30-day morbidity and mortality after transoral robotic surgery for human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma: A retrospective analysis of two prospective adjuvant de-escalation trials (MC1273 & MC1675).

OBJECTIVE: Dose de-escalation of adjuvant therapy (DART) in patients with HPV(+)OPSCC was investigated in two prospective Phase II and III clinical trials (MC1273 and MC1675). We report the 30-day morbidity and mortality associated with primary TORS resection in patients enrolled in these trials. MATERIALS AND METHODS: Patients with HPV(+)OPSCC, who underwent TORS resection between 2013 and 2020 were considered in this analysis. The severity of postoperative transoral bleeding was graded using both the Hinni Grade (HG) transoral surgery bleeding scale and the Common Terminology for Adverse Events (CTCAE) v5.0. Post-surgical complications within 30 days of surgery, as well as rates of tracheostomy, PEG and nasogastric tube placement. RESULTS: 219 patients were included. A total of 7 (3.2 %) patients had a tracheostomy placed at the time of surgery, and all were decannulated within 26 days (median: 5, range: 2-26). There were 33 (15.1 %) returns to the emergency department (ED) with 10 (4.6 %) patients requiring readmission. Using the HG scale, 10 (4.6 %) patients experienced ≥ Grade 3 bleeding with no Grade 5 or 6 bleeds. In contrast, using the CTCAE scale, 15 patients (6.8 %) experienced ≥ Grade 3 bleeding with no Grade 5 bleeds. There was one post-operative death in a patient withdrawn from the trial, and no deaths related to hemorrhage. CONCLUSION AND RELEVANCE: TORS for HPV(+)OPSCC in carefully selected patients at a high volume center was associated with low morbidity and mortality.

Scalable radiotherapy data curation infrastructure for deep-learning based autosegmentation of organs-at-risk: A case study in head and neck cancer.

In this era of patient-centered, outcomes-driven and adaptive radiotherapy, deep learning is now being successfully applied to tackle imaging-related workflow bottlenecks such as autosegmentation and dose planning. These applications typically require supervised learning approaches enabled by relatively large, curated radiotherapy datasets which are highly reflective of the contemporary standard of care. However, little has been previously published describing technical infrastructure, recommendations, methods or standards for radiotherapy dataset curation in a holistic fashion. Our radiation oncology department has recently embarked on a large-scale project in partnership with an external partner to develop deep-learning-based tools to assist with our radiotherapy workflow, beginning with autosegmentation of organs-at-risk. This project will require thousands of carefully curated radiotherapy datasets comprising all body sites we routinely treat with radiotherapy. Given such a large project scope, we have approached the need for dataset curation rigorously, with an aim towards building infrastructure that is compatible with efficiency, automation and scalability. Focusing on our first use-case pertaining to head and neck cancer, we describe our developed infrastructure and novel methods applied to radiotherapy dataset curation, inclusive of personnel and workflow organization, dataset selection, expert organ-at-risk segmentation, quality assurance, patient de-identification, data archival and transfer. Over the course of approximately 13 months, our expert multidisciplinary team generated 490 curated head and neck radiotherapy datasets. This task required approximately 6000 human-expert hours in total (not including planning and infrastructure development time). This infrastructure continues to evolve and will support ongoing and future project efforts.

Organ preservation for advanced laryngeal carcinoma.

BACKGROUND: Inclusion of patients with mobile vocal cords on larynx preservation trials may lead to overstatement of larynx preservation (LPR) and survival (OS) rates. METHODS: This is a retrospective review of patients at our institution who would have been eligible for the Department of Veterans Affairs Laryngeal Cancer Study Group (VA) and Radiation Therapy Oncology Group/Head and Neck Intergroup (RTOG 91-11) clinical trials. No laryngeal conservation procedure could be performed in patients with mobile vocal cords. RESULTS: One hundred one patients at our institution would have been eligible for the VA trial. The 2-year OS was 76% for total laryngectomy and 90% for radiotherapy patients (p = .28) compared with 68% reported for the VA trial. Seventy-three patients at our institution would have been eligible for the RTOG 91-11 trial. The 5-year OS was 52% for total laryngectomy and 63% for radiotherapy patients (p = .18) compared with 55% reported for the RTOG 91-11 trial. Radiotherapy patients had an LPR of 80% (VA trial) and 86% (RTOG 91-11 trial). CONCLUSION: It is unlikely that inclusion of patients with mobile vocal cords had a significant impact on OS or LPR for the VA and RTOG 91-11 larynx preservation trials.

Within-herd use of boar semen at 5 degrees C, with a note on electronic monitoring of oestrus.

A system was designed to allow a small swine farm in a northern latitude to use its own boars for artificial insemination (AI) conveniently. Semen was collected twice weekly for 3 day use (days 0, 1 and 2), extended in an egg yolk extender and stored at 5 degrees C. Farm personnel were trained to manage the entire AI programme. For simplicity all semen collected was used for insemination. In the first test 47 gilts and 15 sows were inseminated with semen from four boars. One boar was subfertile with a farrowing rate of 36%. The averages for the other boars ranged from 71 to 100%. Then semen was collected from seven boars and all was used to inseminate 70 gilts and 55 sows with 3 x 10(9) or more sperm. Overall 63% farrowed an average of 10.1 piglets per litter. Litter size for sows was 1.5 piglets larger than for gilts. There was no difference in farrowing rate when more than 3 x 10(9) sperm were inseminated. The feasibility of initiating a complete AI programme within a small herd using herd boars was established. However, selection of the boars, use of only high quality semen, and experience with detecting oestrus was required to increase the farrowing rate. The use of various agents to protect sperm against cold shock below 15 degrees C is worthy of further investigation. A new type of electronic probe, which measures the conductivity of cervical mucus, could be helpful if a boar is not available for conventional detection of oestrus.

Large batch freezing of bull semen: effect of time of freezing and fructose on fertility.

Large-scale batch freezing of bull semen should be done in a processing schedule that yields the highest fertility and when it can be fitted efficiently into the work schedule. Conflicting reports have appeared on survival and fertility of bull sperm frozen within a few hours of semen collection or on the next day. To study this problem, a factorially arranged experiment with semen from 10 bulls was conducted, comparing whole milk-glycerol semen extender with and without fructose, and semen frozen in 0.5-ml straws after 4 versus 18 h of equilibration at 5 degrees C. Both fructose and 18 h of equilibration resulted in a small but significant improvement in freeze-thaw survival of sperm. A field trial followed with replicated semen collections from nine bulls processed in a whole milk-glycerol control extender frozen after 4 h of equilibration versus the addition of 1.25% (wt/vol) fructose to whole milk glycerol divided to freeze sperm after 4 and 28 h of equilibration. Semen from these bulls was used to inseminate 14,775 first-service cows. The 56-d nonreturn rates obtained for these three treatments were 74.7, 74.3, and 73.9%, respectively. As there was no difference in fertility, it would appear that programs to freeze sperm in whole milk extenders the same day of collection or the day after semen collection should yield equivalent results.

Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer.

PURPOSE: A multi-institutional, prospective, randomized trial was undertaken in patients with advanced head-and-neck squamous cell carcinoma to address (1) the validity of using pathologic risk features, established from a previous study, to determine the need for, and dose of, postoperative radiotherapy (PORT); (2) the impact of accelerating PORT using a concomitant boost schedule; and (3) the importance of the overall combined treatment duration on the treatment outcome. METHODS AND MATERIALS: Of 288 consecutive patients with advanced disease registered preoperatively, 213 fulfilled the trial criteria and went on to receive therapy predicated on a set of pathologic risk features: no PORT for the low-risk group (n = 31); 57.6 Gy during 6.5 weeks for the intermediate-risk group (n = 31); and, by random assignment, 63 Gy during 5 weeks (n = 76) or 7 weeks (n = 75) for the high-risk group. Patients were irradiated with standard techniques appropriate to the site of disease and likely areas of spread. The study end points were locoregional control (LRC), survival, and morbidity. RESULTS: Patients with low or intermediate risks had significantly higher LRC and survival rates than those with high-risk features (p = 0.003 and p = 0.0001, respectively), despite receiving no PORT or lower dose PORT, respectively. For high-risk patients, a trend toward higher LRC and survival rates was noted when PORT was delivered in 5 rather than 7 weeks. A prolonged interval between surgery and PORT in the 7-week schedule was associated with significantly lower LRC (p = 0.03) and survival (p = 0.01) rates. Consequently, the cumulative duration of combined therapy had a significant impact on the LRC (p = 0.005) and survival (p = 0.03) rates. A 2-week reduction in the PORT duration by using the concomitant boost technique did not increase the late treatment toxicity. CONCLUSIONS: This Phase III trial established the power of risk assessment using pathologic features in determining the need for, and dose of, PORT in patients with advanced head-and-neck squamous cell cancer in a prospective, multi-institutional setting. It also revealed the impact of the overall treatment time in the combination of surgery and PORT on the outcome in high-risk patients and showed that PORT acceleration without a reduction in dose by a concomitant boost regimen did not increase the late complication rate. These findings emphasize the importance of coordinated interdisciplinary care in the delivery of combined surgery and RT.

Sperm output and hormone concentrations in Finn and Dorset rams exposed to long- and short-day lighting.

Seasonal changes in photoperiod have a substantial effect on sexual behavior and reproduction in rams. Little information is available on sperm output from high libido versus average libido rams subjected to intensive semen collection while being exposed to controlled short versus long photoperiods. Six Finn and six Dorset rams were compared in a reversal design, which allowed rams of both breeds to be exposed to 8 h versus 16 h of light. During each of two 84-d periods rams were subjected twice to an initial depletion of epididymal sperm reserves by collecting up to 26 ejaculates of semen in 3 d, followed by up to 10 ejaculates per day, 1, 3, 5, and 7 d after the initial depletion. A total of 2673 semen samples were collected. Nearly twice as many ejaculates (63.6% of the total) were obtained from Finn rams as from Dorset rams during both the initial and subsequent 3-d sperm depletion periods. This difference in libido was associated with obtaining 33.6 +/- 3.1 x 10(9) sperm from Finn rams versus 10.0 +/- 2.2 x 10(9) sperm from Dorset rams during the initial depletion period (P<0.05). Changes in photoperiod did not affect sperm output (P>0.05) in Finn rams, but may have affected Dorset rams. With 16 h of light, prolactin was significantly (P<0.05) increased in both breeds, particularly in Finn rams. Testosterone in both breeds followed an endogenous rhythm, not affected by the change in controlled photoperiods.

Inhibition of sperm motility does not affect live-dead separation of bull sperm by glass beads.

AIM: This study was designed to explore factors which influence binding of dead versus live sperm to glass filters. METHODS: Multiple semen collections from bulls were used to explore selective filtration of bull sperm as influenced by nonlethal inhibition of sperm motility with fluoride, killing of sperm by quick-freezing, alteration of the glass surface with silicone, and different intervals of sexual rest between semen collections. RESULTS: A comparison of glass spheres 100, 200 and 390 microm in diameter indicated that 200 microm spheres were optimal for selective filtration. Quantitative separation of live from dead sperm was demonstrated with a correlation between the percentage of motile sperm and retention of sperm by the filter of r = -0.87 (P < 0.05). Up to 0.02 mol/L NaFl did not alter the proportion of sperm retained by the filter despite inhibiting sperm motility during filtration, an inhibition which was reversible. Proportions of live-dead sperm, based upon eosin staining, were unaffected by fluoride. Coating the glass spheres with silicone greatly reduced selective filtration. Dead sperm adherence to glass was reduced and resistance to NaFl inhibition was increased by daily ejaculation versus one-week intervals of sexual rest. CONCLUSION: These studies indicate that the adherence of sperm to glass is primarily due to some form of physico-chemical change accompanying death of the sperm cell independent of active sperm motility. This attraction between the sperm plasma membrane and glass is modified by the age of the ejaculated sperm. This information is useful in evaluating different clinical procedures used for sperm separation.

Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? A prospective double-blind, randomized study.

PURPOSE: To test the hypothesis that increasing the nerve length within the treatment volume for trigeminal neuralgia radiosurgery would improve pain relief. METHODS AND MATERIALS: Eighty-seven patients with typical trigeminal neuralgia were randomized to undergo retrogasserian gamma knife radiosurgery (75 Gy maximal dose with 4-mm diameter collimators) using either one (n = 44) or two (n = 43) isocenters. The median follow-up was 26 months (range 1-36). RESULTS: Pain relief was complete in 57 patients (45 without medication and 12 with low-dose medication), partial in 15, and minimal in another 15 patients. The actuarial rate of obtaining complete pain relief (with or without medication) was 67.7% +/- 5.1%. The pain relief was identical for one- and two-isocenter radiosurgery. Pain relapsed in 30 of 72 responding patients. Facial numbness and mild and severe paresthesias developed in 8, 5, and 1 two-isocenter patients vs. 3, 4, and 0 one-isocenter patients, respectively (p = 0.23). Improved pain relief correlated with younger age (p = 0.025) and fewer prior procedures (p = 0.039) and complications (numbness or paresthesias) correlated with the nerve length irradiated (p = 0.018). CONCLUSIONS: Increasing the treatment volume to include a longer nerve length for trigeminal neuralgia radiosurgery does not significantly improve pain relief but may increase complications.

External-beam radiation therapy in the treatment of diffuse tracheobronchial amyloidosis.

Tracheobronchial amyloidosis is characterized by deposits of amyloid in airway walls. No effective treatment is known. We describe a 59-year-old woman who presented with increasing symptoms of airway obstruction due to diffuse deposition of amyloid throughout her tracheobronchial tree. She was treated with external-beam radiation therapy (20 Gy) with marked improvement in her symptoms, effort tolerance, bronchoscopic appearance, and forced expiratory volume in 1 second (1.39 L to 1.97 L [42%]). This improvement was maintained during 21 months of follow-up.

High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction.

OBJECTIVE: Stereotactic radiosurgery is being used with more frequency in the management of patients with trigeminal neuralgia. To improve facial pain outcomes, many centers have increased the prescribed radiation dose to the trigeminal nerve. METHODS: Between April 1997 and December 1999, 68 patients underwent radiosurgery for trigeminal neuralgia with use of the Leksell gamma knife (Elekta Instruments, Norcross, GA) and a single 4-mm isocenter of radiation. Twenty-seven patients (40%) received 70 Gy (low dose) of irradiation and 41 patients (60%) received 90 Gy (high dose). The groups were similar with regard to age, sex, duration of pain, number of prior surgeries, and preexisting trigeminal deficits. The primary facial pain outcomes for analysis were excellent (pain-free, no medications) and good (pain-free, reduced medications). The mean length of follow-up after radiosurgery was 14.4 months (range, 2-36 mo). RESULTS: At last follow-up examination, 11 (41%) of the 27 patients with low-dose radiosurgery remained pain-free compared with 25 (61%) of the 41 patients with high-dose radiosurgery (P = 0.17). Additional surgery was performed in 12 low-dose patients (44%) and 8 high-dose patients (20%) (P = 0.05). High-dose radiosurgery was associated with an increased rate of permanent trigeminal nerve dysfunction (54% versus 15%, P = 0.003). Bothersome dysesthesias occurred in 13 high-dose patients (32%), whereas only 1 low-dose patient had this complication (P = 0.01). Three high-dose patients (8%) developed corneal numbness after radiosurgery. Pain recurred with more frequency in patients not developing trigeminal nerve dysfunction after radiosurgery (9 of 22 patients, 41 %) compared with those who sustained facial numbness, paresthesias, or dysesthesias (4 of 27 patients, 15%); however, the difference was not statistically significant (P = 0.08). CONCLUSION: Higher doses of radiation may correlate with better facial pain outcomes after radiosurgery for trigeminal neuralgia. However, the incidence of significant trigeminal nerve dysfunction is markedly increased after radiosurgery for patients receiving high-dose radiosurgery. Because of the nonselective nature of this ablative technique, dose prescription should be limited to less than 90 Gy.

Results of combined stereotactic radiosurgery and transarterial embolization for dural arteriovenous fistulas of the transverse and sigmoid sinuses.

OBJECT: Most dural arteriovenous fistulas (DAVFs) of the transverse and sigmoid sinuses do not have angiographically demonstrated features associated with intracranial hemorrhage and, therefore, may be treated nonsurgically. The authors report their experience using a staged combination of radiosurgery and transarterial embolization for treating DAVFs involving the transverse and sigmoid sinuses. METHODS: Between 1991 and 1998, 25 patients with DAVFs of the transverse and/or sigmoid sinuses were treated using stereotactic radiosurgery; 22 of these patients also underwent transarterial embolization. Two patients were lost to follow-up review. Clinical data, angiographic findings, and follow-up records for the remaining 23 patients were collected prospectively. The mean duration of clinical follow up after radiosurgery was 50 months (range 20-99 months). The 18 women and five men included in this series had a mean age of 57 years (range 33-79 years). Twenty-two (96%) of 23 patients presented with pulsatile tinnitus as the primary symptom; two patients had experienced an earlier intracerebral hemorrhage (ICH). Cognard classifications of the DAVFs included the following: I in 12 patients (52%), IIa in seven patients (30%), and III in four patients (17%). After treatment, symptoms resolved (20 patients) or improved significantly (two patients) in 96% of patients. One patient was clinically unchanged. No patient sustained an ICH or irradiation-related complication during the follow-up period. Seventeen patients underwent follow-up angiographic studies at a mean of 21 months after radiosurgery (range 11-38 months). Total or near-total obliteration (> 90%) was seen in 11 patients (65%), and more than a 50% reduction in six patients (35%). Two patients experienced recurrent tinnitus and underwent repeated radiosurgery and embolization at 21 and 38 months, respectively, after the first procedure. CONCLUSIONS: A staged combination of radiosurgery and transarterial embolization provides excellent symptom relief and a good angiographically verified cure rate for patients harboring low-risk DAVFs of the transverse and sigmoid sinuses. This combined approach is a safe and effective treatment strategy for patients without angiographically determined risk factors for hemorrhage and for elderly patients with significant comorbidities.

Accessory sperm as an indication of fertilizing ability of rabbit spermatozoa frozen in egg yolk-acetamide with detergent.

Many factors besides initial semen quality affect fertilization rates as sperm interact with the environment of the female reproductive tract. One of these factors is sperm transport, which can be evaluated by accessory sperm counts. Dutch rabbits were used to test the effects on sperm transport, fertilization, and production of young when sodium and triethanolamine lauryl sulfate (STLS) detergent was added to a medium for sperm cryopreservation. When STLS was added in 10 concentrations ranging from 0% to 2.0% (vol/vol) to an egg yolk-acetamide semen extender, optimal post-thaw motility of rabbit sperm occurred when 0.2% to 0.7% STLS was included. However, when 0%, 0.2%, and 0.7% STLS was included to cryopreserve sperm used for insemination, the fertilization rates were 95%, 68%, and 75%, and the corresponding mean numbers of accessory sperm per embryo were 13.1, 1.7, and 0.4 (P < .05). In another experiment, increasing the acetamide concentration from 0.75 M to 1.25 M decreased fertilization rates from 66% to 35%, and was associated with 4.5 and 0.6 accessory sperm per embryo (P < .05). In the final experiment, 48 does inseminated with sperm cryopreserved with 0%, 0.35%, and 0.70% STLS were allowed to produce young. Corresponding pregnancy rates were 56%, 56%, and 31% (P < .05), and litter sizes were 5.6, 4.1, and 4.2 (P > .05). In these studies, low concentrations of STLS improved motility of frozen-thawed sperm, but fertilization and pregnancy rates were reduced. Sperm transport was correspondingly reduced, and the accessory sperm count provided a reliable measure of the effect of STLS on fertility in contrast to the assessment of the percentage of motile sperm.

Blood catalase and haematocrit values in a breeding colony of Dutch-belted rabbits.

Rabbit seminal plasma catalase is much higher than in the semen of other mammals, and differences appear to be inherited. Because of the scarcity of information on rabbit blood catalase and haematocrit in Dutch-belted rabbits, an investigation of possible effects of gender, age and genetics on these variables was undertaken. There were 191 rabbits sampled at 2-3 months, 130 at 12 months and 61 at 18-24 months of age. There was no age effect on the haematocrit values and on blood catalase activity. At 12 months of age males had an average haematocrit value of 44% compared with 40% for females (P < 0.05). Corresponding average catalase values were 431 and 356 units/ml of blood (P < 0.05). Also catalase was measured in the semen and blood of 34 males, and males differed in both their blood and semen catalase activity (P < 0.05). The correlation between the two traits was r = 0.44. Heritability (h2) estimates, based on 231 rabbits were 0.40 for blood catalase activity, and 0.26 for haematocrit. The genetic correlation between the two variables was 0.83 (P < 0.05). These studies are consistent with the literature in that female rabbits have a slightly lower haematocrit value than males, and this is associated with a lower catalase activity. This appears to be the first report of a study that compares rabbit blood catalase in males and females of different ages. Preliminary evidence that differences may have a heritable basis is consistent with previous studies on rabbit semen catalase.

Freezability of spermatozoa from Finn and Dorset rams in multiple semen extenders.

Ten semen extenders were tested in two experiments for cryopreservation of semen collected from four Finn and four Dorset rams. Two ejaculates of semen were combined from each ram for testing each extender treatment. The extenders consisted of a series of commonly used egg yolk-TRIS media with and without sodium and triethanolamine lauryl sulfate (STLS), a similar extender with 3-N-morpholino propane sulfonic acid (MOPS), and milk and whey extenders. In Experiment 1, extender treatments were replicated with three sets of collections from the eight rams, and in Experiment 2 with two sets. The egg yolk-TRIS-glycerol-STLS (EY(1)TSTLS) extender was significantly superior to other extenders except whole milk in protecting the sperm during freezing and thawing. In Experiment 1, a 20% egg yolk-TRIS-glycerol-STLS extender preserved 71% of the progressively motile Finn sperm (post-thaw divided by pre-freeze percentage of motile sperm), and 76% of the Dorset sperm. In Experiment 2, the corresponding values for the same EY(1)TSTLS extender used with Finn and Dorset sperm were 86 and 64%, respectively. Without STLS the egg yolk extenders were significantly less effective in protecting cryopreserved ram sperm. This egg yolk-TRIS extender, containing STLS and glycerol, may hold promise for freezing ram sperm that could be used successfully for intracervical insemination.

Long-term results of a phase I/II study of high-dose thoracic radiotherapy with concomitant cisplatin and etoposide in limited stage small-cell lung cancer.

This report presents the results from a Mayo Clinic initiated phase I/II study exploring a potentially more aggressive local and systemic approach for treatment of limited-stage small-cell lung cancer (LSSCLC). Five patients with LSSCLC received three cycles of induction cyclophosphamide, etoposide, and infusion cisplatin chemotherapy. This was followed by accelerated hyperfractionated thoracic radiotherapy (AHFTRT) consisting of 30 Gy given as 1.5-Gy fractions twice daily with a 2-week break and then the AHFTRT was repeated. The AHFTRT was given concomitantly with daily oral etoposide and daily intravenous cisplatin. Prophylactic cranial radiation was delivered with the AHFTRT. After completion of the AHFTRT, patients received 4 cycles of oral etoposide maintenance chemotherapy. Follow-up of patients was continued until death or a minimum of 42 months. Three patients had severe toxic responses. No patients completed the entire protocol because of toxicity or progression during treatment. Three patients completed the majority of the protocol except for the four cycles of maintenance etoposide. Four of five patients achieved a complete response. There were two recurrences within the irradiated field, and distant metastases developed in four patients. Acute nonlymphocytic leukemia developed in one patient, who died 2 months later. No patient completed the entire protocol, because of toxicity or progression; therefore, this protocol cannot be recommended for the treatment of LSSCLC.

Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients.

OBJECTIVE: To determine local control (LC) and complication rates for patients with intracranial meningiomas who underwent radiosurgery. METHODS: One hundred ninety consecutive patients with 206 meningiomas underwent radiosurgery between 1990 and 1998. One hundred forty-seven tumors (77%) involved the cranial base. The median age at the time of radiosurgery was 58 years (range, 20-90 yr). There were 126 female patients (66%). One hundred twelve patients (59%) had undergone one or more previous operations (median, 1; range, 1-5). Twenty-two patients (12%) had either atypical (n = 13) or malignant (n = 9) tumors. The median prescription isodose volume was 8.2 cm(3) (range, 0.5-50.5 cm(3)), and the median tumor margin dose was 16 Gy (range, 12-36 Gy). The median imaging and clinical follow-up periods were 40 and 47 months, respectively. RESULTS: Overall survival rates for the entire cohort at 5 and 7 years were 82 and 82%, respectively; cause-specific survival rates at 5 and 7 years were 94 and 92%, respectively. The cause-specific survival rates at 5 years for patients with benign, atypical, and malignant tumors were 100, 76, and 0%, respectively (P < 0.0001). The 5-year LC rate was 89%, with 114 tumors (56%) decreasing in size. LC rates were correlated with tumor histological features (P < 0.0001); patients with benign tumors exhibited a 5-year LC rate of 93%, compared with 68 and 0% for patients with atypical or malignant meningiomas, respectively. No correlation was observed between radiation dose and LC rate. Twenty-four patients (13%) experienced treatment-related complications, including cranial nerve deficits (8%), symptomatic parenchymal changes (3%), internal carotid artery stenosis (1%), and symptomatic cyst formation (1%). Only six patients (3%) exhibited decreases in functional status that were directly related to radiosurgery. Tumor volume, tumor margin dose, or previous radiotherapy was not associated with the development of radiation-related complications. CONCLUSION: Radiosurgery is an effective management strategy for many patients with meningiomas. Patients with atypical or malignant tumors exhibit high recurrence rates despite the use of radiosurgery, and these patients continue to exhibit worse cause-specific survival rates despite aggressive treatment, including surgery, external-beam radiotherapy, and radiosurgery. Further study is needed to determine the tumor control and complication rates 10 years or more after meningioma radiosurgery.

Stereotactic radiosurgery for cavernous malformations.

OBJECT: The use of stereotactic radiosurgery to treat cerebral cavernous malformations (CMs) is controversial. To evaluate the efficacy and safety of CM radiosurgery, the authors reviewed the experience at the Mayo Clinic during the past 10 years. METHODS: Seventeen patients underwent radiosurgery for high-surgical-risk CMs in the following sites: thalamus/basal ganglia (four patients), brainstem (12 patients), and corpus callosum (one patient). All patients had experienced at least two documented hemorrhages before undergoing radiosurgery. Stereotactic magnetic resonance (MR) imaging was used for target localization in all cases. The median margin radiation dose was 18 Gy and the median maximum dose was 32 Gy. The median length of follow-up review following radiosurgery was 51 months. The annual hemorrhage rate during the 51 months preceding radiosurgery was 40.1%, compared with 8.8% in the first 2 years following radiosurgery and 2.9% thereafter. In 10 patients (59%) new neurological deficits developed that were associated with regions of increased signal on long-repetition time MR imaging performed a median of 8 months (range 5-16 months) after radiosurgery. Three patients recovered, giving the group a permanent radiation-related morbidity rate of 41%. Compared with 31 patients harboring arteriovenous malformations (AVMs) of sizes and in locations similar to those of the aforementioned CMs, who underwent radiosurgery during the same time period, the patients with CMs were more likely to experience radiation-related complications (any complication, 59% compared with 10%; p < 0.001; permanent complication, 41% compared with 10%; p = 0.02). CONCLUSIONS: It is impossible to conclude that radiosurgery protects patients with CMs against future hemorrhage risk based on the available data, although it appears that some reduction in the bleeding rate occurs after a latency interval of several years. The risk of radiation-related complications after radiosurgery to treat CMs is greater than that found after radiosurgery in AVMs, even when adjusting for lesion size and location and for radiation dose.

The rabbit as a model for reproductive and developmental toxicity studies.

The rabbit has many advantages as a nonrodent and second model for assessing the effects of toxic agents on semen quality, fertility, developmental toxicity, and teratology. The male and female reproductive systems of the rabbit are described, and data on growth, sexual development and reproduction are compared with mice, rats, and humans. Techniques for semen collection and evaluation in the male, and artificial insemination, superovulation, embryo culture, and embryo transfer in the female are included as useful procedures in toxicity testing. Examples of the use of rabbits and experimental replication for toxicity testing are given. Special features of the visceral yolk sac and development of the chorioallantoic placenta of the rabbit are compared with rodents. The rabbit extraembryonic membranes more closely resemble the human than do the rodents, in some respects. The use of the rabbit in developmental toxicity and teratology studies is discussed.

Decreasing the dosimetric effects of misalignment when using a mono-isocentric technique for irradiation of head and neck cancer.

PURPOSE: The purpose of this study was to quantify and develop methods to decrease inhomogeneities created with field edge mismatch when using a mono-isocentric beam-split technique. METHODS AND MATERIALS: We validated techniques to determine dose across a half-blocked field edge and quantified potential sources of systematic matchline error. Then, two methods were used to evaluate matchline doses. The first used film dosimetry data from a half-beam field and a spreadsheet. Duplication and reversal provided two columns, each representing a beam-split field edge. Summation simulated perfect abutment and shifting created various gaps and overlaps. The second method involved obtaining dose profiles at midfield along the ray perpendicular to abutted, overlapped, and gapped beam-split fields on six linear accelerators. To enlarge the penumbra, we designed several field edge modifiers, then re-evaluated matchline doses. The field edge modifiers applicability to a 3-field head and neck treatment technique was also examined. RESULTS: Film-determined dose profiles provide similar information across a beam-split field edge as an ionization chamber. With the mono-isocentric beam-split technique, a 4-mm overlap or gap produces inhomogeneities nearly 60% above or below the intended dose. A 2-mm overlap or gap produces inhomogeneities nearly 30% above or below the intended dose. A customized penumbra generator decreased the magnitude of these inhomogeneities to 20% and 10%, respectively. CONCLUSION: The two methods of evaluating matchline dose described above gave similar results. When using the mono-isocentric half-field technique, small misalignments produce worrisome regions of inhomogeneity. Our penumbra generator substantially decreases the magnitude of the dose inhomogeneities, although the volume receiving an inhomogeneous dose increases.