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1.
World Neurosurg ; 139: 242-244, 2020 07.
Article in English | MEDLINE | ID: mdl-32330619

ABSTRACT

BACKGROUND: Some petroclival meningiomas cause trigeminal nerve compression, leading to disabling trigeminal neuralgia (TN). Tumor resection and nerve decompression can offer pain relief but might not be feasible in all patients. Simultaneous stereotactic radiosurgery (SRS) to the tumor and nerve is another option. SRS is an effective means of treating meningiomas and TN separately, but data on the efficacy and outcomes of their concomitant treatment are limited. CASE DESCRIPTION: We report a series of 4 patients who presented with TN secondary to a petroclival mass causing compression of the trigeminal nerve. All patients underwent SRS to both the petroclival mass and trigeminal nerve in a single session. The average margin tumor dose was 12.25 Gy (range, 12-12.5 Gy), and the average maximum trigeminal nerve dose was 80 Gy (range, 75-85 Gy). In all patients, before intervention, the Barrow Neurologic Institute (BNI) pain intensity score was grade IV or V. At last follow-up (average, 29.8 months), all patients were pain-free (BNI I or IIIA). Two patients experienced reduced facial sensation in 1 or all 3 distributions. No brainstem edema was seen. CONCLUSIONS: This series highlights the benefits and safety of simultaneous treatment of petroclival tumors and the trigeminal nerve in a single session for patients affected by tumor-related TN.


Subject(s)
Meningeal Neoplasms/complications , Meningioma/complications , Radiosurgery/methods , Trigeminal Nerve/radiation effects , Trigeminal Neuralgia/radiotherapy , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Nerve Compression Syndromes/etiology , Nerve Compression Syndromes/radiotherapy , Pain Management/methods , Trigeminal Neuralgia/etiology
2.
Ophthalmic Plast Reconstr Surg ; 34(2): 172-177, 2018.
Article in English | MEDLINE | ID: mdl-29517594

ABSTRACT

PURPOSE: To evaluate the effectiveness of orbital radiotherapy (ORT) in the treatment of thyroid eye disease (TED)-compressive optic neuropathy. METHODS: A retrospective review of patients with corticosteroid-responsive compressive optic neuropathy due to TED treated with ORT. Study was conducted in compliance with Health Insurance Portability and Accountability Act. One hundred four patients (163 orbits) with a mean age of 61.7 years met inclusion criteria. Seventy-four percent (77/104) were female, and 32.7% (34/104) were current or previous smokers. A total absorbed dose of 2000 cGy fractionated in 10 treatment doses over the course of 2 weeks was administered to the retroocular tissues according to a standard protocol. The primary end point was failure of ORT, defined as persistent optic neuropathy following completion of radiotherapy that mandated urgent orbital decompression surgery. RESULTS: Ninety-eight of 104 (94%) patients or 152 of 163 (93.3%) orbits did not require orbital decompression surgery during the acute phase. Patients who responded successfully to ORT had similar improvements in visual acuity, color vision, Humphrey threshold visual field testing, and afferent pupillary defects compared with patients who failed ORT and underwent urgent decompression surgery. Only 36.7% of successfully treated patients ultimately underwent elective surgery, including orbital decompression, strabismus, or eyelid surgery, during the inactive phase of TED. CONCLUSIONS: The data from this study, the largest retrospective review reported to date, supports the use of ORT in eyes with corticosteroid-responsive TED-compressive optic neuropathy. ORT may favorably alter the natural history of active-phase TED by preventing recurrent compressive optic neuropathy after withdrawal of corticosteroids.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , Graves Ophthalmopathy , Nerve Compression Syndromes , Optic Nerve Diseases , Adult , Aged , Color Vision/physiology , Combined Modality Therapy , Female , Graves Ophthalmopathy/drug therapy , Graves Ophthalmopathy/physiopathology , Graves Ophthalmopathy/radiotherapy , Humans , Male , Middle Aged , Nerve Compression Syndromes/drug therapy , Nerve Compression Syndromes/radiotherapy , Optic Nerve Diseases/drug therapy , Optic Nerve Diseases/physiopathology , Optic Nerve Diseases/radiotherapy , Retrospective Studies , Visual Acuity/physiology
3.
PLoS One ; 9(3): e89894, 2014.
Article in English | MEDLINE | ID: mdl-24594641

ABSTRACT

Dorsal root ganglia (DRG) are vulnerable to physical injury of the intervertebral foramen, and chronic compression of the DRG (CCD) an result in nerve root damage with persistent morbidity. The purpose of this study was to evaluate the effects of low level laser therapy (LLLT) on the DRG in a CCD model and to determine the mechanisms underlying these effects. CCD rats had L-shaped stainless-steel rods inserted into the fourth and fifth lumbar intervertebral foramen, and the rats were then subjected to 0 or 8 J/cm2 LLLT for 8 consecutive days following CCD surgery. Pain and heat stimuli were applied to test for hyperalgesia following CCD. The levels of TNF-α, IL-1ß and growth-associated protein-43 (GAP-43) messenger RNA (mRNA) expression were measured via real-time PCR, and protein expression levels were analyzed through immunohistochemical analyses. Our data indicate that LLLT significantly decreased the tolerable sensitivity to pain and heat stimuli in the CCD groups. The expression levels of the pro-inflammatory cytokines TNF-α and IL-1ß were increased following CCD, and we found that these increases could be reduced by the application of LLLT. Furthermore, the expression of GAP-43 was enhanced by LLLT. In conclusion, LLLT was able to enhance neural regeneration in rats following CCD and improve rat ambulatory behavior. The therapeutic effects of LLLT on the DRG during CCD may be exerted through suppression of the inflammatory response and induction of neuronal repair genes. These results suggest potential clinical applications for LLLT in the treatment of compression-induced neuronal disorders.


Subject(s)
Ganglia, Spinal/pathology , Low-Level Light Therapy , Nerve Compression Syndromes/radiotherapy , Animals , Disease Models, Animal , GAP-43 Protein/metabolism , Ganglia, Spinal/diagnostic imaging , Gene Expression Regulation , Hyperalgesia/etiology , Hyperalgesia/radiotherapy , Inflammation Mediators/metabolism , Male , Nerve Compression Syndromes/complications , Nerve Compression Syndromes/diagnostic imaging , Nerve Compression Syndromes/genetics , RNA, Messenger/genetics , RNA, Messenger/metabolism , Radiography , Rats, Sprague-Dawley , Tumor Necrosis Factor-alpha/genetics , Tumor Necrosis Factor-alpha/metabolism
4.
Neurochirurgie ; 53(1): 23-31, 2007 Feb.
Article in French | MEDLINE | ID: mdl-17337013

ABSTRACT

BACKGROUND AND PURPOSE: Several selective approaches have been recommended for access to the petroclival region (PCR). However, locoregional extension of the tumor may necessitate more extensive procedures. Dissections from injected specimens allowed us to describe the different osteodural triangles that are exposed to provide an extensive access to the PCR. METHOD: The bony step included a temporopterional flap and exposure of the paraclinoid carotid after removal of the anterior clinoid process. The sphenoid wing was then extensively drilled, exposing the foramen rotundum and ovale. An anterior petrosectomy was subsequently performed. The dura propria of the cavernous sinus was elevated as far as the Meckel cave. The sylvian fissure was also opened. Then, the temporobasal dura and the dura from the posterior surface of the petrous bone were opened and the superior petrosal sinus was coagulated and divided. The tentorium was divided toward its free edge. RESULTS: Via this approach, cranial nerves from the olfactory tract to the acousticofacial bundle are exposed. In the same way, the ventral and lateral surface of the pons is identified. CONCLUSION: The epidural temporopolar transcavernous transpetrous approach is useful to expose during the same procedure, elements of the posterior and middle cranial fossa. It is of particular value when managing tumors simultaneously involving the PCR, the parasellar, and the suprasellar regions.


Subject(s)
Cavernous Sinus/surgery , Chordoma/surgery , Cranial Fossa, Posterior/surgery , Petrous Bone/surgery , Skull Neoplasms/surgery , Temporal Bone/surgery , Adult , Cavernous Sinus/pathology , Chordoma/diagnosis , Chordoma/radiotherapy , Combined Modality Therapy , Cranial Fossa, Posterior/pathology , Disease Progression , Dura Mater/pathology , Dura Mater/surgery , Humans , Male , Neoplasm Invasiveness/pathology , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/radiotherapy , Neoplasm Recurrence, Local/surgery , Neoplasm, Residual/diagnosis , Nerve Compression Syndromes/diagnosis , Nerve Compression Syndromes/radiotherapy , Nerve Compression Syndromes/surgery , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/radiotherapy , Optic Nerve Diseases/surgery , Petrous Bone/pathology , Postoperative Complications/diagnosis , Radiotherapy, Adjuvant , Reoperation , Skull Neoplasms/diagnosis , Skull Neoplasms/radiotherapy , Temporal Bone/pathology
5.
Clin Neurol Neurosurg ; 108(8): 806-8, 2006 Dec.
Article in English | MEDLINE | ID: mdl-16530323

ABSTRACT

Trigeminal neuralgia (TN) is often secondary to an underlying structural cause, frequently compression of the fifth nerve root by an ectatic artery. Here we describe a case of a 36-year-old woman with symptoms of TN who was found to have severe communicating hydrocephalus. Further investigation revealed a lumbar myxopapillary ependymoma, which in turn was responsible for the communicating hydrocephalus. An argument connecting these seemingly disparate findings is made. This unusual set of circumstances is an example of "action at a distance" in the nervous system, and reminds clinicians to think broadly about the various pathophysiologic mechanisms that can potentially underlie common disorders.


Subject(s)
Ependymoma/complications , Hydrocephalus/complications , Lumbar Vertebrae , Nerve Compression Syndromes/etiology , Spinal Neoplasms/complications , Trigeminal Neuralgia/etiology , Adult , Cerebral Ventricles/pathology , Diagnosis, Differential , Ependymoma/diagnosis , Ependymoma/radiotherapy , Ependymoma/surgery , Female , Humans , Hydrocephalus/diagnosis , Hydrocephalus/etiology , Hydrocephalus/surgery , Laminectomy , Lumbar Vertebrae/surgery , Magnetic Resonance Imaging , Nerve Compression Syndromes/diagnosis , Nerve Compression Syndromes/radiotherapy , Nerve Compression Syndromes/surgery , Radiotherapy, Adjuvant , Spinal Neoplasms/diagnosis , Spinal Neoplasms/radiotherapy , Spinal Neoplasms/surgery , Subarachnoid Space/pathology , Trigeminal Neuralgia/diagnosis , Ventriculoperitoneal Shunt
6.
Neurol Med Chir (Tokyo) ; 44(1): 47-52, 2004 Jan.
Article in English | MEDLINE | ID: mdl-14959938

ABSTRACT

A 63-year-old man presented with rapidly progressive visual field deficit and hypopituitarism including diabetes insipidus, 8 years after treatment for a renal cell carcinoma. Neuroimaging studies revealed a dumbbell-shaped pituitary mass that had destroyed the sellar floor and abutted against the optic apparatus. Fractionated stereotactic radiotherapy (SRT), employing computer-image integration techniques and a frame that could be relocated to facilitate a fractionated dosing scheme, was carried out under a plan for reducing the treatment risk to the optic apparatus. Three months later, the patient exhibited marked improvement in the visual field deficit and visual acuity concomitant with a reduction in tumor volume. Magnetic resonance imaging of the sellar region confirmed striking shrinkage of the metastasis. His neurological status remained stable at 12 months after the SRT with no complications. Fractionated SRT appears to be effective for preserving or improving the residual vision in patients with visual loss secondary to metastatic tumor of the pituitary gland, and may result in a longer and better quality of life.


Subject(s)
Carcinoma, Renal Cell/secondary , Dose Fractionation, Radiation , Kidney Neoplasms/radiotherapy , Pituitary Neoplasms/secondary , Radiotherapy Planning, Computer-Assisted , Bone Neoplasms/secondary , Carcinoma, Renal Cell/diagnosis , Carcinoma, Renal Cell/radiotherapy , Disease Progression , Humans , Kidney Neoplasms/diagnosis , Magnetic Resonance Imaging , Male , Middle Aged , Nerve Compression Syndromes/diagnosis , Nerve Compression Syndromes/radiotherapy , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/radiotherapy , Pituitary Neoplasms/diagnosis , Pituitary Neoplasms/radiotherapy , Radiotherapy Dosage , Stereotaxic Techniques , Visual Fields/physiology
7.
Radiat Med ; 21(4): 145-9, 2003.
Article in English | MEDLINE | ID: mdl-14514119

ABSTRACT

OBJECTIVE: Secondary prostate cancer affection of the cauda equina (SPCCE) can be an ultimate cause of morbidity and mortality. Since the results of management of this particular disease condition remain largely unknown, a retrospective case review was undertaken to determine the effects of treatment by radiation in SPCCE patients. METHODS: The records of 12 patients with SPCCE treated at the Division of Therapeutic Radiology during the period 1984 to 1998 were reviewed. The administered total radiation dosage ranged from 6 Gy to 32 Gy (average, 26.6 +/- 2.0 Gy). Two individuals underwent decompressive laminectomy and bilateral orchiectomy at the time of SPCCE and prostate cancer diagnoses. Ten patients had prior hormonal manipulative treatment (orchiectomy, estrogen, or Flutamide therapy). RESULTS: Pain was relieved in three of four symptomatic patients (75%). Five of nine patients unable to walk before therapy could walk after treatment. One of two individuals with anal or bladder sphincter dysfunction improved following irradiation. The overall mean duration of survival was five months. With treatment, survival was approximately three times as long for ambulatory versus non-ambulatory patients. CONCLUSION: We conclude that radiation treatment is efficacious in promoting palliation of SPCCE, although it may not prolong life.


Subject(s)
Cauda Equina , Nerve Compression Syndromes/radiotherapy , Palliative Care , Prostatic Neoplasms/pathology , Radiotherapy, High-Energy , Aged , Humans , Male , Nerve Compression Syndromes/etiology , Paraplegia/etiology , Paraplegia/radiotherapy , Radiotherapy Dosage , Retrospective Studies
8.
Radiother Oncol ; 67(2): 207-12, 2003 May.
Article in English | MEDLINE | ID: mdl-12812852

ABSTRACT

BACKGROUND AND PURPOSE: Trans-Tasman Radiation Oncology Group 96.05 is a prospective randomized controlled trial comparing a single 8 Gy with 20 Gy in five fractions of radiotherapy (RT) for neuropathic pain due to bone metastases. This paper summarizes the quality assurance (QA) activities for the first 234 patients (accrual target 270). MATERIALS AND METHODS: Independent audits to assess compliance with eligibility/exclusion criteria and appropriateness of treatment of the index site were conducted after each cohort of approximately 45 consecutive patients. Reported serious adverse events (SAEs) in the form of cord/cauda equina compression or pathological fracture developing at the index site were investigated and presented in batches to the Independent Data Monitoring Committee. Finally, source data verification of the RT prescription page and treatment records was undertaken for each of the first 234 patients to assess compliance with the protocol. RESULTS: Only one patient was found conclusively not to have genuine neuropathic pain, and there were no detected 'geographical misses' with RT fields. The overall rate of detected infringements for other eligibility criteria over five audits (225 patients) was 8% with a dramatic improvement after the first audit. There has at no stage been a statistically significant difference in SAEs by randomization arm. There was a 22% rate of RT protocol variations involving ten of the 14 contributing centres, although the rate of major dose violations (more than +/-10% from protocol dose) was only 6% with no statistically significant difference by randomization arm (P=0.44). CONCLUSIONS: QA auditing is an essential but time-consuming component of RT trials, including those assessing palliative endpoints. Our experience confirms that all aspects should commence soon after study activation.


Subject(s)
Bone Neoplasms/radiotherapy , Medical Audit/standards , Pain/radiotherapy , Quality Assurance, Health Care , Radiotherapy, Conformal/standards , Bone Neoplasms/complications , Bone Neoplasms/secondary , Humans , Nerve Compression Syndromes/complications , Nerve Compression Syndromes/radiotherapy , Pain/etiology
9.
Arthroscopy ; 19(5): 554-7, 2003.
Article in English | MEDLINE | ID: mdl-12724687

ABSTRACT

We developed a minimally invasive technique of releasing the piriformis muscle under endoscopic control for entrapment neuropathy of the sciatic nerve because of tension and contraction of the piriformis muscle. This surgical technique was performed in patients who fulfilled at least 5 of 9 diagnostic criteria we established and who did not respond to conservative therapy for 6 months or more. Although a cavity was maintained using a disposable syringe (10 mL) with a cut tip, an arthroscope (4 mm in diameter) was inserted at an oblique viewing angle of 30 degrees, and the muscle was identified. The area from the musculotendinous junction to the muscle was gradually incised using a special scraper. In particular, pain disappeared simultaneously with release of the piriformis muscle during surgery. With this technique, an adequate cavity can be produced and maintained in a manner similar to that in posterior endoscopic surgery for intervertebral disc herniation. This technique is useful for reducing postoperative pain and allows early return to activity.


Subject(s)
Arthroscopy/methods , Decompression, Surgical/methods , Hip Joint/surgery , Muscle, Skeletal/surgery , Nerve Compression Syndromes/surgery , Sciatic Neuropathy/surgery , Anesthesia, Local , Humans , Lidocaine , Minimally Invasive Surgical Procedures , Muscle Contraction , Nerve Compression Syndromes/radiotherapy , Sciatic Neuropathy/radiotherapy , Sciatica/etiology , Sciatica/surgery , Treatment Outcome
12.
J Pain Symptom Manage ; 19(4): 257-64, 2000 Apr.
Article in English | MEDLINE | ID: mdl-10799792

ABSTRACT

One hundred sixty-six patients presented to a cancer center with malignant spinal cord compression (SCC) proven by magnetic resonance imaging (MRI). The majority of patients (92%) were treated with radiotherapy. Changes in functional capability over time were assessed using performance (PS) and neurological status (NS). Over the course of treatment, there was no significant change in PS or NS. The median survival from confirmation of SCC was 82 days (range 1-1349 days). Survival was significantly better for those presenting with good functional status. One hundred thirteen patients (68%) were discharged from hospital; 88 (78%) were discharged home, 11% were sent to another hospital, 4% were transferred to a rehabilitation unit, and 5% went to a hospice. Fifty-three patients (32%) died before discharge. The confirmation that PS and NS have prognostic significance in the functional outcome of patients with SCC may prove helpful in decisions regarding care planning for individual patients with SCC who are discharged from hospital.


Subject(s)
Nerve Compression Syndromes/etiology , Spinal Cord Neoplasms/complications , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Nerve Compression Syndromes/radiotherapy , Palliative Care , Retrospective Studies , Spinal Cord Neoplasms/radiotherapy
14.
Int J Radiat Oncol Biol Phys ; 46(4): 975-81, 2000 Mar 01.
Article in English | MEDLINE | ID: mdl-10705020

ABSTRACT

PURPOSE: Radiotherapy (RT) has a proven role in palliation of pain from bone metastases with numerous randomized trials obtaining response rates (RRs) of typically 70-80% regardless of the fractionation employed. However RT for neuropathic bone pain (NBP), i.e., pain with a radiating cutaneous component due to compression/irritation of nerves by tumor has not previously been studied, and its role is thus uncertain. METHODS AND MATERIALS: In February 1996, the Trans-Tasman Radiation Oncology Group (TROG) initiated a multicenter randomized trial comparing a single 8 Gy fraction with 20 Gy in 5 fractions for NBP with an accrual target of 270. Formal interim analyses were planned at 90 and 180 patients. The 90th patient was accrued in June 1998, and data from the first interim analysis with both arms combined form the basis of this report. RESULTS: Forty-four patients were randomized to a single 8 Gy, 46 to 20 Gy in 5 fractions. The commonest primary sites were prostate (34%), lung (28%) and breast (10%). Median age was 68 years (range 37-89). The index site was spine (86%), rib (13%), base of skull (1%). On an intention-to-treat basis, the overall RR was 53/90 = 59% (95% CI = 48-69%), with 27% achieving a complete response and 32% a partial response. The overall RR for eligible patients was 49/81 = 60% (95% CI = 49-71%) with 27% and 33% achieving complete and partial responses respectively. Estimated median time to treatment failure was 3.2 months (95% CI = 2.1-5.1 months), with estimated median survival of 5.1 months (95% CI = 4.2-7.2 months). To date, six spinal cord/cauda equina compressions and four new or progressive pathological fractures have been detected at the index site after randomization, although one cord compression occurred before radiotherapy was planned to commence. In February 1999, the Independent Data Monitoring Committee strongly recommended continuation of the trial. CONCLUSION: Although these results are preliminary, it seems clear that there is indeed a role for RT in the treatment of NBP. Analysis of outcome by treatment arm awaits completion of the randomized trial.


Subject(s)
Bone Neoplasms/radiotherapy , Nerve Compression Syndromes/radiotherapy , Pain/radiotherapy , Adult , Aged , Aged, 80 and over , Bone Neoplasms/complications , Bone Neoplasms/secondary , Breast Neoplasms/pathology , Female , Humans , Lung Neoplasms/pathology , Male , Middle Aged , Nerve Compression Syndromes/complications , Pain/etiology , Patient Selection , Prostatic Neoplasms/pathology , Spinal Cord Compression/complications , Spinal Cord Compression/radiotherapy , Spinal Fractures/complications
15.
Semin Urol Oncol ; 15(1): 65-72, 1997 Feb.
Article in English | MEDLINE | ID: mdl-9050141

ABSTRACT

Progressive, hormonally resistant prostate cancer presents a multitude of challenges to the patient and physician. The appropriate delivery of palliative care requires a full assessment of the patients medical condition, and the treatment offered must take into account the patients physical, psychological, and social needs. Opinions from medical oncology, surgical oncology, radiation oncology, pain management, and palliative care specialists are often required to devise the most appropriate treatment strategy. The pain from osseous metastases is the most common indication for palliative radiotherapy in this setting. Localized external beam therapy will provide prompt pain relief in the treated area for 80% to 90% of treated individuals, but the optimum dose/fractionation schedule remains to be determined. Wide field radiotherapy with hemibody irradiation or strontium89 (89Sr) isotope therapy will relieve the pain of widespread metastases in 50% to 90% of individuals, depending on the dose and extent of disease. Hemibody irradiation has a quicker onset of action, and will also treat extraosseous disease, but is more likely to produce gastrointestinal toxicity than 89Sr. Both modalities can delay the progression of asymptomatic bony metastases, with 89Sr being slightly more effective in this regard. Palliative radiotherapy provides a simple and effective method of treating many of the other complications of progressive prostate cancer and these are discussed.


Subject(s)
Neoplasms, Hormone-Dependent/radiotherapy , Palliative Care , Prostatic Neoplasms/radiotherapy , Bone Neoplasms/radiotherapy , Bone Neoplasms/secondary , Humans , Male , Nerve Compression Syndromes/etiology , Nerve Compression Syndromes/radiotherapy , Pain/etiology , Pain/radiotherapy , Prostatic Neoplasms/complications , Prostatic Neoplasms/pathology , Spinal Cord Compression/etiology , Spinal Cord Compression/radiotherapy
16.
Clin Oncol (R Coll Radiol) ; 8(2): 120-2, 1996.
Article in English | MEDLINE | ID: mdl-8859612

ABSTRACT

Extramedullary haematopoiesis is sometimes encountered in severe anaemia. Rarely, it may cause neurological symptoms, leading to spinal cord or cauda equina compression. Three patients with thalassaemia intermedia, who developed neurological complications, are described. The diagnoses were based on the clinical findings, computed tomography and magnetic resonance imaging. Small doses of radiotherapy (10-20 Gy in 5-10 fractions) relieved symptoms in all of these patients. Our experience supports the role of radiation therapy as a treatment for this complication.


Subject(s)
Hematopoiesis, Extramedullary/physiology , Spinal Cord Compression/radiotherapy , beta-Thalassemia/physiopathology , Adult , Cauda Equina , Follow-Up Studies , Hematopoiesis, Extramedullary/radiation effects , Humans , Magnetic Resonance Imaging , Male , Nerve Compression Syndromes/etiology , Nerve Compression Syndromes/radiotherapy , Radiotherapy Dosage , Spinal Cord Compression/etiology , Tomography, X-Ray Computed
17.
Int J Radiat Oncol Biol Phys ; 33(3): 595-8, 1995 Oct 15.
Article in English | MEDLINE | ID: mdl-7558948

ABSTRACT

PURPOSE: To examine the frequency of initial multiple epidural metastases, and the occurrence of secondary spinal cord compression (SCC). METHODS AND MATERIALS: To evaluate the frequency of a recurrent SCC after radiotherapy, and to compare among patients with single and multiple intraspinal metastases the risk of having a second SCC, we followed 107 patients with SCC from a histologically verified solid tumor prospectively with regular neurological examinations until death. RESULTS: Multiple metastases were demonstrated in 37 (35%). Eight (7.5%) patients developed a second occurrence of SCC all in a new location within the spinal canal. The second occurrence of SCC was found with the same frequency in patients with single metastases (7.1%) compared to patients with multiple metastases (8.1%). The median survival time after the diagnosis of spinal cord compression was 3.4 months, while in the group of patients who developed a second occurrence of SCC the median survival time was 9.2 months. CONCLUSION: Only symptomatic epidural metastases should be irradiated, and that all patients treated for SCC should be followed regularly and observed for development of a second SCC.


Subject(s)
Breast Neoplasms , Lung Neoplasms , Prostatic Neoplasms , Spinal Cord Compression/epidemiology , Spinal Cord Neoplasms/secondary , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Nerve Compression Syndromes/epidemiology , Nerve Compression Syndromes/etiology , Nerve Compression Syndromes/radiotherapy , Prospective Studies , Recurrence , Spinal Cord Compression/etiology , Spinal Cord Compression/radiotherapy , Spinal Cord Neoplasms/complications , Spinal Cord Neoplasms/epidemiology , Spinal Cord Neoplasms/radiotherapy , Spinal Nerve Roots , Survival Analysis
18.
Radiol Med ; 87(6): 858-64, 1994 Jun.
Article in Italian | MEDLINE | ID: mdl-7518934

ABSTRACT

Lumbosacral carcinomatous neuropathy (LCN) may be caused by infiltration or compression of the lumbosacral plexi and nerves from intrapelvic or paraaortic neoplasms. The authors submitted 23 patients complaining of LCN with CT documented intrapelvic or paraaortic tumors to palliative radiotherapy. Megavoltage external beam irradiation was administered using a 6-MV linear accelerator. Treatment field sizes ranged from 56 cm2 to 235 cm2 (mean: 150.54 cm2) and encompassed only the site where the disease involved the lumbosacral plexus or its branches. > or = 3 Gy/day fractions were used. Twenty-one of 22 assessable patients (95.4%) obtained LCN pain relief; 19 (86.3%) obtained complete LCN pain relief. The median time to pain progression (TPP) was 150 days (range: 39-510 days). The median survival was 165 days. Seven patients were LCN pain-free at death. Two patients are alive and LCN pain-free. The remaining 12 patients had recurrent LCN pain: four of them were reirradiated at the site of previous neuropathy and only two had partial relief again. The authors conclude that it is advisable to submit to palliative radiotherapy the inoperable disseminated and/or recurrent cancer patients complaining of LCN, to use large fractions not to occupy the extant time of their already short life-expectancy, and to design small fields to avoid acute side-effects.


Subject(s)
Lumbosacral Plexus , Neoplasm Recurrence, Local/radiotherapy , Nerve Compression Syndromes/radiotherapy , Palliative Care/methods , Pelvic Neoplasms/radiotherapy , Adult , Aged , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/complications , Neoplasm Recurrence, Local/mortality , Nerve Compression Syndromes/etiology , Nerve Compression Syndromes/mortality , Particle Accelerators , Pelvic Neoplasms/complications , Pelvic Neoplasms/mortality , Radiotherapy Dosage , Radiotherapy, High-Energy , Remission Induction
19.
Acta cancerol ; 24(2): 16-20, jun. 1994. tab, ilus
Article in Spanish | LILACS, LIPECS | ID: lil-154664

ABSTRACT

Los autores realizan una revisión retrospectiva de 105 casos tratados en el Departamento de Radioterapia del instituto de Enfermedades Neoplásicas atendidos entre 1973 y 1992. La finalidad de la presente evaluación fue determinar la influencia del tratamiento de radiaciones en los pacientes con síndrome de compresión medular en lo referente a paliación de la sintomatología (dolor) y mejoría del déficit funcional (deambulación) porpio de este síndrome. Se recurrió a las fichas de tratamiento del archivo del Departamento de Radioterápia del INEN que tenían el diagnóstico de síndrome de compresión medular y con los números de las historias clínicas procedimos a recolectar los datos que en ella se reportan. Treitidós, de treitinueve pacientes (82 por ciento), que acudieron por sus propios medios a recibir tratamiento luego del diagnóstico de síndrome de compresión medular, continuaron caminando luego de recibir tratamiento. Ocho de sesentiseís pacientes (12 por ciento) que acudieron en silla de ruedas o cama, a recibir tratamiento, pudieron movilizarse por sus propios medios una vez finalizado el tratamiento con radiaciones. Cuarentiún pacientes (64 por ciento) tuvieron mejoría parcial del dolor y quince (24 por ciento) total, luego de recibir tratamiento. En los pacientes que acudieron por sus propios medios y no perdieron esta característica luego del tratamiento, se observó mejoría en su funcionalidad. Concluimos que el tratamiento con radiaciones ofrece beneficio paliativo en los pacientes con síndrome de compresión medular.


Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Adult , Middle Aged , Spinal Cord Compression/diagnosis , Spinal Cord Compression/etiology , Spinal Cord Compression/radiotherapy , Spinal Cord Compression/diagnosis , Nerve Compression Syndromes/classification , Nerve Compression Syndromes/diagnosis , Nerve Compression Syndromes/etiology , Nerve Compression Syndromes/pathology , Nerve Compression Syndromes/radiotherapy , Nerve Compression Syndromes/therapy
20.
Handchir Mikrochir Plast Chir ; 26(3): 137-40, 1994 May.
Article in German | MEDLINE | ID: mdl-8050742

ABSTRACT

The incidence of secondary tumors in the hand is set slightly over 0.1%, the primary tumor localized in the lung, followed by the breast and the kidney. The authors describe a case of a renal carcinoma metastatic to the soft tissue of the palm of the hand in a patient who had undergone nephrectomy for carcinoma of the right kidney eleven years previously. The sixty-one year old female patient developed a swelling of the palm of the left hand and showed symptoms of median and ulnar nerve compression. The patient had neurosurgery because of a solitary metastatic brain tumor of the right hemisphere three months earlier and did not approve to an additional surgical intervention in the hand at that time. The decision was made to treat the tumor with a local radiation therapy. Five months later, the treatment showed no effect and the patient decided to have the operation done. Histologic examination established the diagnosis of a metastatic renal cell carcinoma. The healing was prolonged. An ulceration developed in the distal part of the wound area and healing took seven weeks. Seven months after the operation the patient was alive and well without evidence of disease. The hand showed a good function with little impairment and the symptoms of nerve compression had completely disappeared.


Subject(s)
Carcinoma, Renal Cell/secondary , Hand , Kidney Neoplasms/surgery , Median Nerve , Nerve Compression Syndromes/etiology , Soft Tissue Neoplasms/secondary , Ulnar Nerve , Carcinoma, Renal Cell/pathology , Carcinoma, Renal Cell/radiotherapy , Carcinoma, Renal Cell/surgery , Combined Modality Therapy , Female , Follow-Up Studies , Hand/innervation , Humans , Kidney Neoplasms/pathology , Kidney Neoplasms/radiotherapy , Median Nerve/pathology , Median Nerve/radiation effects , Median Nerve/surgery , Middle Aged , Motor Skills/physiology , Nerve Compression Syndromes/pathology , Nerve Compression Syndromes/radiotherapy , Nerve Compression Syndromes/surgery , Range of Motion, Articular/physiology , Soft Tissue Neoplasms/pathology , Soft Tissue Neoplasms/radiotherapy , Soft Tissue Neoplasms/surgery , Ulnar Nerve/pathology , Ulnar Nerve/radiation effects , Ulnar Nerve/surgery
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