ABSTRACT
INTRODUCTION: To assess treatment outcome and prognostic factors associated with prolonged survival in patients with brain metastases (BM) treated with stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (HFSRT). METHODS/PATIENTS: This study retrospectively reviewed 200 patients with 324 BM treated with one fraction (15-21 Gy) or 5-10 fractions (25-40 Gy) between January 2010 and August 2016. 26.5% of patients received whole brain radiotherapy (WBRT) and 25% initial surgery. Demographics, prognostic scales, systemic and local controls, patterns of relapse and rescue, toxicity, and cause of death were analyzed. A stratified analysis by primary tumor was done. RESULTS: Median overall survival (OS) was 8 months from SRS/HFSRT. Breast cancer patients had a median OS of 17 months, followed by renal (11 months), lung (8 months), colorectal (5 months), and melanoma (4 months). The univariate analysis showed improved OS in females (p 0.004), RPA I-II (p < 0.001) initial surgery (p < 0.001), absence of extracranial disease (p 0.023), and good disease control (p 0.002). There were no differences in OS or local control between SRS and HFSRT or in patients receiving WBRT. Among 44% of brain recurrences, 11% were in field. 174 patients died, 10% from confirmed intracranial progression. CONCLUSIONS: SRS and HSFRT are equally effective and safe for the treatment of BM, with no exceptions among different primary tumors. Disease control, surgery, age, and prognostic scales correlated with OS. However, the lack of survival benefit regarding WBRT might become logical evidence for its omission in a subset of patients.
Subject(s)
Brain Neoplasms/radiotherapy , Brain Neoplasms/secondary , Radiation Dose Hypofractionation , Radiosurgery/methods , Adult , Aged , Aged, 80 and over , Brain Neoplasms/mortality , Cranial Irradiation , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Prognosis , Radiosurgery/adverse effects , Retrospective StudiesABSTRACT
Between January 1992 and December 1994, a prospective study was performed in two centres comparing chemical synovectomy using repeated weekly injections (range, 1-17) of Rifampicin (Group R) vs. radioactive synovectomy using 1-2 injections of Yttrium-90 (Group Y). The study was performed on 38 joints in a total of 35 haemophilic patients suffering from chronic haemophilic synovitis unresponsive to 3 months of conservative treatment (substitution therapy with the deficient coagulation factor plus a rehabilitation protocol). Group R included 18 patients with an average age of 9 years, with an average follow-up time of 25 months. In Group R, 19 joints were treated: nine knees, four elbows and six ankles. Group Y included 17 patients with an average age of 18 years, with an average follow-up time of 23 months. In Group Y, 19 joints were treated: 14 knees, two elbows and three ankles. The joints were evaluated according to the frequency of bleeding episodes and the Pettersson radiographic score. On the basis of the radiographic scale at the time of the synoviortheses, the joints were categorized as stage I (0 points), stage II (1-2 points), stage III (3-7 points), stage IV (8-10 points) and stage V (11-13 points). The overall results showed that in Group R, bleeding decreased in 12 joints, remained the same in six and worsened in one. In Group Y, bleeding decreased in 11 joints, remained the same in seven and worsened in one. In both Groups, bleeding was controlled best if joints were in stages I and II. In stages III, IV and V, synoviorthesis should not be carried out in haemophilia because it is not effective. Use of radioactive substances in persons under the age of 9 years has been discouraged in the past and therefore only Rifampicin was used in this age group. However, in patients over 9 years of age, this study showed similar decrease of bleeding in both treatment groups. Taking into account the advantages and disadvantages of both agents, we suggest the use of Rifampicin in elbows and ankles but prefer Yttrium-90 for the knees.
ABSTRACT
La reciente constatación de que el síndrome de inmunodeficiencia adquirida (SIDA) podría afectar en forma especial a homosexuales, drogadictos por vía intravenosa y hemofílicos motivó el inicio, en marzo de 1983, de un seguimiento clínico, inmunológico y microbiológico en 67 pacientes hemofílicos que reciben atención en la Unidad de Hemofilia de la Ciudad Sanitaria La Paz de Madrid. De ellos, 31 eran asintomáticos y 36 portadores de alguno de los signos o síntomas prodrómicos del SIDA. Los resultados obtenidos demostraron, em primer lugar, que un alto número de pacientes hemofílicos presentaban inversión del cociente de linfocitos T inductores/linfocitos T supresores sin que existiera una relación clara con la presencia de signos y síntomas asociados con el SIDA; en segundo lugar, la presencia de infecciones recientes y pasadas en proporciones similares en pacientes sintomáticos y asintomáticos, así como la mayor frecuencia de infecciones recientes por virus del grupo herpes en los hemofílicos con síntomas clínicos, y, en tercer lugar, que uno de los casos evolucionó hacia un cuadro compatible con SIDA. Estos resultados sugieren la existencia del riesgo de que los enfermos de hemofilia padezcan el SIDA, por lo debe mantenerse un control médico especial sobre ellos