ABSTRACT
BACKGROUND AND AIM: The role of stereotactic body radiation therapy (SBRT) in the management of liver metastasis is increasing, using ablative doses with the goal of local control and ultimately improving survival. The aim of this study is to evaluate our initial results regarding local control, overall survival and toxicity in patients with liver metastases treated with this technique, due to the lack of evidence reported in Latin America. MATERIALS/METHODS: We performed a retrospective chart review from November 2012 to June 2018 of 24 patients with 32 liver metastases. Kaplan-Meier curves were constructed for local control and overall survival. Clinical and prognostic factors were further analyzed by independent analysis. Median follow-up period was 22 months (range, 1-65 months). RESULTS: Median age was 62 years (range, 40-84 years). Colorectal carcinoma was the most common primary cancer. Overall 1-year and 2-years local control rates were 82% (95% Confidence Interval [CI], 70-98%) and 76.2% (95% CI, 45-90%), respectively. Median overall survival rate was 35 months (95%, CI 20.5-48 months). Overall 1-year and 2-year survival rates were 85.83% (95% CI, 64-99%) and 68% (95% CI, 45-84%), respectively. No acute or late grade 3 or 4 toxicity was observed during the follow-up period. CONCLUSIONS: SBRT achieves excellent local control and overall survival rates with low toxicity in patients with liver metastases. Based on our literature review, our results are consistent with larger reports. Further randomized trials are required to compare with other local therapies.
ABSTRACT
PURPOSE: Catheter ablation is an effective therapy for atrial fibrillation (AF). However, risks remain, and improved efficacy is desired. Stereotactic body radiotherapy (SBRT) is a well-established therapy used to noninvasively treat malignancies and functional disorders with precision. We evaluated the feasibility of stereotactic radioablation for treating paroxysmal AF. METHODS: Two patients with drug-refractory paroxysmal AF underwent pulmonary vein isolation with SBRT. After placement of a percutaneous active fixation temporary pacing lead tracking fiducial, computed tomography (CT) angiography was performed to define left atrial anatomy. A tailored planning treatment volume was created to deliver contiguous linear ablations to isolate the pulmonary veins and posterior wall. Patients were treated on an outpatient basis in the radioablation suite. Clinical follow-up was performed through at least 24 months after therapy. RESULTS: Both patients successfully underwent SBRT planning and treatment without significant early or long-term side effects up to 48 months of follow-up. One patient had AF recurrence after 6 months free of arrhythmia, while the second patient remains free of AF after 24 months with fibrosis detected on MRI scan consistent with the ablation lesion set. An incidentally noted small pericardial effusion occurred in one patient. CONCLUSION: Stereotactic radioablation may be feasible for the treatment of drug-refractory AF. Further evaluation is warranted.
ABSTRACT
BACKGROUND AND AIM: Stereotactic radiosurgery is increasingly being employed for the treatment of brain metastases, both as an adjuvant to surgical resection, and also as a primary treatment modality. The aim of this study is to evaluate overall survival and local control in patients with brain metastases treated with CyberKnife Stereotactic Radiosurgery (CKRS), due to the lack of evidence reported in Latin America. MATERIALS AND METHODS: We performed a retrospective chart review from October 2011 to January 2017 of 49 patients with 152 brain metastases. Clinical and prognostic factors were further analyzed by independent analysis. Kaplan-Meier curves were constructed for overall survival and local control. The median follow-up period was 12 months (range, 1-37 months). RESULTS: The median age was 61 years (range, 27-85 years) and Karnofsky performance status >70 in 96% of the patients. The median overall survival rate was 15.5 months (95% confidence interval [CI], 10.23-24.3 months). Overall 3-month, 6-month and 1-year local control rates were 98% (95% CI, 85-99%), 96% (95% CI, 82-99%), and 90% (94% IC, 76-96%), respectively. Local failure (LF) was observed in 6 patients (18 lesions). No late complications, such as radiation necrosis, were observed during the follow-up period. CONCLUSIONS: CKRS achieves excellent overall survival and local control rates with low toxicity in patients with brain metastases.
ABSTRACT
Giant cell tumours (GCT) of the skull is a rare entity with only small number of cases reported in literature and optimal treatment is yet to be determined. These tumours have shown high recurrence rates after incomplete surgery, usually occurring during the first year. Even with new surgical techniques a complete resection in skull base tumours is not always possible without functional compromise. Therefore, adjuvant therapy is essential to enhance local control and quality of life. We report a rare case of a 34-year-old male with giant cell tumour (GCT) of the skull base involving the petrous bone, clivus and sphenoid body. The patient received Cyberknife stereotactic radiosurgery (CK SRS) and denosumab after surgery. This combined therapy allowed local control and tumour reduction with secondary neurological improvement during a 4-year follow up.
ABSTRACT
Pulmonary vein isolation using robotic radiosurgery system CyberKnife is a new non-invasive treatment of atrial fibrillation, currently in clinical phase. Robotic radiosurgical pulmonary vein isolation (RRPVI) uses stereotactic, non-invasive (painless) pinpoint radiation energy delivery to a small, precise area to accomplish ablation. The purpose of this report is to describe the finding of an increase in the enhancement of the left atrium demonstrated with the use of cardiac magnetic resonance imaging using late gadolinium enhancement (LGE-CMR) as a result of RRPVI in the first case in the world in humans using CyberKnife as a treatment for paroxysmal atrial fibrillation (PAF).
