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Objective To study the physical characteristics of the OPEN stereotactic body radiotherapy system for the clinical application. Methods The 0. 125cc ioniztion chamber, 160 mm polystyrene sphere model,Gafchromic EBT2 films and IBA film analysis software were used to evaluated the focus position tolerance,dose rate,repeatability,linear relation,penumbra and composite error of the OPEN stereotactic body gamma knife. We used the DTA method to verify the accuracy of dose distribution between the plans and measured value. Resualts The focus error was 0. 36 mm,max dose rate tolerance 3%,linear relation error 2%,repeatability error 0. 3%,composited error 2. 5 mm. There was 90% pass rate when the distance away from test point was less than 2 mm and the dose error was set less than 5 % . Conclusions Parts of the test resualts were similar to the head gamma knife national protocal of OPEN stereotatic body gamma knife. The deliver dose distribution can meet the clinic need.
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PURPOSE: To evaluated the patterns of failure, survival rate, treatment-related toxicity and prognostic factors in postoperative radiotherapy of patients with ependymoma. MATERIALS AND METHODS: Thirty patients who underwent surgery and postoperative radiotherapy for ependymoma between the period of June 1994 and June 2008 were reviewed retrospectively. The age of patients ranged from 21 months to 66 years (median, 19 years). Seventeen patients had grade II ependymoma, and 13 had grade III anaplastic ependymoma according to the World Health Organization grading system. The postoperative irradiation was performed with 4 or 6 MV photon beam with median dose of 52.8 Gy (range, 45 to 63 Gy), and radiation field including 2 cm beyond the preoperative tumor volume. Median follow-up period was 51 months (range, 12 to 172 months). RESULTS: Fourteen out of 30 (46.7%) patients experienced recurrence, and 12 of those died. Among those 14 patients who experienced recurrence, 11 were in-field and 3 were out-of-field recurrence. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 66.7% and 56.1%, respectively. On univariate analysis, tumor grade was a statistically significant prognostic factor for OS and PFS. There were two complications after surgery and postoperative radiotherapy, including short stature and facial palsy on the left side. CONCLUSION: We observed good survival rates, and histologic grade was a prognostic factor affecting the OS and PFS. Almost all recurrence occurred in primary tumor site, thus we suggest further evaluation on intensity-modulated radiotherapy or stereotatic radiosurgery for high-risk patients such as who have anaplastic ependymoma.
Subject(s)
Humans , Disease-Free Survival , Ependymoma , Facial Paralysis , Follow-Up Studies , Radiosurgery , Radiotherapy, Intensity-Modulated , Recurrence , Retrospective Studies , Survival Rate , Tumor Burden , World Health OrganizationABSTRACT
PURPOSE: To evaluated the patterns of failure, survival rate, treatment-related toxicity and prognostic factors in postoperative radiotherapy of patients with ependymoma. MATERIALS AND METHODS: Thirty patients who underwent surgery and postoperative radiotherapy for ependymoma between the period of June 1994 and June 2008 were reviewed retrospectively. The age of patients ranged from 21 months to 66 years (median, 19 years). Seventeen patients had grade II ependymoma, and 13 had grade III anaplastic ependymoma according to the World Health Organization grading system. The postoperative irradiation was performed with 4 or 6 MV photon beam with median dose of 52.8 Gy (range, 45 to 63 Gy), and radiation field including 2 cm beyond the preoperative tumor volume. Median follow-up period was 51 months (range, 12 to 172 months). RESULTS: Fourteen out of 30 (46.7%) patients experienced recurrence, and 12 of those died. Among those 14 patients who experienced recurrence, 11 were in-field and 3 were out-of-field recurrence. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 66.7% and 56.1%, respectively. On univariate analysis, tumor grade was a statistically significant prognostic factor for OS and PFS. There were two complications after surgery and postoperative radiotherapy, including short stature and facial palsy on the left side. CONCLUSION: We observed good survival rates, and histologic grade was a prognostic factor affecting the OS and PFS. Almost all recurrence occurred in primary tumor site, thus we suggest further evaluation on intensity-modulated radiotherapy or stereotatic radiosurgery for high-risk patients such as who have anaplastic ependymoma.
Subject(s)
Humans , Disease-Free Survival , Ependymoma , Facial Paralysis , Follow-Up Studies , Radiosurgery , Radiotherapy, Intensity-Modulated , Recurrence , Retrospective Studies , Survival Rate , Tumor Burden , World Health OrganizationABSTRACT
Objetivos: Descrever cirurgias guiadas por agulhamento de lesões mamárias não palpáveis e avaliar sua correlação anatomopatológica. Métodos: Realizou-se um estudo descritivo, retrospectivo, a partir da análise dos prontuários de pacientes da Clínica de Mastologia do Instituto de Previdência dos Servidores do Estado de Minas Gerais (IPSEMG). Foram selecionados todos os casos de pacientes submetidas à biópsia cirúrgica de lesão mamária não palpável após agulhamento guiado por mamografia ou ultrassonografia, durante o período de 3/8/2004 a 25/5/2006. Foram analisadas as seguintes variáveis: idade da paciente à época da cirurgia, tipo de lesão mamária apresentada ao exame de imagem e resultado anatomopatológico. Resultados: Houve um total de 261 cirurgias. Foram elegíveis 236 casos. A idade média das pacientes foi de 50,9 anos (19-91 anos). Em 120 casos (50,85%), a biópsia foi realizada em virtude de microcalcificações mamárias; em 95 casos (40,25%), por nódulo; em 15 casos (6,36%), por assimetria focal e em 6 casos (2,54%), por distorção arquitetural. O resultado anatomopatológico foi benigno em 170 casos (72,03%) e maligno em 66 (27,97%). Conclusões: A casuística do Serviço de Mastologia do IPSEMG está de acordo com os dados encontrados na literatura. A biópsia cirúrgica de lesões mamárias não palpáveis guiada por agulhamento é um procedimento capaz de estabelecer o correto diagnóstico diferencial dessas lesões, diagnosticar o câncer de mama em fases iniciais e promover a remoção completa das lesões em tempo cirúrgico, frequentemente, único.
Objectives: To describe surgical biopsies after wire localization of non palpable mammary lesions and to consider their anatomopathological correlation. Methods: A descriptive and retrospective study was realized through analysis of handbooks of patients at Mastology Clinics of the Instituto de Previdência dos Servidores do Estado de Minas Gerais (IPSEMG). All cases of patients submitted to surgical biopsy of non-palpable mammary lesion after wire localization for mammography or ultrasound, during the period of 8/3/2004 to 5/25/2006, were selected. The variables analyzed were: age of the patient at the time of the surgery, type of breast lesion presented during the tests of image and anatomopathological result. Results: There were a total of 261 surgeries, which 236 cases were elected. The average age of the patients was 50,9 years (19-91 years). In 120 cases (50.85%) the biopsy was made due to the mammary microcalcifications; in 95 cases (40.25%) for nodule; in 15 cases (6.36%) for focal asymmetry and in 6 cases (2.54%) for architectural distortion. The anatomopathological result was benign in 110 cases (12.03%) and malignant in 66 (27.91%). Conclusions: The casuistic of the Mastology Service of IPSEMG is compatible with the data founded in literature. The surgical management of non-palpable breast lesions after wire localization is a procedure which is able to establish the differential diagnostic of these lesions, breast cancer diagnosis in early stage and to promote the complete removal of the injuries in frequently single surgical time.
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Humans , Biopsy, Needle , Carcinoma, Ductal, Breast/diagnosis , Breast/injuries , Diagnosis, Differential , Diagnostic Techniques, Surgical , Diagnostic Imaging/classificationABSTRACT
Purpose:To investigate method of early detection of breast cancer with microcalcification observed by mammograph but without palpable mass clinlcally.Methods:Stereotatic core needle biopsy (SCNB) were performed in 35 patients with calcification observed by mammography,and 29 people received stereotatic needle localized breast biopsies (NLBB).All tissues were routinely processed.Microscopic analysis of calcification and morphologic analysis of calcifica- tion were done,as well as histologic diagnosis.Results:Among the 35 specimens of SCNB,microscopic calcification,in- traductal carcinoma and invasive ductal carcinoma were detected in 24,8,and 4 respectively.Calcification was identified in 25 of the 29 cases of NLBB.Five cases of intraductal carcinoma,six cases of invasive ductal carcinoma as well as one case of invasive lobular carcinoma were diagnosed in these 29 patients.Conclusions:With close cooperation among pathol- ogists,surgeons and radiologists,the application of SCNB and NLBB may benefit the early detection of breast cancer with microcalcification observed by mammograph but without mass being palpable clinically and finaly improve the survival of breast cancer patients.
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Objective To evaluate the effect of treating malignant biliary obstruction by expandable metallic biliary endoprosthesis(EMBE) via percutaneous transhepatic approach companied with stereotactic radiotherapy(SRT). Methods We implanted total 19 stents via percutaneous transhepatic in 15 patients with malignant biliary obstuction, then the patients received stereotactic radiotherapy.Results The stent implanting in 15 cases was successful,and followed-up for 12 months .3 cases died in the third,fourth and eleventh month respectively without jaundice,others survied formore than one year.The survival rate for one year was 80%.Conclusion Implanting stent in bile ducts companied with stereotactic radiotherapy is an effective way in treating malignant biliary obstruction.
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Among the existing radiotherapy technologies, ?(X) stereotatic radiotherapy,especially the whole body ? knife,provides better dose distribution and has advantages in increasing target volume dose and reducing normal tissue damage.The whole body ? knife,patented in China with unique characteristics of dose focusing and dose distribution,could provide higher curative effect and minimal toxicity in the treatment of cancers of the lung,liver,pancreas,etc.It has initiated a new phase of Chinese mode of ?(X) stereotatic radiotherapy and was drawn great attention at home and abroad.In this review,the clinical application criteria,treatment progress,existing problem and expectation of ?(X) stereotatic radiotherapy have been summarized.
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Hemangioblastomas are benign tumors that most commonly occur in the posterior fossa around the 4th ventricle. Recurrent mutifocal hemangioblastomas are often found as a part of a systemic autosomal dominant disease, the Von Hippel-Lindau syndrome. Surgical removal of recurrent multifocal tumors are technically more difficult and challenging than solitary ones due to their proximity to critical structures, disturbed anatomical landmark and adehesion to the surrounding tissue, all of which may lead to high postoperative morbidity and mortality. Authors have experienced 2 cases of the multiple and recurrent hemangioblastomas with Von Hippel-Lindau syndrome. The patients of each of the cases underwent surgery for tumor removal at least 2 times. In the first patient, a 42-year-old male, a solitary cerebellar hemangioblastoma had been removed 6 years prior to recurrence. On followup MRI, more than three solid, homogenously enhanced nodules were found in the cerebellum. These tumors were operated on through the previous craniectomy site, but only two of them could be removed. This patient was discharged without additional neurologic deficit. The 2nd patient, a 40-year-old-male, had undergone three prior operations for cerebellar hemangioblastomas. On followup examination, he presented with progressive ataxia and confusion. Brain MRI showed multiple recurrent lesions of homogenously strongenhanced masses in the 4th ventricle and cerebellar vermis surrounded by cystic lesions, accompanied by obstructive hydrocephalus. No additional surgery of tumors were attempted, and only ventriculoperitoneal shunt was performed. He was discharged with improved neurological symtomes and sign.
Subject(s)
Adult , Humans , Male , Ataxia , Brain , Cerebellum , Follow-Up Studies , Hemangioblastoma , Hydrocephalus , Magnetic Resonance Imaging , Mortality , Neurologic Manifestations , Radiosurgery , Recurrence , Ventriculoperitoneal Shunt , von Hippel-Lindau DiseaseABSTRACT
In spontaneous brain stem hemorrhage, efforts are being made to treat the hemorrhage by means of active medical treatment of intricate suboccipital craniectomy. But these efforts are still unsatisfactory in decreasing the high mortality and morbidity. Our recent efforts have got good results in the 11 cases of brain stem hemorrhage by removing the hemorrhage through the application of R.R.W. stereotactic system and gradual urokinase irrigation. The residual hemorrhage following the initial aspiration was completely evacuated by gradual urokinase irrigation through stereotactically placed catheter. Also this catheter was used for monitoring of intrahematomal intracranial pressure for an early stoppage of the increased intracranial pressure or early detecting of rebleeding. This kind of stereotactic evacuation and gradual irrigation with urokinase could remove the brain stem hemorrhage accurately and easily in a short time under the local anesthesia. Mean-while the normal brain tissue is subjected to less surgical trauma by this procedure, which can be interpreted as having a wide indication, a definite advantage, with a low mortality of 27.3%.
Subject(s)
Anesthesia, Local , Brain Stem , Brain , Catheters , Electric Impedance , Hemorrhage , Intracranial Pressure , Mortality , Urokinase-Type Plasminogen ActivatorABSTRACT
The Brown-Robert-Wells(BRW) stereotactic system has many advantages in the supratentorial spontaneous intracerebral hemorrhage(ICH), but is has less accessibility to the spontaneous cerebellar hemorrhage by stereotactic suboccipital approach. To overcome this disadvantage, we have tried to treat stereotactically three patients of spontaneous intracerebellar hemorrhage through tentorium using BRW stereotaxis and gradual irrigation wth urokinase(UK). This new approach has been used successfully under the local anesthesia with satisfactory postoperative neurological results. We present a detailed technique of this approach.