ABSTRACT
PURPOSE: Neoadjuvant chemoradiation is an alternative to the surgery-first approach for resectable pancreatic cancer (PDA) and represents the standard of care for borderline resectable (BLR). MATERIALS AND METHODS: All patients with resectable and BLR PDA treated with neoadjuvant chemoradiation using IMRT between 1/2009 and 11/2011 were reviewed. Patients were treated to a customized CTV which included the primary mass and regional vessels. RESULTS: Neoadjuvant chemoradiation was completed in 69 patients (39 BLR and 30 resectable). Induction chemotherapy was used in 32 (82%) of the 39 patients with BLR disease prior to chemoXRT. All resectable patients were treated with chemoXRT alone. Following neoadjuvant treatment, 48 (70%) of the 69 patients underwent successful pancreatic resection with 47 (98%) being margin negative (RO). In 30 of the BLR patients who had arterial abutment or SMV occlusion, 19 (63%) were surgically resected and all had RO resections. The cumulative incidence of local failure at 1 and 2 years was 2% (95% CI 0-6%) and 9% (95% CI 0.6-17%) respectively. The median overall survival for all patients, patients undergoing resection, and patients without resection were 20, 26 and 11 months respectively. Sixteen (23%) of the 69 patients are alive without disease with a median follow-up of 47 months (36-60). CONCLUSION: Neoadjuvant chemoXRT can facilitate a margin negative resection in patients with localized PCa.
Subject(s)
Adenocarcinoma/therapy , Chemoradiotherapy, Adjuvant/methods , Pancreatic Neoplasms/therapy , Radiotherapy, Intensity-Modulated/methods , Adenocarcinoma/mortality , Adult , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemoradiotherapy, Adjuvant/adverse effects , Chemoradiotherapy, Adjuvant/mortality , Female , Humans , Male , Middle Aged , Neoadjuvant Therapy/adverse effects , Neoadjuvant Therapy/methods , Neoadjuvant Therapy/mortality , Pancreatic Neoplasms/mortality , Radiotherapy, Intensity-Modulated/adverse effects , Radiotherapy, Intensity-Modulated/mortality , Retrospective Studies , Treatment OutcomeABSTRACT
A woman in her early 60s with hypertension and hyperlipidemia was undergoing investigations for anemia of unknown etiology. She developed a sudden reduction in visual acuity and bilateral visual field impairment. MRI and angiography revealed acute infarcts in the posterior circulation and severe narrowing of the left vertebral artery origin. Digital subtraction angiography demonstrated a high-grade stenosis of the left vertebral artery origin with a thrombus just distal to the stenosis. The patient developed recurrent infarcts while on antithrombotic therapy. The lesion was successfully treated by vertebral artery origin angioplasty and stenting (VOAS) using a flow reversal technique and distal embolic protection. She was discharged to a rehabilitation facility 4 days later without worsening or new neurological deficits. A search of the literature yielded a similar report managed with anticoagulation and subsequent VOAS after complete lysis of the thrombus. Our report highlights the technique, safety and feasibility of VOAS in the presence of a thrombus using a flow reversal technique and distal protection.
Subject(s)
Endovascular Procedures , Thrombosis/diagnosis , Thrombosis/surgery , Vertebrobasilar Insufficiency/diagnosis , Vertebrobasilar Insufficiency/surgery , Acute Disease , Disease Management , Endovascular Procedures/methods , Female , Humans , Middle Aged , Thrombosis/complications , Vertebrobasilar Insufficiency/complicationsABSTRACT
PURPOSE: Our study evaluated techniques for percutaneous gastrostomy (G)-tube placement without the use of a nasogastric (NG) tube. Instead, direct puncture of a physiologic air bubble or effervescent-enhanced gastric bubble distention was performed in patients with upper digestive tract obstruction (UDTO) or psychological objections to NG tubes. MATERIALS AND METHODS: A total of 886 patients underwent G-tube placement in our department during a period of 7 years. We present our series of 85 (9.6%) consecutive patients who underwent percutaneous G-tube placement without use of an NG tube. RESULTS: Of these 85 patients, fluoroscopic guided access was attempted by direct puncture of a physiologically present gastric air bubble in 24 (28%) cases. Puncture of an effervescent-induced large gastric air bubble was performed in 61 (72%) patients. Altogether, 82 (97%) of 85 G tubes were successfully placed in this fashion. The three failures comprised refusal of effervescent, vomiting of effervescent, and one initial tube misplacement when a deviation from our standard technique occurred. CONCLUSION: The described techniques compare favorably with published large series on G-tube placement with an NG tube in place. The techniques are especially suited for patients with UDTO due to head, neck, or esophageal malignancies, but they should be considered as an alternative in all patients. Direct puncture of effervescent-enhanced gastric bubble distention is a safe, patient-friendly and effective technique.
Subject(s)
Gastrostomy/methods , Adult , Aged , Aged, 80 and over , Angiography , Barium Sulfate/administration & dosage , Contrast Media/administration & dosage , Female , Fluoroscopy , Humans , Male , Middle Aged , Punctures , Radiography, Interventional , Retrospective Studies , Treatment OutcomeABSTRACT
Three-dimensional holograms were recorded in a cerium-doped, strontium barium niobate (SBN:75) photorefractive crystal. These holograms are shown to not degrade after more than one week of continuous readout and to reconstruct reproductions of the original object with an observable field of view of approximately 35 degrees.
