Gamma Knife Radiosurgery for Cavernous Malformations of Basal Ganglia and Thalamus: A Retrospective Study of 53 Patients.

INTRODUCTION: Gamma Knife radiosurgery (GKRS) has been used to treat cavernous malformations (CMs) located in basal ganglia and thalamus. However, previous reports are limited by small patient population. METHODS: We retrospectively reviewed the clinical and radiological data of 53 patients with CMs of basal ganglia and thalamus who underwent GKRS at West China Hospital between May 2009 and July 2018. All patients suffered at least once bleeding before GKRS. The mean volume of these lesions was 1.77 cm3, and the mean marginal dose was 13.2 Gy. After treatment, patients were followed to determine the change in symptom and hemorrhage event. RESULTS: The mean follow-up period was 52.1 months (6.2-104.3 months). The calculated annual hemorrhage rate (AHR) was 48.5% prior to GKRS and 3.0% after treatment (p < 0.001). The Kaplan-Meier analysis revealed that 2-, 3-, and 5-year hemorrhage-free survival were 88, 80.9, and 80.9%, respectively. Preexisting symptoms were resolved in 11 patients, improved in 14, and stable in 5. Only 2 patients (3.8%) developed new neurological deficit. CONCLUSION: Our study suggests that AHR after GKRS was comparable to the recorded AHR of natural history (3.1-4.1%) in previous studies. GKRS is a safe and effective treatment modality for CMs of basal ganglia and thalamus. Considering the relative insufficient understanding of natural history of CMs, future study warrants longer follow-up.

Comparison of clinical outcomes in patients who underwent Gamma Knife radiosurgery for parasellar meningiomas with or without prior surgery.

BACKGROUND: Parasellar meningioma is a common benign tumour in brain. Both surgery and radiosurgery are important treatment modalities for this tumour. The study was designed to investigate whether prior surgery would affect treatment outcomes of patients with parasellar meningiomas after management with Gamma Knife radiosurgery. METHODS: A total of 93 patients who received Gamma Knife surgery were included in this retrospective study. There were 30 males and 63 females, with a median age of 48.6 years (range, 15.2-78.7 years). Prior surgery was performed in 45 patients. The median tumor volume was 5.02 cm3 (range 1.07-35.46 cm3) and median marginal dose was 12 Gy (range 10-15 Gy). The mean imaging follow-up and clinical follow-up periods were 40.7 and 52.7 months, respectively. RESULTS: In the group without prior surgery, 31 patients had improvement of preexisting symptoms; and in the group with prior surgery, 20 patients were noted to improve. The difference in symptom improvement between the two groups reached statistical significance (P = 0.009). Patients with prior surgery were more likely to have stable symptoms after Gamma Knife surgery (P = 0.012). Tumor recurrence was reported in 8 patients out of 45 patients with prior surgery, and 3 patients out of 48 patents without prior surgery (P = 0.085). After Gamma Knife surgery, 5 and 4 patients in two groups developed new neurological symptoms, respectively (P = 0.651). Cox regression analysis identified follow-up period as prognostic factor of progression-free survival. Ordinal logistic regression analysis identified surgery prior to Gamma Knife surgery as an unfavorable factor of symptom change. CONCLUSION: Gamma Knife radiosurgery provided long-term effective tumor control and better symptom recovery compared with those with prior surgery. Patients with surgery before Gamma Knife radiosurgery were more likely to have stable symptoms. Further analyses indicated that long follow-up is essential to determine the efficacy of radiosurgery for parasellar meningiomas. Further study needs to include more patients with longer follow-up to draw a more solid conclusion.

Efficacy and Safety of Hypofractionated Stereotactic Radiotherapy for Recurrent Malignant Gliomas: A Systematic Review and Meta-analysis.

BACKGROUND: The current treatment for patients with relapsed malignant glioma (MG) remains unsatisfactory. Use of hypofractionated stereotactic radiotherapy (HFSRT) for recurrent MG has shown some encouraging results and may be a viable option. METHODS: We performed a systematic review and meta-analysis of articles that investigated the use of HFSRT for recurrent MG. Relevant studies were obtained through searching PubMed, Embase, and the Cochrane Library. Data about treatment regimens, median overall survival, and radiation necrosis (RN), as well as other major neurologic complications were extracted. We performed a descriptive analysis of the median overall survival and meta-analysis of the reported rates of RN and other major neurologic complications (MNCs). RESULTS: A total of 26 studies were included in our study, comprising 861 patients. Median overall survival ranged from 8.6 to 18 months. A total of 19 studies were included to perform a meta-analysis of the RN rate and the pooled RN rate was 5% (3%-7%). The pooled rate of other MNCs was 2% (1%-4%), calculated from 20 studies. CONCLUSIONS: The present evidence suggests that HFSRT is an efficacious and safe treatment approach to treat patients with recurrent MG. However, the retrospective and observational nature of the studies included in our systematic review and meta-analysis restricted formation of more solid conclusions. Thus, well-designed prospective controlled trials are warranted to further define the therapeutic role of HFSRT for recurrent MG.

[Anterolateral thigh flap for reconstruction of defects after en bloc resection of buccal cancer : a retrospective study of 23 cases].

PURPOSE: This study was aimed to observe the effects of anterolateral thigh flap for reconstruction of tissue defects after en bloc resection of buccal cancer. METHODS: Twenty-three patients with soft tissue defects after en bloc resection of buccal cancer underwent simultaneous reconstruction with anterolateral thigh flap from May, 2013 to May, 2015 were observed. Anterolateral thigh flaps were designed and harvested in form of single or multiple islands to restore the defect in buccal region after surgery. The appearance and function of both the oral and maxillofacial region and the donor site were recorded and evaluated. RESULTS: All the 23 flaps survived. Only 3 of them experienced vascular crisis within 24 hours after surgery, and recovered gradually after salvage. The success rate was 100%. One to three years of follow-up showed satisfying morphology and function for both the receipt sites and the donor sites. Buccal abscess was observed in 1 patient and recovered after rinsing and drainage. Two patients died of recurrence. CONCLUSIONS: Good effects can be achieved using anterolateral thigh flap to reconstruct buccal defects after en bloc resection of cancer, which is suitable for application in clinical practice.

Trend Analysis of Betel Nut-associated Oral Cancer and Health Burden in China.

OBJECTIVE: To forecast the future trend of betel nut-associated oral cancer and the resulting burden on health based on historical oral cancer patient data in Hunan province, China. METHODS: Oral cancer patient data in five hospitals in Changsha (the capital city of Hunan province) were collected for the past 12 years. Three methods were used to analyse the data; Microsoft Excel Forecast Sheet, Excel Trendline, and the Logistic growth model. A combination of these three methods was used to forecast the future trend of betel nut-associated oral cancer and the resulting burden on health. RESULTS: Betel nut-associated oral cancer cases have been increasing rapidly in the past 12 years in Changsha. As of 2016, betel nuts had caused 8,222 cases of oral cancer in Changsha and close to 25,000 cases in Hunan, resulting in about ¥5 billion in accumulated financial loss. The combined trend analysis predicts that by 2030, betel nuts will cause more than 100,000 cases of oral cancer in Changsha and more than 300,000 cases in Hunan, and more than ¥64 billion in accumulated financial loss in medical expenses. CONCLUSION: The trend analysis of oral cancer patient data predicts that the growing betel nut industry in Hunan province will cause a humanitarian catastrophe with massive loss of human life and national resources. To prevent this catastrophe, China should ban betel nuts and provide early oral cancer screening for betel nut consumers as soon as possible.

[A retrospective study of oral squamous cell carcinomas originated from oral submucous fibrosis].

OBJECTIVE: To investigate the clinical characteristics, pathological and biological behaviors of oral squamous cell carcinomas (OSCC) originated from oral submucous fibrosis (OSF). METHODS: A total of 528 patients with OSCC treated at Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University from 2002 to 2010 were divided into two groups, OSCC originated from OSF and OSCC not originated from OSF. The clinical data regarding age, gender, location, pathological type, metastasis and recurrence rate of these patients were analyzed retrospectively. RESULTS: The mean age of the group of OSCC originated from OSF (45.8 years) was younger than that of the group of OSCC not originated from OSF (55.9 years). The male female ratio of the group of OSCC originated from OSF (32.3:1) was higher than that of the group of OSCC not originated from OSF (2.3:1). The metastasis and recurrence rate of the group of OSCC originated from OSF (13.5%, 39.1%) was higher than that of the group of OSCC not originated from OSF (7.6%, 27.8%.). CONCLUSIONS: OSCC originated from OSF occurs at younger age and more in male, and is clinically more invasive and metastatic.

[Application of bioinformatics tools in analysis of differentially expressed genes in oral submucosal fibrosis].

OBJECTIVE: To apply the bioinformatics tools for analyzing the differentially expressed genes in oral submucous fibrosis (OSF) to obtain the implied biological significance. METHODS: By using DAVID and Onto-express bioinformatic tools, 865 differentially expressed genes in OSF were analyzed and the analysis of chromosome location, gene ontology (GO) and genetic-association diseases were performed. RESULTS: A majority of the differentially expressed genes were located on chromosome 1,2,5,6,7,11,12 (P < 0.01). GO classification of the differentially expressed genes identified the biological process subgroups, including genes involved in immune response, defense response and so on. The cellular component subgroups were associated with extracellular matrix, cytoskeleton and membrane, molecular function subgroups related to protein binding, extracellular matrix structural constituent and signal transducer activity. The diseases genetically associated with these genes included infection, immune and cardiovascular diseases. CONCLUSIONS: Bioinformatics can provide the quick and parallel analysis of massive data got from gene microarrays and enable the function classification of the differentially expressed genes, which provides new ideas on the research of pathogenesis and epidemiology of OSF.