Analysis on the therapeutic effects of re-irradiation with stereotactic body radiation therapy for the advanced recurrent locally pancreatic cancer / 中华胰腺病杂志

Objective To investigate the safety and efficacy of re-irradiation with stereotactic body radiotherapy(SBRT) for treating locally recurrent advanced pancreatic cancer.Methods From 2014 to 2017,7 patients with stage Ⅲ pancreatic cancer were treated by re-irradiated with SBRT at Shanghai Changhai Hospital.SBRT was delivered via the G4 type cyberknife robotic stereotactic radiosurgery system in all the patients.The median dose of the first SBRT was 35Gy/5-7 fx,and the median dose of re-irradiation with SBRT was 31 Gy/5-8 fx.6 patients had undergone sequential chemotherapy either with gemcitabine or S-1 based therapy except one patient who refused the chemotherapy.Results There were 5 male and 2 female patients.The median overall survival (OS) of 7 patients was 30 months.Patients were re-irradiated with SBRT after a median interval of 10 months after the first SBRT.Median OS and locally relapse-free survival (LFRS) from re-irradiation were 13 months and 11 months,respectively.Three months after re-irradiation,3(42.9％) patients had partial remission and 4 patients had stable disease.Pain disappeared in 4 patients at the end of reirradiation and significant pain was alleviated in 2 patients 1 month after re-irradiation.There were no toxicities of grade 3 or higher grade during two courses of SBRT.Conclusions For patient with locally recurrent advanced pancreatic cancer,SBRT re irradiation regimen was associated with acceptable toxicity,which can effectively alleviate the pain,prolong the survival and improve the life quality.

Psychosurgery: from ablation to neuromodulation / 上海交通大学学报（医学版）

Psychosurgery, the neurosurgical treatment for psychiatric disorders, has a long and controversial history. The review introduces the birth of psychosurgery, the rise and fall of the frontal lobotomy and the transition to the modern era of psychosurgery, due to the development of the stereotactic instruments, and the different psychosurgical procedures. Today, recent advances in neuromodulation may provide an opportunity for psychosurgery to become a more attractive option for the treatment of psychiatric diseases. Current states in China and prospects of psychosurgery are also discussed.

MRI-guided stereotactic supratentorial lesion biopsy:a report of 103 patients / 中国肿瘤临床

To evaluate the reliability and accuracy of MRI-guided stereotactic biopsy for supratentorial brain lesions. Method: A total of 103 cases of MRI-guided biopsy were performed between November 2009 and December 2013. Patients' pathological results and postoperative rehabilitation courses were analyzed. Results: A total of 102 patients (99.0%) had pathological results, of which 97 cases were brain tumors (86.0%), including 36 cases of astrocytoma, 9 cases of anaplastic astrocytoma, 10 cases of oligoastrocytoma, 4 cases of anaplastic oligoastrocytoma, 4 cases of anaplastic ligodendroglioma, 3 cases of glioblastoma multiforme, 27 cases of lymphoma, 3 cases of germcell tumors, and 1 case of rhabdomyosarcoma. Inflammatory lesions were found in 3 cases (2.9%). Displacement of brain gray matter was reported in 2 cases (2.0%), and 1 case (1.0%) of cerebral infarction existed. A total of 3 patients suffered intracranial hematoma after biopsy, and 1 patient underwent craniotomy to remove the hematoma. No death or intracranial inflammation occurred after biopsy.Conclusion: MRI-guided stereotactic biopsy is a safe and reliable method in qualitative diagnosis. It is a very important tool for diagnosis and treatment selection for intracranial lesions.

MRI-guided stereotactic supratentorial lesion biopsy:a report of 103 patients / 中国肿瘤临床

To evaluate the reliability and accuracy of MRI-guided stereotactic biopsy for supratentorial brain lesions. Method: A total of 103 cases of MRI-guided biopsy were performed between November 2009 and December 2013. Patients' pathological results and postoperative rehabilitation courses were analyzed. Results: A total of 102 patients (99.0%) had pathological results, of which 97 cases were brain tumors (86.0%), including 36 cases of astrocytoma, 9 cases of anaplastic astrocytoma, 10 cases of oligoastrocytoma, 4 cases of anaplastic oligoastrocytoma, 4 cases of anaplastic ligodendroglioma, 3 cases of glioblastoma multiforme, 27 cases of lymphoma, 3 cases of germcell tumors, and 1 case of rhabdomyosarcoma. Inflammatory lesions were found in 3 cases (2.9%). Displacement of brain gray matter was reported in 2 cases (2.0%), and 1 case (1.0%) of cerebral infarction existed. A total of 3 patients suffered intracranial hematoma after biopsy, and 1 patient underwent craniotomy to remove the hematoma. No death or intracranial inflammation occurred after biopsy.Conclusion: MRI-guided stereotactic biopsy is a safe and reliable method in qualitative diagnosis. It is a very important tool for diagnosis and treatment selection for intracranial lesions.

Significant Risk Factors for Postoperative Enlargement of Basal Ganglia Hematoma after Frameless Stereotactic Aspiration: Antiplatelet Medication and Concomitant IVH

OBJECTIVE: Frameless stereotactic aspiration of a hematoma can be the one of the treatment options for spontaneous intracerebral hemorrhage in the basal ganglia. Postoperative hematoma enlargement, however, can be a serious complication of intracranial surgery that frequently results in severe neurological deficit and even death. Therefore, it is important to identify the risk factors of postoperative hematoma growth. METHODS: During a 13-year period, 101 patients underwent minimally invasive frameless stereotactic aspiration for basal ganglia hematoma. Patients were classified into two groups according to whether or not they had postoperative hematoma enlargement in a computed tomography scan. Baseline demographic data and several risk factors, such as hypertension, preoperative hematoma growth, antiplatelet medication, presence of concomitant intraventricular hemorrhage (IVH), were analysed via a univariate statistical study. RESULTS: Nine of 101 patients (8.9%) showed hematoma enlargement after frameless stereotactic aspiration. Among the various risk factors, concomitant IVH and antiplatelet medication were found to be significantly associated with postoperative enlargement of hematomas. CONCLUSION: In conclusion, our study revealed that aspirin use and concomitant IVH are factors associated with hematoma enlargement subsequent to frameless stereotactic aspiration for basal ganglia hematoma.

Stereotactic vacuum-assisted breast biopsy under lateral decubitus position

PURPOSE: Stereotactic vacuum-assisted breast biopsy (VAB) has been established as a standard method for histological diagnosis of microcalcification or nonpalpable breast lesions on mammography. Generally, the procedure has been done under the prone position or upright sitting position. We herein attempt to evaluate clinical utility of Stereotactic VAB under lateral decubitus position. METHODS: One hundred six women (mean age, 51.2 years) with mammographically detected microcalcification underwent lateral decubitus positioning VAB using the 8G probe. In all cases, we obtained mammography specimens for identification of microcalcification and postprocedure mammography. We reviewed mean procedure time, pieces of specimen, pathology and follow-up mammography. RESULTS: The procedure took approximately 20 minutes (range, 15-24 minutes). Average number of obtained specimens was 8.5 pieces (range, 6-12 pieces). Microcalcifications were confirmed in both specimen mammography and microscopic slides. Of 106 cases, 10 cases were diagnosed as ductal carcinoma in situ. Additional surgical management was performed. Atypical ductal hyperplasias were found in 8 cases, and fibrocystic changes in 88 cases. CONCLUSION: Stereotactic VAB using the 8G probe under lateral decubitus position does not need a dedicated table, and is easier to maintain the position. Also, this procedure is accurate and safe. Thus, stereotactic VAB using the 8G probe under lateral decubitus position will be a useful method for diagnosis of microcalcification or nonpalpable breast lesions on mammography.

Feasibility and Efficacy of Stereotactic Ablative Radiotherapy for Barcelona Clinic Liver Cancer-C Stage Hepatocellular Carcinoma

The purpose of this study was to assess the feasibility and efficacy of stereotactic ablative radiotherapy (SABR) for liver tumor in patients with Barcelona Clinic Liver Cancer (BCLC)-C stage hepatocellular carcinoma (HCC). We retrospectively reviewed the medical records of 35 patients between 2003 and 2011. Vascular invasion was diagnosed in 32 patients, extrahepatic metastases in 11 and both in 8. Thirty-two patients were categorized under Child-Pugh (CP) class A and 3 patients with CP class B. The median SABR dose was 45 Gy (range, 30-60 Gy) in 3-5 fractions. The median survival time was 14 months. The 1- and 3-yr overall survival (OS) rate was 52% and 21%, respectively. On univariate analysis, CP class A and biologically equivalent dose > or = 80 Gy10 were significant determinants of better OS. Severe toxicity above grade 3, requiring prompt therapeutic intervention, was observed in 5 patients. In conclusion, SABR for BCLC-C stage HCC showed 1-yr OS rate of 52% but treatment related toxicity was moderate. We suggest that patients with CP class A are the best candidate and at least SABR dose of 80 Gy10 is required for BCLC-C stage.

Lateral Decubitus Positioning Stereotactic Vacuum-Assisted Breast Biopsy with True Lateral Mammography / 한국유방암학회지

Stereotactic vacuum-assisted breast biopsy (VAB) has been used to evaluate microcalcifications or non-palpable breast lesions on mammography. Although stereotactic VAB is usually performed in a prone or upright position, an expensive prone table is necessary and vasovagal reactions often occur during the procedure. For these reasons, the lateral decubitus position can be applied for stereotactic VAB, and true lateral mammography can be used to detect the lesion. We report on 15 cases of lateral decubitus positioning for stereotactic VAB with true lateral mammography for non-palpable breast lesions or microcalcifications. The mean procedure time was approximately 30.1 minutes, and no complications occurred during the procedures. Fourteen cases had benign breast lesions and one case had a ductal carcinoma in situ. The lateral decubitus stereotactic VAB with true lateral mammography can be applied for microcalcifications or non-palpable breast lesions and helps to minimize anxiety and vasovagal reactions in patients.

Diagnosis and treatment of craniocerebral firearm wounds in peacetime / 中华创伤杂志

Objective To review the features of diagnosis and treatment of craniocerebral firearm wounds in peacetime. Methods A total of 86 cases with various kinds of firearm wounds were retrospectively analyzed for discussing the characteristics of diagnoses and treatment of firearm wounds so as to provide the best treatment methods for firearm wounds of the brain. Results Of all, 80 cases (93%) won full recovery and four (5%) partial recovery but two (2%) were died of massive vascular damage and severe cerebral injuries within 24 hours after operation. Conclusions Craniocerebral firearm wounds are among the most devastating causes for morbidity and mortality in the civilian population. It is important to remove all foreign bodies, especially broken bones and necrotic tissues, and turn the open injury to the close injury. Stereotactic technique, localization of foreign bodies, culture of foreign body bacteria, drug allergy test and correct use of antibiotic and antiepileptic drugs are also critical for eliminating mortality and complications of craniocerebral firearm wounds.

Directional, Vacuum-Assisted Stereotactic Biopsy of Nonpalpable Breast Lesions with Surgical Correlation

BACKGROUND: The vacuum suction probe is an alternative to the 14-gauge needle and automatic gun for performing stereotactic core needle biopsies. This study assesses the accuracy of the directional, vacuum-assisted stereotactic biopsy (DVAB) of nonpalpable breast lesions. Materials and METHODS: Four hundred and thirty DVABs were performed on 412 patients between January 1998 and December 2000. Using 11-gauge or 14-gauge needles, six to 22 core samples (mean=13) per lesion were obtained. One hundred and fifty-five lesions were subsequently excised, and 223 patients with benign diagnoses had mammographic follow-ups. The results of the DVABs and surgeries were reviewed and correlated. RESULTS: The results of the DVABs and surgeries were concordant in 98 of 113 cases and discordant in 15 cases, including 15 cases for which DVAB results indicated ductal carcinoma in situ (DCIS) but surgery yielded invasive carcinoma. The overall sensitivity, specificity, and positive and negative predictive values of the DVABs were 99.3%, 100%, 100%, and 99.7%, respectively. The positive predictive value for the presence of invasion was 100% and the negative predictive value was 81%. Histologic comparison was performed in 19 of 31 atypical ductal hyperplasias (ADHs) diagnosed with DVAB. Of the 19 ADHs, histologic findings showed DCIS in one, ADH in 9, atypical lobular hyperplasia in one, and no residual lesions in 8. Cases with less than 3 lobules were involved with ADH, or cases with more than 50% of microcalcification retrieved were all adequately diagnosed. Only 17 of 240 benign lesions diagnosed with DVAB were subsequently excised. These were confirmed to be ADH in three of the cases, and other benign diagnoses were confirmed in 14 of the cases. The others were confirmed to be benign lesions upon mammographic follow-up. Lesions less than 1.0 cm in maximal diameter can be removed completely by DVAB. CONCLUSION: DVAB reduced the number of underestimated infiltrating tumors, but still, significant cases were found to be invasive. ADH diagnosed with DVAB does not require subsequent surgery for a rule-out diagnosis of carcinoma, if the sampling is adequate and less than 3 lobules are involved with ADH. Lesions less than 1.0 cm in maximal diameter can be removed completely by DVAB. Benign lesions diagnosed with DVAB did not require subsequent surgery, so DVAB can reduce the probability of unnecessary surgery for benign lesions and/or small lesions.

THERAPEUTICS EFFECT OF INTRACTABLE SCHIZOPHRENIA BY LESIONING DIFFERENT SUBNUCLEUES OF AMYGDALA AND FRONT PART OF CALLOSAL GYRUS WITH STEREOTACTIC TECHNIQUE / 解放军医学杂志

To investigate feasibility and effect of schizophrenia treatment by stereotactic lesioning, CRW stereotactic apparatus and PICKER spiral CT were used to define nucleus location and RADONICS radiofrequency instruments were used to lesion different subnucleuses of amygdala and the front part of callosal gyrus. All schizophrenic patients were diagnosed by ICD Ⅲ standards, In cases with one year followup ,the effect were analysed with Global Improvement (GI) scoring. In this group , 21 cases were significantly improved , 8 cases improved, 3 cases slightly improved, 1 case unchanged, and 0 case deteriorated. These results suggest selective lesioning subnucleus of amygdala according to different symptoms of schizophrenia could improve the curative effect of surgical treatment for schizophrenia.

Application of stereotactic core needle biopsy in diagnosis of breast disease / 中华放射学杂志

Objective To evaluate the value of stereotactic core needle biopsy(SCNB)in diagnosis of breast lesions.Methods Forty-seven cases were punctured with computer-assisted stereotactic system, spring-loaded biopsy guns and 16 G core needles.The record of each item was collected,including clinical manifestations,descriptions of the mammographic characteristics(such as calcification,mass and architectural distortion),the pathology of the SCNB and the surgical pathology or mammographic follow-up data.Then the results of SCNB were analyzed based on the comparison of SCNB pathology and the surgical pathology.The reason that SCNB failed and misdioagnosed was inferred from the relationship of SCNB accuracy and the X-ray characteristics.Results Forty-four cases were punctured successfully,3 cases failed.Thirty-one patients were operated soon after biopsy.The results of 27 SCNB cases agreed well with the final pathology but the other 4 did not.Conclusions SCNB as an accurate,time-saving and cost- effective method,is also minimally invasive and hardly changes the architecture of the breast.SCNB can diagnose breast lesions in advance,reduces the number of surgical biopsy,and is promising in clinical application.