurological complications after stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT). MATERIAL AND METHOD: The Ramathibodi Radiosurgery Unit started its service in August 1997, using the linear-accelerator based system. There were 144 patients treated from August 1997 to October 1999. Single fraction SRS was performed in 56 cases consisting of 46 arteriovenous malformations (AVMs), 4 cranial nerve (CN) schwannomas, 3 pituitary adenomas, 2 meningiomas, and 1 multiple hemangioblastomas. Eighty eight patients received multifractionated SRT, including 27 meningiomas, 17 pituitary adenomas, 13 benign and malignant gliomas, 8 brain metastasi(e)s, 5 CA nasopharynx, 5 craniopharyngiomas, 5 CN schwannomas, 2 AVMs, 2 chordomas, and 4 others. After treatment the patients were clinically evaluated every 1-6 months and MRI was scheduled at 6 or 12-month interval or when there were abnormal clinical signs/symptoms. The complications included any new neurological complaints or findings during and after treatment. RESULTS: Median follow-up time was 9.5 (0-20) months. Of 138 patients with available follow-up data, there were 23 (13 SRS and 10 SRT) cases who experienced new neurological symptoms at 3 weeks - 20 months (median = 3 months) from the time treatment started. Symptoms included headache, seizure, weakness, decreased vision, vertigo with/without ataxia, diplopia, dizziness, impaired memory, hemifacial spasm, decreased sensation and facial palsy. Three AVM patients had intraventricular hemorrhage from the patent nidi. After symptomatic treatment there were 15 cases with complete recovery (including seizure control) and 6 with partial recovery. There were 2 deaths from ruptured AVM and progressive metastatic brain lesion. There were 79 patients who had at least 1 follow-up MRI, and changes were detected in T2-weighted images in 19 cases at 3-18 months after treatment. Ten cases had symptoms corresponding to the image changes, the other 9 patients were asymptomatic. CONCLUSIONS: Longer follow-up time is needed to fully evaluate the complications after SRS/SRT, however, preliminary results showed that most of the complications were mild and transient. There was a tendency of a higher complication rate in the SRS group. Not all patients with post treatment image changes developed symptoms.

7 year-survival of 2 cases of multicentric or metastatic osteosarcoma.

Osteosarcoma is a fatal disease. Neoadjuvant chemotherapy combined with irradiation treatment provide a better survival. In the Faculty of Medicine, Ramathibodi Hospital, the overall 9 year survival probability was 55 per cent among 130 cases of more than Enneking stage II osteosarcoma. Between 15 cases of bony metastases, there were 2 cases which were classified as multifoci osteosarcoma or osteosarcomatosis. These two cases developed second bone disease, 32 and 38 months after initial diagnosis and survived for 84 and 88 months with one patient also developing pulmonary metastasis. Both of them are still alive and in very good health.

Osteosarcoma: a study of 130 cases.

Multidisciplinary treatment of osteosarcoma in the Faculty of Medicine Ramathibodi Hospital, Mahidol University, using preoperative intraarterial and postoperative chemotherapy, with or without local irradiation, combined with surgery and prophylactic lung irradiation provided an excellent 5 years' survival of 55 per cent, the same rate as the 9 years' survival. The survival was stable after 4.4 years. The patients with local irradiation had more tumor destruction apparent on the surgical specimen. The administration of prophylactic whole lung irradiation provided an outcome without any undesirable complication. Sixteen per cent of the cases with PLI developed lung metastasis compared to 48 per cent without PLI. The most important prognostic factor was low level of serum lactic acid dehydrogenase. The unanswered question is what is the optimal treatment for osteosarcoma?

The role of radiation therapy in retinoblastoma.

Retinoblastoma is the most common eye malignancy in Southeast Asia. In the early stage of the disease, photocoagulation, cryotherapy combined with chemotherapy and radiation therapy not only preserve vision but also preserve life. In advanced cases, the patient almost always refuses treatment when they are told to have enucleation and this leads them to more severe disease with distant metastasis. Nevertheless, even in such a poor condition, this report has shown several cases with very poor prognostic factors but effective radiation, chemotherapy after surgery still provided a very good outcome. Thus, the public should be educated that this disease can be cured even in the advanced stage. Early detection for the sake of vision and quality of life is the future intent. In the near future, it is hoped that fewer patients will refuse treatment or be lost to follow-up because of their ignorance and poverty.